‘Our daughter was toilet trained but she has been having accidents’

Question: Our daughter Orla (three-and-a-half-years old) was toilet trained at two-and-a-half with no issues. However, for the last six months she has been continuously having small wets in her pants. This started happening one month before her little sister arrived and we thought it was just a small phase.

However it has persisted and even worsened recently – up to 10 wets each day. She is dry at night and is a happy girl with no issues other than that. We have had multiple uti checks with nothing found. 

Obviously, this is tough on her and us and we have tried everything with no luck. Any help you can provide would be great.

Answer: While there can be pressure to toilet train children at young ages, many are simply not developmentally ready to be fully toilet trained until well after their third birthday. In addition, many children who appear to be toilet trained early at age two go on to have later set backs with accidents, day time wetting and soiling. Taking a long term patient and child-centred approach to toilet training is very important. Your daughter is still very young so there is plenty of time to help her learn to master going to the toilet when she needs to.

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Understanding your daughter's wetting
There are sometimes physical causes for daytime wetting such as Urinary Tract Infections which you have already checked out and also constipation which you may also want to explore. Given that your daughter is dry at night, a probable reason is that she might have developed a habit of holding on too long before going to the toilet which weakens her control of her bladder. For example, your daughter may not notice the urge to wee until her bladder is very full so she has to 'hold it in'. When she finally does get to the toilet she then might not be able to fully relax to let all her wee out – as a result she can't fully empty her bladder. Then when she leaves the toilet the remaining wee leaks out later at another time.

To change this habit the goal is to teach your daughter to notice early on when her bladder is getting full and then to teach her to take more time to relax when she does go to the toilet.

Helping your daughter notice when she needs to go
If you observe your daughter carefully, you may be able to notice when she is starting to hold as her bladder is getting full. Some children start to squirm at this point or look a little agitated, or adopt a holding posture squeezing their legs together etc. When you notice this you can ask "do you need to wee? shall we go to the toilet together?" It is important to use a gentle inquisitive tone of voice. Remember your child is never holding on purpose and getting angry or critical never helps (and indeed can make the child hold on more and have more accidents)

Make the toilet fun and relaxed
Second, it is important to make a visit to the toilet a relaxed experience. Make sure her toilet seat is comfortable - some children need a special foot stool to ensure they feel secure and relaxed. Encourage your daughter not to rush the weeing process. Consider playing music and reading a book together or even playing games to help her relax. I often recommend blowing bubbles with young children on the toilet, as this is a great game and the blowing action helps them release and relax. Once she has done a wee, encourage her to wait a little longer to make sure all the wee has emptied.

Reduce embarrassment
Embarrassment and shame are real blocks to managing toilet problems. Reduce embarrassment by making sure your daughter always has spare underwear and never make a big deal about changing if she wets. As she is so young, you could also consider going back to using some version pull ups for a few weeks as she is learning – make sure to explain this is in a way that does not add to her embarrassment.

Seek further help
Do seek further help if the problem persists. Your GP or Public Health Nurse will be able to provide support or recommend a specialist to help you. I also recommend the excellent website and helpline eric.co.uk.

Read: ‘My son frequently finishes the day with a smear of poo in his pants’

- John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. See solutiontalk.ie.