Ask the Doctor - Answers to your Parenting Questions

Dear Ed,
It's great that your daughter is fine at preschool. That means that she is physically fine -- no physical issues that need to be checked out by your pediatrician. Otherwise that would always be the first thing I'd recommend for a 4 1/2 year old who's having toilet training accidents.

First, I want to say that this is not an unusual situation. 4-5 year olds are very busy, and they get absorbed in what they are doing.  It takes time for humans to learn just how long we can delay starting for the bathroom.

Second, do not punish her for accidents. There is a lot of research data on this, and punishing kids for potty accidents always increases the frequency of the accidents.  It turns into a power struggle, and fights with your child about her body are fights you will never win. You don't even want to make a huge deal about this or she may begin using accidents as a way to get attention. Hiding your disappointment and being very low-key about this is the best approach.

Third, you do not say whether this is a regression, i.e., whether she was ever completely toilet trained without accidents. If she was, and is now having accidents, then there may be an emotional reason for her regression, like some stressor in her life.

Even something you would not notice or would think is a small change in her life can throw a four year old off. If this is a regression, then treat her accidents casually by cleaning them up quickly and matter of factly. Say something like "Oh, oh. Let's clean you up. Soon you'll be making it to the toilet in time again, just like you used to." And she will.

If, though, she has never been completely toilet trained at home, then we need to focus on helping her master that. Obviously she can do so, since she does well at school. But it is not uncommon for kids to let their guard down at home, especially since there are no peers to ridicule her.

I would start by discussing with her what she thinks is different at home than at school. Remind her that she needs to go to the potty AS SOON AS she notices she needs to, rather than waiting just another few minutes. Ask her if she thinks she can do that and listen to her answer.

It is probably just a matter of being willing to interrupt what she is doing to go to the bathroom. You'll need to remind her that anything she is doing can be stopped for the three minutes it takes to use the bathroom, much like a videotape can be "paused".

Be sure that she is not wearing pull ups or any other kind of absorbent underwear. It is important that if she starts to have an accident, she notices and is uncomfortable.

For now, you may need to remind your daughter to check in with her body and to take regular potty breaks. At school, of course, bathroom breaks are scheduled in. So offer reminders throughout the day, and have her use the bathroom at regular times, such as before and after every meal or snack. If you see her fidgeting, remind her that she needs to go to the potty AS SOON AS she notices she needs to.

If she resists going to the potty at the scheduled times, you can tell her that as soon as she has been dry for a week (or whatever) she is allowed to skip those potty breaks, but until then, the rule is that everyone uses the bathroom at those times. (It helps if you also do it so she doesn't feel penalized.) Don't make the rule a penalty, be matter of fact about it. Just don't get into a power struggle over the potty breaks.

You might also get her a special watch and tell her that every time the hand gets to the hour and half hour she needs to go to the potty. You may still have to remind her of course.

You may also need to find a way to motivate your daughter to head for the bathroom earlier. I am not a big reward person, I generally prefer to praise kids for the desired behavior.

But many parents successfully use rewards. You don't say how often she has accidents. If it is once a week, for instance, then every Saturday she could have a special reward if she has not had an accident that week. By reward, I mean a new book that you could read together, or a special trip to the playground with you, or something else she enjoys (not necessarily material). Even if you use rewards, praise is always the most important reward.

Remember to be patient and praise all progress in the right direction. "You remembered and got to the bathroom in time today EVERY SINGLE TIME! I am so proud of you!" feels so good to hear that she'll want to hear it every day.

Best of luck,
Dr. Laura

Dear Ed-
Pullups at night are fine. It is not uncommon for kids to go backwards at age 4 and begin to have accidents. I think talking to her and stressing that she has to go AS SOON AS she feels the need, and motivating her to do so will be your best bet (as detailed above). Just don’t make it into a power struggle by punishing or criticizing her.
Good luck!
Dr. Laura