ASK THE EXPERT:Your son may not want to change his bad habits as they are getting him noticed, writes DAVID COLEMAN.
OUR NINE-YEAR-OLD son is a bright, healthy, active boy but he has one persistent problem which concerns his mother and me. He regularly wets himself (and occasionally soils himself) during the day.
He never wets his bed at night; and the problem seems to occur when he is fully engaged in some activity, when he “forgets” to go until it is too late. Some weeks there is no problem at all, and sometimes it seems like every day.
He always gets into some trouble over it but we do not want to make it into a big deal. I know that he is quite disappointed in himself when it occurs and I am concerned that it may start to affect his self-esteem. It has been happening to some extent ever since he was toilet trained.
Wetting problems, called enuresis, and soiling problems, called encopresis, are common enough. When they happen as a continuation of the toilet training process (ie a child has “always” had accidents) they are called primary enuresis or encopresis.
When they start to happen later, after toileting has been successfully established, they are called secondary enuresis or encopresis. Since you describe the accidents happening “to some extent ever since he was toilet trained” it sounds to me like it is primary enuresis and encopresis. Primary toileting problems are usually easier to resolve.
Secondary toileting problems often occur with emotional difficulties and so can be harder to tackle.
Usually, when children have ongoing toileting accidents of a primary nature it is worth exploring if there are any physical causes. Sometimes, accidents can occur due to physiological immaturities in the bladder or bowel or from ongoing infection.If you are confident that there is no physical problem then it is most likely to be a habit that your son has fallen into. The great thing about habits is that, if everyone has the will, they can be effectively changed.
It may be the case, however, that while you and your wife have a great desire to change things, your son may not. Children often, unconsciously, take on roles in the family and these roles give them status, attention or both.
It may be that your son is the child in the family with the “toileting problem” and this may be guaranteed to get him some notice (albeit negative attention) which he subconsciously comes to rely on.
The fact that there is always “trouble” when he has an accident may be motivating or reinforcing for him. The key, therefore, may lie in getting him to believe that he would be better off if he avoids the accidents and gets noticed instead for some other, more positive, aspect of his behaviour or personality.
So, given that your son is now nine you can have a discussion with him about the issue. This is not about rowing with him or telling him off. Instead, help him to identify that the toileting accidents, while unpleasant, could be rewarding for him and encourage him to decide if it is worth his while getting that attention from something else more positive.
If he seems motivated to change things then focus your plan on his developing maturity and responsibility. Explain to him that he can be proud of being a bigger boy who takes more responsibility. Appeal to this developing maturity and explain that getting to the toilet on time is simply part of being more grown up.
Let him know that from this conversation onwards, getting to the toilet on time will be fully his responsibility and that you and his mum are no longer going to be prompting or reminding him (which I am guessing you currently do and which undoubtedly helps to maintain the problem).
Then get him to start to connect the physical sensations of needing to go (that “bursting to go” feeling) with the messages that his brain gets. He can do this by deliberately delaying his trip to the toilet for a few minutes so that he feels very clearly the sensations in his body of needing to go. This will help him to become better able to judge the timing of his trips to the loo.
Allied to, hopefully, his growing accuracy in judging the need to go, you can help to build his self-esteem generally. By focusing on things that help him to feel capable and lovable he will feel better about himself and begin to realise that his worth is not measured only on how much notice he gets for his “accidents”. You could introduce some kind of a reward system for successfully using the toilet (a more grown-up version of a star chart) but these systems generally have only short-term success before their effectiveness wears off. They can be helpful to kick start a change-process though.
Ideally, however, the longer lasting change will occur because he starts to feel better about himself, generally.
Hopefully he will learn that successfully using the toilet brings its own sense of confidence and maturity and gives him a new role in the family as the nine year old who is more grown up!
David Coleman is a clinical psychologist and broadcaster with RTÉ television
Readers’ queries are welcome and will be answered through the column, but David regrets he cannot enter into individual correspondence.
Questions can be e-mailed to healthsupplement@irishtimes.com