Saturday 21 September 2019

Dear David Coleman: My five-year-old can't stop going to the toilet. Please help

The transition from using nappies to using the toilet is very significant for children
The transition from using nappies to using the toilet is very significant for children

Q My five-year-old girl lacks confidence to identify when she actually needs to go to the bathroom. She's a very sensitive girl and had been extremely attached to nappies, and it was an awfully long, slow process to encourage her out of them (she trained less than a year ago). The trouble now is that she goes to the bathroom constantly. Because she goes so often, she doesn't know what having a full bladder is like, and so, probably has no physical urge to guide her. This problem is upsetting her and us, although I try not to make an issue of it. How can we help her?

David replies: Toileting can be a very fraught issue for lots of children. The transition involved in moving from having no bladder control, and being reliant on nappies, to having the control necessary to be able to successfully use the toilet, is a very significant developmental shift for children.

Usually, we look for some signs that a child might be ready to train. Having longer time periods with dry nappies is one. Their own awareness that a wee or poo is coming is another. Showing interest in the toileting habits of others is a third. Some children also ask to be able to use a toilet like older siblings or parents do.

Was there a time when your daughter, while still wearing nappies, had long gaps with a dry nappy? If not, then there may be a physical immaturity with her bladder function. I would recommend bringing her to your GP and getting her physically checked out, since a physical problem needs to be addressed before you focus on behavioural or psychological aspects to the issue.

Assuming that she is physically fine, then it is most likely that her going to the toilet so regularly is a habit. That habit may have developed, or been exacerbated, by some anxiety about toileting, even from the start of the toilet-training process. Her reluctance to give up nappies suggests that she felt a comfort in not having to think about her toileting, or that she was anxious, in some way, about toileting accidents.

That may have been to do with embarrassment or shame, or her sense, even, that she may be disappointing you by not getting to the toilet on time. It may be that simply having the responsibility to be in charge of her own toileting was anxiety-provoking for her, and it was easier for her to put off taking on that responsibility

As you guess, her bladder may be over-sensitive and could benefit from a re-training programme. A reward system, that reinforces her for waiting between toilet trips, might help her.

Find a reward that she will be motivated to achieve or get, and then set up a system, such that she gets a sticker for delaying going to the bathroom. Depending on her current frequency, you set the delay period so that it is achievable with a small bit of effort (so if she goes every 20 minutes now, then maybe waiting 25 or 30 minutes is the initial goal). If she can wait, then she gets a sticker, with a set number of stickers earning her the reward (you can decide the number of stickers, although it, too, needs to be achievable for her).

The aim of this kind of reward system is that it is all positive. So, there are no penalties for going to the bathroom too soon. She can only gain points, not lose them.

Alongside the behavioural reward system, some education about her bladder and urinary system might help her realise what her body is trying to do. Talking about how her body works may also be an opportunity to explore if she does have any worries about the whole toileting process.

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