It's common for young children to run into problems going to the bathroom, whether they become constipated or experience bedwetting. For parents, it can be hard to know how to handle these issues, and when you need to seek expert help.
Rina M. Sanghavi, M.D., Director of Neurogastroenterology and GI Motility at Children's Health℠ and Associate Professor of Pediatrics at UT Southwestern, and Janelle Traylor, FNP, Nurse Practitioner with Children's Health Urology, answer parents' most common potty questions.
Why does my child hold it so long?
Holding it, or avoiding going to the bathroom, can cause accidents, even in kids who are already potty trained.
"Often kids ignore the urge to go to the bathroom because they're having so much fun in their current activity," says Traylor. "They just don't want to stop playing long enough to go to the bathroom."
Why is my child having difficulty potty training?
Potty training can be a difficult time for both the parent and the child. To help make it easier on both, make sure your child is age ready and emotionally ready.
"If children can verbalize the need to go to the bathroom, that indicates a readiness," says Traylor. "If they can dress and undress themselves, they are ready to work on potty training." Traylor says most children are ready for potty training between 2 ½ and 3 ½ years of age, but if your child isn't ready, that's okay. Some children can take until age 4 or 5 to be ready to potty train.
"If your child is not interested in potty training, don't force it. Forcing the issue can cause voiding dysfunction," says Traylor. "It also becomes a stressor for the parent, which in turn stresses the child and can delay potty training."
If your child tells you he or she needs to go, or even sits on the potty without going, offer praise. When your child goes to the potty, celebrate! This reinforcement helps make potty training positive and fun.
Why does my child have accidents?
Accidents are most commonly caused by either constipation or holding the urge too long.
"We recommend the three Rs," says Traylor.
- Regular voiding every two or three hours.
- Relax when using the bathroom to help empty the bladder completely.
- Record it. Monitor how frequently the bathroom is used and offer reminders when it's time to go.
When an accident occurs, it's important not to embarrass your child. Most likely, the child isn't happy about it either. Traylor says if daytime accidents affect a child’s self-esteem, seek help from a medical professional.
Why is my child bedwetting?
Bedwetting is often caused by the same problems as daytime accidents: holding it or constipation.
"Bedwetting is one of the most common stressors I find with my patient's parents," says Traylor. "Many parents think their child is the only child wetting his or her bed, but bedwetting is actually more common than parents realize."
Traylor says regular potty breaks and limiting fluid before bed can help stop bedwetting.
Tip: If your child is still wetting the bed frequently at age 6, a pediatric urologist may be able to help.
Why is my child afraid to use the bathroom at school?
Younger children may also be afraid to use a bathroom that is not at home. This can lead to accidents or constipation, especially while on vacation, at school or when out running errands. Parents can help calm fears by accompanying their children to the restroom and giving positive feedback when they do use a toilet that is not at home.
Dr. Sanghavi says kids who have bathroom difficulties while at school might be able to use an alternative restroom. Parents can talk to the school counselor and ask if the child can use the school nurse's bathroom, which is more private and may help them relax enough to go at school.
If a child is extremely anxious about using a bathroom outside the home, it's helpful to talk with the child's pediatrician or enlist the help of a psychologist.
Why is my child constipated?
The start of the school year is a common time for constipation problems, according to pediatric gastroenterologist Dr. Sanghavi.
"Schedules can be very busy at the beginning of the school year, and kids often don't keep track of the times they've used the bathroom," says Dr. Sanghavi. "Try not to overschedule your child with too many activities. Offer them extra time to be at home, in their comfort zone, to use the bathroom."
There are also distractions that can impede a child's ability to focus on going potty. Dr. Sanghavi advises against using a tablet or smartphone while on the toilet.
"Screens distract kids from the main task," says Dr. Sanghavi. "They are on the potty to either pee or poop. Limit distractions and set a timer for no more than 10 minutes."
To make it easier for children to go to the bathroom, you can use a step stool so knees are higher than their hips when they sit on the toilet.
Tip: You can allow your child to blow bubbles because it helps contract and relax the same muscles used to poop.
What dietary choices are best for digestive health?
Poor nutrition or not drinking enough water can also lead to constipation. Both can lead to hard stools, which makes pooping difficult.
"A good way to determine how much water your child needs is to first determine your child's weight in pounds. Half of that number is the ounces of water needed each day," says Dr. Sanghavi.
"A child should eat at least two servings of fruits and three servings of vegetables every day and avoid eating too many foods containing all-purpose flour – such as white bread and pizza crust, which can be difficult to digest."
Dr. Sanghavi also recommends keeping a stool journal to track how often your child is pooping. If after a month of eating healthy your child is still having constipation problems, you should speak to your child's pediatrician.