Ask the expert: Our son (6) wets himself up to six times a day

Q Our six-year-old is the youngest of three boys and was diagnosed last year with sensory processing disorder (SPD). He attends an occupational therapist every week. SPD affects his fine motor skills – especially using a scissors, holding a pen, using cutlery; he cannot tolerate certain textures of food; and his hands and feet are very sensitive to pain and temperature (the slightest knock will result in crying followed by anger). Transition is difficult for him (getting ready to leave the house, returning home, going somewhere he is not familiar with, even getting in and out of the car). All of these things increase his anxiety levels and often lead to meltdowns which involve crying, anger, shouting and kicking out.

The reason I am contacting you is that he wets his pants up to six times a day. No link has been made between the SPD and the wetting. All through junior infants and now halfway through senior infants he wets his pants up to three times during the school day and on average three more times at home. It is only a matter of time before a classmate notices and we fear the emotional damage this may cause. He has been assessed by his GP and a paediatric renal consultant both of whom think the problems is behavioural/psycological. He is awaiting a HSE assessment of needs but it could be up to nine months before the assessment will begin. Have you come across this before?

A Sensory processing disorder (SPD) is one of several developmental difficulties children can have that can lead to a range of emotional and behavioural problems.

You are right to try and seek a multi-disciplinary assessment of your son’s needs as each child with SPD has very individual needs. Indeed, there is a big overlap between SPD and other developmental difficulties such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).

Most children with ASD have sensory processing difficulties. In addition, some children are only mildly affected by sensory processing difficulties (and largely grow out of the problems as they mature), while others are more severely affected and need more intervention and support.

So, it is important to get a good assessment of your child’s development, so you have a clear picture of his difficulties and his strengths and so will be in a good position to help him.

SPD and toilet training

There is a strong link between delayed toilet training and SPD (as well as the other developmental difficulties) and I have worked with many children who take much longer than others to become fully toilet trained. The exact mechanics of the link are not fully understood and likely to be different for each individual child. For example, some children might be out of touch

with the body signals from their bladder and don’t notice when it is full. For others, they might get distracted when they need to go to the toilet or some might have a fear of using the toilet. Others might avoid using the toilet because the process is very uncomfortable for them (due to their sensory issues).

Helping your son learn to keep dry

From my perspective, the best way to approach the problem is to view your child’s difficulty as a specific immaturity that he will eventually overcome as he gets older. Unlike his brothers, your son will need some extra support and lots of patience as he learns to manage his bladder

. Below are some specific ideas to help him.

1. Closely observe

the pattern

The first step is get a detailed picture of the what, when, where and how your son wets during the day so you can understand any patterns. In particular, it is important to get a sense of any exceptions

– are there times he does do his wee in the toilet? If so, how does he manage this? In addition, try to understand what the specific challenges for him might be – is he simply out of touch with the body signals from his bladder? If so, he needs to learn over time how to slow down and tune into these. Or are there other issues for him?

2. Break down his learning into small steps

The next step is to break down his learning into very small steps, building on what he knows already. For example, if he needs to learn to tune into his body, the first step might be him telling you when he has just wet his pants so you can use this as an opportunity for learning – oh what did you notice when the wee came out? What did you feel just before?

Or if he has a specific sensory issue/ fears about using the toilet, make the process more enjoyable for him, perhaps by playing music in the toilet or reading stories there.

It might help to break the process into small steps that you help him learn one by one, for instance, first he learns to do a wee in his pull-ups standing on the toilet, then he learns to do it sitting on the toilet in his pull-ups and then taking the pull-ups off as he sits.

Reward charts can work when you are in a learning phase, but make sure to give him a star for a very small step – such as telling you when he has wetted, and then a big star for bigger progress.

3. Going at your son’s pace

The key is to be very positive and very gradual. Never criticise your son and forget about the pressure from outside to do this quicker – you can only go at your son’s pace. You talk about wanting to protect him from being embarrassed in school and this is important. How is this currently done by the teacher?

Think of other ways you can protect him. For example, you could let him go to school wearing some form of pull-ups/ special pants (so no one notices) and only work on the toilet training at home at his own pace. You could also discuss with his teacher implementing a programme of subtle reminders to help him use the toilet in school.

Do also consult with the OT you are seeing about other ideas. Dr John Sharry is a mental health professional and co-developer of the Parents Plus programmes. He will be delivering a series of talks on promoting self-esteem and overcoming anxiety in children in Dublin on Mondays starting on April 11th. See solutiontalk.ie for details.