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4 Year Old Potty Training Setbacks

Dr. Markham,
My daughter is 4.5 yrs. old and she still has potty accidents at home, but she is fine at preschool. What is the proper action at this time? What steps should i take next? Thank you.
Ed

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, but on a short-term basis, a four year old can find rewards quite motivating, as long as she actually has the capacity to achieve the reward.

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). E

Remember to be patient and encourage 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

Dr. Laura-
My daughter is physically fine and yes she is fully potty trained and has been since she was 1.5 yrs old.When i said she had accidents that happens a couple of times a week depending what she is doing. You mentioned using pull ups, i use them at night time is this a good ideal or not?  Thank you for your advice and how to react to this situation.
Ed

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

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stacey b commented on 21-Apr-2009 01:18 PM
Thank you for all this great advice, I am struggling with my 4 year old right now. She is having accidents at pre-school as well at home. I do notice the power struggle when she is asked if she has to go potty... Unfortunatly, I have managed to get upset with her when she has an accident even though I know that it's wrong. Perhaps behavior modification on my part will help her with her use of the "potty".
Anonymous commented on 06-Oct-2009 05:20 PM
My daughter just turned 4 and is having the opposite problem. She will go potty at home, but not when out or in a group setting like pre-k. When we are out I have to physically put her on the potty and have her try. (usually successful) I need some ideas to get her to go at pre-k.
Anonymous commented on 26-Jan-2010 07:51 PM
My daughter will be 4 next month. She was trained for about 6 months-close to a year with the rare nighttime accident. Then I had my son back in september of 2009. She started regularly wetting the bed at night & during the day, including soiling herself. She hadn't done that in over a year! I tried the not a big deal approach & the punishment approach which both yielded the same results-nothing. She stopped going in her pants & stayed dry all night again but now has gone back to wetting herself at night with 1 BM once. I had to go back to pull ups at night or otherwise I would be washing her bedding every night. She has in the last 3 days, wet herself during the day again. I don't know what to do. I know a lot of children regress after a new sibling because they aren't getting the attention like before. I feel awful because I can't give her the same amount of attention before & I feel like when I do it's because I have to reprimand her. She is very strong willed & independent that's why I'm baffled by this regression. I am strictly breast feeding my son which puts me unavailable to pick her up & run to the potty all the time. Does anyone have any advice?
Anonymous commented on 26-Jul-2010 05:24 PM
I know how all of you feel. My daughter turned 4 in June she had been potty trained for 2 years! Still had to wear a pull up at night, but no problems! I had a another little girl right after my oldest 3rd birthday, not one accident. My youngest just turned one and about 2 months ago my oldest started having accidents. I did a TON of reaserch, asked friends talked to doctors, I was at my end! Then after reading this article and a couple of the similar ones I realized my oldest was having accidents more because we are interacting with my younger one now! We have talked to our daughter and explain that we need to work harder at doing things together. It is very tuff but one day at a time seems to be working not completely done with the accidents but defiantely getting better.
Unsure commented on 27-Jul-2010 08:21 PM
I have to things happening. Firstly, my daughter has just turned 4 (she is the oldest of 3 kids of which were 3 under 3.5)and has been dry during the day since she was 2.5 and at nights since she was 3.5. However, in the past month she has only been dry at night 2 times in a week. We have just ignored the wet and just cleaned it all up quickly and got her changed saying "never mind will get you out of those we PJ's". The second other thing I have noticed (in hindsight) that has been going on for months now but I now see it happening at all meal times, is that at dinner time she excuses herself from the table to go to the toilet (says its wees). Once back she then goes again a few minutes later (says its poos). Then could go another 2 times straight after that. Eventually she comes back to the table and then resumes her meal comfortably. I didnt think anything of it, until I now see it happening during breakfast and lunch. Anyone else had this?
Sofia commented on 01-Mar-2011 01:11 PM
Anonymous commented on 06-Oct-2009 05:20 PM My daughter just turned 4 and is having the opposite problem. She will go potty at home, but not when out or in a group setting like pre-k. When we are out I have to physically put her on the potty and have her try. (usually successful) I need some ideas to get her to go at pre-k. Hello Anonymous, I have the EXACT same problem. Did you find anything that worked. Is it okay in daycare now?
Gabrielle commented on 01-Apr-2011 03:40 PM
My daughter is 4 years&3 months old, potty trained at 2y & 3 months, and has been "tinkiling" for several months now. We kept thinking she would outgrow it and so we ignored for a while, then gently reminded, and most recently have threatened pull-ups
until today. With some resistants because she doesn't like them, she put them on because I took away her underwear. (She just requested some "princess" pull-ups.) I also have an almost 2 year old son that is showing interest in the potty. If I try to psychoanalize
this brother sister dynamic, my head begins to spin. What conerns me most right now is that like others have mentioned, she has peed through her clothes twice this week. Unfortunately, I have reacted negatively and she is fearful of us checking her panties.
From reading, I know we have made situation worse! So now, the question I have is, pull-ups or no pull-ups? One article said to give her the choice to wear them and if she wanted to then she could also decided when to wear big girl underwear again (i.e. 1
week later). This one says no pull-ups. No matter what, I think I will have to back-off and simply go back to the potty routine. Because she is actually not uncomfortable with wet underwear, one thing is for sure, it will be stinky at our house!
Anonymous commented on 19-Jul-2011 05:32 PM
Wow, I am so glad that we are not the only ones going through this problem. My son who is almost 4 has had a huge setback and like Gabrielle, my husband and I have not dealt with it in a positive light. So now after reading all these postings, it makes
me feel really terrible, however we have also tried the praise and providing positive feedback and this hasn't worked either. And as for rewarding, that never worked for us. I also have a daughter who will be 2 in a month and she has been showing ALL the signs
of potty training, but I am not ready because of my son. Not to mention we are going to be moving overseas in about 3 months. I know it is an attention thing and also my son is obviously sensing the move, but it is really trying and very frustrating. After
today's numerous accidents I ended up putting him back in diapers and of course he was extremely and I mean extremely reluctant, but I know this has caused an ever bigger setback as he is really wet now, stinks of pee and doesn't care that he is wearing a
wet diaper. I guess sometimes we expect too much from our little ones!!!
Anonymous commented on 20-Jul-2011 12:48 PM
My daughter will be 4 next month and has been trained since just after she turned 3. She has been having accidents now for about a month and it seems to be getting progressively worse and more frequent. Yesterday she peed & pooped in her underwear while
we were gardening. When I asked her why she is going in her pants and not the potty she tells me 'because it feels comfy' in her pants. I am not even sure how to respond to this. She tunes me out when I try to talk to her about it and doesn't care that she
won't be able to go to school in September if she continues to have accidents. (schools in Ontario require that JK students are fully potty trained) Any suggestions would be very helpful. :)
Kristina commented on 05-Aug-2011 10:23 AM
I am having the same issue, my daughter whose 4yrs old. is completely uninterested in potty training, i can get her to pee in the potty but when she needs to BM? She goes in her underwear. I have been potty training for a year now, and for this to happen
sucks, cause school starts this month. Professionals say put her on the potty every 20min everyday for two weeks. Who has that kind of schedule? I'm desperate.
Anonymous commented on 19-Aug-2011 04:03 PM
Dear Dr. Laura, My son is going to be 4 years old next month and will be starting preschool in a couple of weeks. He has a fear of public toilets but uses ours and his grandparents toilet just fine. However, just yesterday his grandmother took him to a
park where he saw a port-a-potty and now he is terrified of using any toilet. I made the mistake of getting upset when he went on the floor because he did not want to use the potty. What do you make of this??
Corinne commented on 22-Aug-2011 03:02 PM
Dr. Laura, My son just turned 4 years on on the 16th of this month and isnt really potty trained yet. Weve been at this for a year now and i decided to just put him in underwear and remind him constantly. Is there anything else I can do to make this easier,
he started school today and had two accidents and was sent home. Im afraid that this will become a pattern. I let the teacher know we were having some issues, and she said it was fine but when i went in she acted like it wasnt normal for him to have two accidents.
What can i do?
Anonymous commented on 02-Nov-2011 09:51 PM
My son just turned 5 and he's been regressing. He feels bad and tries to hide it. When I ask him why he giggles, averts all eye contact, and says that he was too busy playing. I think he is actually trying to get more attention than his little sister.
She's only two so she obviously requires more care so there's nothing I can do about that. I tried explaining to him that it's important to go as soon as he feels like he has to. I even tried a sticker chart. I was dreadfully sick today and he did it again.
Now it's apparent to him that I'm upset. I am really frustrated. I don't know what to do other than to wait this out. Any advice would be greatly appreciated.
Susan commented on 15-Jan-2012 07:26 PM
I am a preschool teacher and have a 4 yr.old girl student who will occasionally poop and wet her pants. She will sit in this until I begin to smell it. Could be as long as 1-2 hours. It does not bother her. Sometime she thinks it is funny. We have discussed
that it is not. She has done this about 5 times now at school and her Mom says she also does this at home from time to time. I have talked to Mom and she has started a reward system at home. Not sure how this is going. How can I as a teacher help her change
this behavior? We have regular bathroom times and the children are able to go anytime they need too.
Donna commented on 19-Jan-2012 02:06 PM
I have a four year old that is completely potty trained during the day and at nap-time (mostly). Sometimes at naptime he has accidents (usually #2) in his underwear and I believe he does it on purpose because he knows he has permission to get out of bed
if he has to use the bathroom. His excuse is I don't know why I did it. We tried potty charts with rewards but that didn't last long .. he became uninterested in the rewards so what now? It seems he's doing it either for attention or laziness. He is a very
bright child so understanding all of this is not the problem. It seems he needs to be disciplined in some way because I feel he is doing it on purpose.. Any discipline ideas?
Caroline commented on 28-Jan-2012 04:08 AM
Thank you for posting this article Dr Laura, I have just put my 4 year old daughter to bed after she has once again had another accident. Toilet trained since 2 I have been really struggling with this. She starts 4 year old kinder next week! I must admit
like some of the parents above I have been getting mad with her. However after reading your article I believe the penny may have dropped - we are currently living with my parents while we build our house, maybe this has something to do with it. Also I take
note that maybe I need to be a little less stressed about it and treat it more like what it is an accident. Thanks.
Anonymous commented on 01-Feb-2012 09:08 PM
Help!! My son and his son (our grandson) live with us and have for a few years. Our grandson will be 4 in a few weeks and he is still having accidents. He seldom pees in his pants but does poop in them often - usually just a small amount and a few times
in a row. He sometimes does real well but for the last 3 or 4 weeks has been doing poorly. He has been 86ed from the actual preschool he goes to because he has accidents. They will not let him go back down to the younger class where they do potty train because
he is too old. This daycare has let us keep him there in the afternoons until he gets potty trained but they do not help with it and even often forget to take off his pull up after his nap so then he has accidents there in the afternoons. Our last baby sitter
did not work much on potty training with him and we are having a difficult time with him. We having varying work scheduled and do get stressed and then upset with him. It is hard as he now cannot be in preschool in the mornings and we can't afford to keep
him in two different places. We are looking for a different situation and I have a doctor's appointment for him to see if there is anything physically wrong. The daycare provider mentioned that there are medications and some kind of belt that doctor's sometimes
suggest for kids that may have problems like this. They are all also frustrated with him so are not much help. I know that we all need to KEEP CALM....but what else can we do when we need him to be potty trained!!! Thanks!
Laura Markham commented on 02-Feb-2012 03:43 PM
My dear suffering frustrated parent- There is actually an epidemic of three and four year old kids having potty accidents in this country today. It seems like willful behavior but it isn't. Here's what is happening. Our poor diet combined with fear of
using the toilet causes constipation. This can be true even in children who poop daily. Experts estimate that 30% of kids are actually constipated. In their little bodies, that means much less room for the bladder, and more pressure on the bladder. So the
child has accidents. There's a new book out on this. I haven't read it yet, but I'm already recommending it because so many parents need it. It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and Other Potty Problems by Steve
J. Hodges MD & Suzanne Schlosberg
Anonymous commented on 03-Mar-2012 01:49 PM
Thanks. Just ordered this book on Amazon..cause we need help.
Toni commented on 28-Apr-2012 12:36 AM
My son is 4 years old and has been perfectly potty trained for over a year now. Just recently he's been having accidents right in front of the toilet. I dont really know why he is doing this and if it is just because he's to late or what. It seems really
weird that the only accidents he's had is directly in front of the toilet. Has this problem happened to any one else and what should i do to help him? I put him back in pull ups but i dont know if thats the best thing to do. Please help. Thanks.

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