Pee Accidents in 4 Year Olds

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Questions

4-year-old: But I don't HAVE to to go potty!!

Sept 2008

My 4-year old son is potty trained but adamantly refuses to go to the bathroom whenever we ask him to try. Sometimes he will hold his pee for 7 hours or more, hopping up and down, running in circles, etc. but still says he doesn't have to go. If we ask him just to try before getting in the car for a long trip, he won't do it -- even if that means he doesn't get to go to the party, zoo, etc. We have tried all kinds of games to make it more lighthearted and appealing, or more ''his choice.'' He will go on his own if the timing is right, but not when we ask, and the result is occasional accidents. I know this is fairly common and probably just another way to test his power . . . but what do I do? I end up sitting around the house all day, trying to reinforce my ultimatums, while he calls my bluff. Never ever ever never!

I suggest you start making sitting on the potty part of his daily routine. Don't tell him he has to go, just that he needs to sit on the potty and try to go. Let him read a book, read to him, give him a game to play with, so that he'll sit there and relax.

By daily routine I mean at routine intervals in the day: when he wakes up, after eating breakfast, before lunch, before rest time, after dinner, before going to bed. But especially anytime he does what we used to call ''the pee-pee dance'' LOL!

Also, don't show him how exasperated you are, or upset, angry, etc. Just tell him matter of factly it's time to try and go potty and he has to sit there for 2-3-4-5 minutes before going anywhere. When you see him ''dancing'' just say, ''Oh I see you are feeling like you have to go potty, so now is the time to try'' and let him know he has to sit/stand there for 2-3-4-5 minutes regardless of whether anything comes out.

What does his preschool teacher suggest? Good luck! Stephanie

Believe it or not, this one is easy.

Stop asking him if he wants to go! For that matter, you should stop ASKING your child if he wants to do much anything. Especially since your child seems to want to resist, it's time to teach him that there are rules and ... you just do them. Trust me on this. When my child was 4, I totally changed my parenting style. I had to.

So you say: ''It's time to pee.'' He says ''I don't have to.'' You say (consulting watch) ''It's 11:20. It's time to pee. Give it a try and perhaps your body will surprise you.''

It's important to STOP saying ''Jonny, I'd like it if you would.'' or ''Jonny, would you like to'' or ''Jonny, could you...'' because even though this may sound odd, each of those statements gives the child permission to NOT listen to them! Stop giving your child an ''out.'' Be extremely direct. ''You need to X.'' ''It's time for you to X.'' If there's a problem, give them a choice: ''X or Y.'' And then stop there.

While it's nice to teach babies and small children to say please, when a child gets older, and especially if it's a child that is a resistant child, it actually does the child a favor to REMOVE ambiguity. If you want them to do something, you say ''You need to do X.''

Being very clear helped my son a lot. Rules are good to learn

It sounds like you are already doing something similar so I'm not sure if this will help but here's what I do with my very independant/often stubborn 5 year old. When I tell her to go and she says ''but I don't have to'' I say ''that's fine if you don't need to use it just sit on the toilet. If you don't pee that's fine, just try.'' She usually sucks her teeth or does some other completly rude response but then goes to sit on the toilet and nine times out of ten she goes pee. If she doesn't that's fine. I, like you, stand my ground about using the bathroom, but my thing is about her trying/sitting. If she doesn't use it that's fine, she just has to try. Hope this helps. Good luck. M

We have the same issue with our daughter. I think the thing to do is just let them control when they want to go to the bathroom. It sounds like with your son it's turned into a major control issue and probably the best thing to do is back off and let him go when he wants to go. Accidents are annoying (especially on carpet!), but not the end of the world. And an occasional accident sounds better than what you're describing. Also, you could buy a portable potty so if he refuses to go before leaving the house, only to have to go half an hour later when you're not near a bathroom, you can just whip out the portable potty. At some point, I'd like to have the policy we go to the bathroom before we leave the house, but in the meantime the portable potty keeps it from mattering too much. (BTW, the Fisher Price brand one is great.) Sarah

My 3 1/2 year old has been almost potty trained for like 8 months now, slowing moving toward 100% (not counting nightime of course). But I havn't had him refuse to sit very often.

What one friend suggested to us was not to ask if he ''needs'' to potty. But simply say it is ''time to potty'' and take him into the bathroom and sit. Then you can say ''hey, look, there is potty in there!'', or ''oh well, nothing there. Maybe next time''. Eventually, it will become routine and they will relax. Good luck. Bryan

It sounds really challenging! And it sounds like it's become a big power-play between the child and his parents.

My suggestion would be to neutralize the emotion of it. We found success using a timer that went off every hour. When the bell rang, it was potty time. That helped separate potty time from my authority. The other idea I had was to combine it with a sticker chart -- positive reinforcement. So every time that he sits on the toilet and produces, he gets a sticker. Once he gets x-number of stickers, he gets a special outing with a parent or a toy or something special. Good luck. Rachel

Why not just let him go on his own without reminding him? Sounds like a power struggle is going on here. He's old enough that if he does have accidents, he can change his clothes and ''clean up'' after himself. Of course, you'll have to follow up his cleaning. But, put it all back on him and see what happens. Not going out on a fun adventure is not really a natural consequence to not going to the bathroom when you need to, so he's not making the connection in his mind (or he is and he's just testing to see if you're for real.) In either case, no one's winning.

When my 4 year-old says that he doesn't need to go potty, I usually sympathize and make a big deal about how I really understand that he doesn't need to go, but that he must do it anyway (before bed, bath, or before we leave the house), whether he needs to or not. If he says he just went, then I also say I understand and that's great, but I need you to do it again, because I know that ''I just went'' can mean he did it 2 hours ago. Susan

I posted a reply to a similar question last week. when my now 4 1/2 year old used to say he didn't have to go and then later had an accident, i would tell him that if he didn't at least try or if he had another accident, it meant he still needed to wear a diaper. also, if we say he can't do something or go somewhere until he actually tries to go to the potty, we mean it. even if it means not going to the zoo, etc. we try to do this early enough so that we are not rushing to go to some event and this way it gives him some time to ''change his mind'' about really not caring about the event or trying to go to the potty. he rarely has an accident now. no pee in pants!

There are three things you will drive yourself insane trying to get your kids to do: eat, sleep and use the toilet. My advice (on all three) is to back off -- WAY off. I did EC with my youngest, and giving this strong-willed firecracker of a toddler autonomy over her toileting was one of the happiest (accidentally smart) decisions I ever made. I tell my older child (5 y.o.) at the table, ''You are in charge of your own tummy. If you want a sticker, you need to try one bite of each thing on your plate. After that, you decide how much you want or need to feel full. If you don't eat enough, you will have to wait until the next snack/meal'' If she eats three bites, that is her choice. You can try something similar with your potty- striker: ''You are in charge of your own body. If you feel peepee or poopoo, you can take yourself to the bathroom and let me know if you need help. You can earn one sticker for your sticker chart by keeping your undies dry all day.'' There is no punishment for accidents, just lack of reward. Doing a sticker for the day instead of each trip to the potty allows you to step back since you will only need to keep track of accidents, which are easy to spot. In short, he's trying to drive you nuts, and it's working. Simlply remove yourself from the equation (don't worry, he will find something else to drive you crazy when you guys get over this!). When we were doing EC, we had all kinds of waterproof pads. You may want them for the carseat, rugs or sofa if that helps you relax and give him space to assume the independence he is craving. Hope I don't sound harsh -- I almost stuck a fork in my daughter's eye before I learned to leave her alone at the table! Live and learn. :) Happier Hands Off

If I were you, I would completely let it go and let him go when he feels like it. With my son he it was a control thing and also fear of the toilet. The problem was more with poop than with pee. He ended up with a constipation problem and a leaking problem. He is 6 now and does go on his own but he still leaks stool without knowing it sometimes. Its from so much practice of holding it in. Your son will have accidents and maybe he still needs pull-ups. He will figure out on his own that it is more comfortable to not be wet. This is better then the physiological problems that can develop down the line. been there

My advice is let him have the occasional accidents. Just pack a change of clothing with the assumption that it will happen, so you will be prepared. (And try to get emotionally prepared too!) If you are nonchalant about it and just tell him, ok well you can always go when we get 'there' if you need to, then the power struggle will be diffused and the accidents will eventually annoy him enough to be an incentive to go more often. logical consequences are your best weapon

Oh my gosh...this used to drive me absolutely insane!!!! You can't make them go pee. It's the one of the few things they feel they have control over. These are things I tried: a chart....after three times of going pee when I asked he got a reward. It worked once. I let him pee in the yard. (This worked great for us.) I changed the wording from 'going' pee to 'do you want to try?' But, it passes, it really does. He'll have accidents and get tired of changing his clothing. mom of boys

First you have to un-do the power struggle this has become. It's worth continuing to work on getting him to go pee because there can be long-term effects on the urinary system from holding it in too much. I would start having regularly scheduled potty time every 3-4 hours without fuss. Simply at these times (either by the clock or by event -- pre or post breakfast, lunch, etc) he sits on the toilet for 10 minutes. He can either get up after he pees or after it's been 10 minutes. No struggles, no rewards/punishment, no attention, no nothing but 10 minutes on the pot. Hopefully after some time of this he'll decide there's no point to holding on. My daughter has held it in up to 12 hours rather than use a scary public potty, and frequently insists she doesn't need to go. But she has to go to the pot when we say, and when she does she usually pees.

Many people had good takes on this and suggestions. One thing I can add, that would work with many different approaches, is to eliminate the word ''try,'' which implies one needs to make a special effort, and will either succeed or fail. Instead, say ''check,'' which is about finding out what your body needs at the moment. R.K.

I agree with all the advice so far, both about backing off and not letting it be a power struggle, and also about not making it always up to them. Sometimes they have to sit on the potty, whether they ''go'' or not. One thing my daughter enjoyed was when I would say, ''You have to sit on the potty now, but I don't think you have to go. I bet ''no pee pee''. What do you bet? Who do you think will be right?'' (Of course I only did this when I was pretty sure that she did have to go.) Then when she went pee, I'd say ''You were right! You win!'' Sometimes she would even take my hand and lead me to the bathroom saying, ''I want to be right. Do the betting thing.'' Good luck!

4-year-old's pee accidents are making me crazy

April 2004

My almost 4 year old has started peeing her pants everyday, just when she's with me. I started by ignoring it because it's happened before over the past year, i.e: when her brother was born, later when he was in the hospital, when I've had work trips, etc. But then it happened a few days and then would stop.

This time it's been fairly consistent for the past month. Everyday when I pick her up from preschool, she's wet. Then sometimes even after we are home she pees her pants. Once, during her brother's nap, while I was playing Candyland with her, I looked over and there she was peeing her pants. I've taken her to the doctor to rule out a UTI. I assume it's a cry for attention given that her brother is going through advancements and she gets quite jealous of the attention he gets. But I do try to spend time with her that's just her time.

But I'm getting tired of this. So I decided to start removing favorite toys each time she wets. So this week she's lost Barbie, Groovy Girls, Candyland, art projects and scissors, favorite stuffed toys, and I've stopped putting her to bed with bedtime stories and songs. So this morning she peed all over her room. So obviously this isn't working.

She has known how to go potty for almost 2 years now but periodically gets into these wetting phases. This is the longest one of these regressions has lasted.

So now I've put her in her brothers diaper which she seems quite excited about actually and I'm at an absolute loss. I don't know whether to go back to ignoring it and just keep telling her to change herself. She doesn't seem to care about losing any of the favorite toys.

I'm really tired of the extra laundry and not knowing where I can take her and if she'll pee her pants or not. I've tried the ''time to go potty'' and pretty much she'll go if there's a bribe as in...can't go to the park unless you go potty but then we'll get to the park and she'll pee her pants (20 minutes after going potty at home).

She knows it upsets me and it does upset me, it's making me crazy and she seems to enjoy that power.

Any suggestions? I thought things would get easier the closer we got to four, which all of my friends and relatives keep telling me is the magic age.

tired and frustrated

One of my four year old twins has started wetting again also-- not as frequently as yours apparently is, and I think it's more that she just is so busy playing that she puts it off until it's too late. Have you considered putting her back in pull ups for now? It sounds like you're going crazy trying to deal with this. I'll bet if you just use pull ups, praise her when she uses the potty and ignore it when she doesn't, this behavior will stop. I don't think taking toys away/punishing your daughter will have positive effects. I would stress how glad I am to have a ''big girl'' as well as a baby, because there are so many things a big girl can do that a baby cannot. So-- my advice is get a box of pull ups, and just relax. This too will pass. another mom

My heart goes out to you; it really does. My son's been trained since 2.5 years and has had quite a few accidents lately (though not on the scale of your daughter's accidents). I think the key is to keep it from being charged. Try to hide your disappointment and frustration (and I know too well how very hard this is), and consider putting her back in pull-ups for a week or two. I suggested this to my son (as off-handedly as I could), and he seemed a bit shook up and has had no accidents lately.

I suspect your daughter wants to feel like the baby in the family, hence ''she seems quite excited about actually.'' Let her. I suspect taking the 'power' away and letting her be a baby for a bit will get old for her quickly enough. Plus, if she's in pull-ups, you won't have as much laundry nor need to change her wet clothes. Nearly a win-win, with the downside being the cost of pull-ups.

Good luck. As I said, I know how darned frustrating this can be. My son was just this morning lamenting a book I threw away that he had peed on in the bathroom. (sigh) Jennie

Thank you all for your advice so far. I'm the person that put the original post up and what seems to be working for the moment is I did continue to take a toy away each time she had an accident but I also spent more alone time with her. I've also had her help a bit more with her brother.

In any case, we've only had one accident in 5 days and she was devastated when I took her favorite Spot book away. So I'm still spending time reading but her favorite book disappeared and she was not happy.

She's also asked where some of her toys went and I told her, remember, you peed your pants and they disappeared.

So she's making the connection.
until it happens again......

I didn't catch your original posting, but read about how you've chosen to deal with your near 4 year old potty accidents, and I think you should take care when punishing potty issues. Taking toys away for an accident is punitive, and it will likely give your child a negative feeling about the potty, which I know you don't want, as it will ultimately create more issues (mental and physical). Possitive reinforcements are always a better, and healthier, choice for children.

For instance, a pat on the back when your child rememebers to use the potty goes a long way. I know from experience (I have a 4 and 2 year old) that it can be very frustrating to go through steps over. Regression is tough on a mother, and you've already potty trained your 4 year old. But, try to be patient again, and give possitive rewards for getting to the potty. ''You remembered to use the potty every time today! Great Job'' would feel so good to hear, that your child will want to hear it again the next day. If you use a reward system, give a sticker everytime she remembers.

A child this age who is having accidents is generally having them for 1 of 2 reasons. (1) attention / regression (in this case, my advice is...give attention -- possitive attention. Reread some potty books with your kid, like 'Once Upon a Potty', and tell them how happy you are to have a 4 year old who is using the potty so much -- don't mention the mistakes, just the successes)

Another reason for mistakes (2) attention span. Some kids at this age have a real hard time separating themselves from their play. for these kids a playful reminder is very helpful. Talk to them about listening to their bodies, give them a ''potty''watch (everytime any hand gets to, say the 4, check in with the potty). This option actually works great for both cases, as it also gives special (possitive) attention to the child.

Please don't give your child negative feedback regarding their body functions. We want to raise our children to feel happy with and love their bodies and everything they do. If adults don't use kid's body functions against them, they will not learn to use them against others (like peeing just to tell you she is angry).
AS

4-year-old has started wetting her pants at school

I would welcome replies from anyone who has had experience with this problem...

When my daughter turned 4, 6 months ago, she started wetting her pants several times a day, and she has not stopped. I've tried not nagging her for several days and I've tried reminding her several times a day -- neither works for very long. I've had her tested twice for urinary tract infections (both negative). Until very recently, she hasn't seemed to even mind being damp or wet, but recently one girl in her preschool class mentioned that she should wear training pants and she related that to me. My pediatrician mentioned medication, but I am very much against that except as a last resort -- especially since I suspect that it is a control thing. My daughter refuses to stop playing, watching a movie, etc. until she can barely walk. It's quite obvious. Also, she is very headstrong in a quiet way and I think it is her manner of taking control. But, we are debating whether to send her to kindergarten in the fall and I'm not sure whether peer pressure would make her stop or be devastating.

Has anyone had this experience? I would welcome input either on the Digest or personally. Thanks. Stefanie

My 4 year old son recently went through a phase of this a few weeks ago, though it didn't not last as long as your daughter's. It didn't seem to upset him very much, in fact he rarely noticed, or he noticed but didn't mind the wet clothes. It mostly happened on weekends, and I honestly think that he would forget (actually ignore it) because he was so wrapped up in whatever he was doing. After a couple of weekends, we figured out (with his help) that he would try to hold his pee because he didn't want to miss out on anything. We gave him the option of training pants, which he considered and then rejected. We also tried to downplay it alot and explain how he could stop or pause playing and then come back to it. We were able to illustrate this most effectively with his videos, by teaching him how to pause a tape all by himself, go potty, and then come back and start playing it again without missing anything. (I'll never forget the look of astonishment and understanding when he finally understood that possibility!) After another couple of weeks (and of course, with continued reminders of now would be a good time to go potty) he seems back on track. [We're still working with him on the idea of going potty before we go out (especially in the car), but he's stubborn and sometimes tells us I can hold it, but that's a whole other issue.] I think you're right, it is partly a control thing, but I also think that 4 is still pretty new to the whole potty thing. We also suspected with my son that it was also partly a regression which we've noticed before (the regressing part) before some big developmental stage. Good luck and hang in there! Hopefully, your pediatrician will rule out health issues. Natasha

I also have a 4 yr old and find the best strategy for bathroom use is a firm announcement several times a day (It's time to use the bathroom) rather than posing a question (the always ridiculous: Do you need to use the bathroom? - my son has never said yes to this one) or suggestion (You should use the bathroom - and the power struggle begins). Sometimes just the above announcement works but is usually followed by: I don't need to from him and Just try from me. If a battle ensues, I drop it - it is definitely a losing one. Unless a good bribe is handy Well, we can't go to the park until you do. Ellen

Since it seems obvious to you when your daughter needs to use the bathroom, enforce a bathroom break where possible: turn the movie off or interrupt play with a guarantee that she can continue when she returns.

I also make a point of having rules about bathroom habits: We use the bathroom before we go to bed, get dressed, eat lunch, etc. This way it isn't so much a power struggle between us, just following the rules (which alot of 4 year olds are very attached to). He doesn't seem to hold me and his dad or his 9 yr old brother to these same rules so I have the sense that he gets it somehow and understands the rules let him save face about being told what to do all the time. Note, my son is generally an easy going guy so this strategy might not work for some.

I would ask the teacher's at your daughter's school for some help too; i.e. asking them to have her use the bathroom several times a day in a low key way. This certainly isn't an unusual situation and a good teacher will have some strategies that work without shaming the child in front of her peers: gently reminding her to use the bathroom frequently; having the child change her own clothes privately (sometimes taking the time out from play is an incentive for cooperation); positive reinforcement, etc.

Wetting pants: My daughter was out of diapers for about six months at age 3+, and then regressed and needed diapers again for more than eight months. I think it was a combination of things, but that control issue was a big part. One of her preschool teachers said that maybe when she was first toilet-trained, she responded positively by performing well, which is different from doing it from a deeper self-motivation. One is internal, the performing is behavior for others' approval. Nancy

One of ours did something very like this, even to the refusal to stop what they were doing and take care of things, and didn't fully resolve it till age 7, despite scoldings, understanding talks, rewards, nothing, you name it. I think it is partly a power-struggle thing, maybe even within the child him/herself, and partly just overall immaturity (though it does indicate admirable powers of concentration and a long attention span!). We finally quit racking our brains over it and said, You're wearing pull-ups to school until you get this under control, and by the way this is your problem, not ours, and eventually s/he did.

Peer pressure was not a big thing in kindergarten. I think few kindergartners have toilet training so well under control that they can afford to tease their peers! This may be a sign, though, that she's not ready for kindergarten--she'd be not-quite-five when she started, and that can be hard for a kid--not-quite-six is far easier.

Teacher pressure is another thing. If you decide to send her to kindergarten with this unresolved, you should certainly get the teacher's input. Kindergarten teachers have enough to do without daily mop-ups. John

re four-year old girl wetting pants -- I recently went through what seems the very same situation with my four year old girl. Also went to the doctor, no infection. It seems that it may be a similar situation -- they're just too busy with what they're doing to take the time to pee. We made it a policy that she at least had to try peeing before we left the house, every two hours, etc. We also went the big girls don't pee in their pants, and your friends are going to start thinking it's yucky if you're peeing in your pants routine. The results were not immediatate, but she's gone back to using the toilet -- I'd say it took a couple of months or so before she cleaned herself up. Good luck. Andrea

4-year-old wets her pants when she laughs hard

June 2002

Hi, my 4.5 year old daughter has periods of time when she pees in her pants when she laughs hard. There are a lot of times when she wets the pants like 10 min after she's been to the bathroom. She is not a bed wetter and this does not happen at preschool as far as we know. We tried rewards, punishments etc but she says that when she feels she needs to go she had already wetted the pants. She knows this is bad. Any ideas ? Thank you. A puzzled Mom

Please, you must not punish your child for this! It is not her fault, she cannot control it and it happens to many children and adults. I had this problem as a child, and so did my mother. Thankfully, she was sympathetic to my embarassment. We both had immature kidney and bladder issues and I have an extra ureter between my bladder and one kidney that gave me a variety of problems as a child which resolved as it grew and matured. Talk to your pediatrician and see a good urologist such as Joel Piser at Berkeley Urological. I'm sure there are a variey of causes for this and most she will outgrow. In the meantime, shame and punishment will not help.

I would not! punish a child for inadvertently peeing! No kid wants to wet himself deliberately. If you have ruled out organic causes by consulting a board-certified pediatric urologist, try teaching your kid to do kegels. Seriously, it can help tremendously with incontinence. Finally, the muscles responsible for voiding or not voiding will strengthen as your child matures. Punishment for accidentally peeing can scar your kid--maybe she will start ''holding'' her pee, which can give rise to a host of medical problems. Go easy. G

If your daugther had been an adult, I would suspect weakened pubic floor muscles and suggest Kegel exercises. That could still be your daugther's problem. I would have a doctor check it out. By the way, Rudolf Dreikurs, in ''Children the Challenge'', says that punishment never works for elimination problems; it only makes the situation worse. Fran

Not only did I pee my pants when I laughed too hard as a kid, I still do it as an adult! I also wet my pants when I vomit, jump up and down too hard and sometimes when I run. I really can't help it, and my husband is a very, very funny guy so it can be a real problem in public.

Its my bladder; it is weak and overactive, and I've tried medication (my grandmother actually had surgery on hers to solve the problem) but now I just tie a long-sleeve shirt or jacket around my waist and keep an extra pair of pants at the office. Medication just made my mouth dry and made me sleepy. I also have learned to squeeze my legs shut tight and even press on my crotch with my hand to keep the urine in if need be.

If this doesn't work and I pee my pants, everyone is usually laughing pretty hard anyway, and in a great mood, and we just keep laughing, even about the pee.

I remember peeing in my pants once as child at a slumber party (we were crank-calling late at night) and the host refused to let me borrow some pjs and I was a bit traumatized by that but I don't remember any lasting effects from it.

See a urologist for 4.5 year old's Enupresis diagnosis?

Feb 2003

I am trying one more behavioral approach to dealing with my 4.5 year old son's wetting problems, but if this doesn't work, I am advised to look into a possible medical problem. The nurse in my pediatrician's office has informed me that to look into this, first a urine analysis is done in the pediatrician's office to rule out urinary tract infections (which I know it's not, since this problem has existed for a year and half and my son would be pretty sick by now if he had a uti!), and if that's clean, then we'd go on to a urologist. She said she thought the tests they would do would involve catheterization, the thing I am most looking to avoid (hence not exploring a medical condition sooner). My question is twofold: 1) Does anyone have any experience with bringing their young child to a urologist, how did you prepare them/help them cope, and are there alternative ways to looking into this problem other than through a catheter (say, ultrasound, MRI etc.)? and 2) If, god forbid, we have to go through with the catheter, do you think I can convince/hold out for my son to be at least sedated if not put under completely? The nurse told me this is not usually done, but my son has sensory integration dysfunction and impulse disorder, and at his age, this is not an experience he'd forget, I fear, and I don't want to put him (or me) through it, if it's medically feasible to avoid it or at least make him unaware of it. Thanks for any help Susan

Dear Susan, My son is 9 months old and has urinary tract anomalies which have required many tests. Already he has had 7 catheterizations. I understand your hesitation and fear. I cannot give any advice on preparing your older son for it but I must say that I have been amazed at how quickly and easily the tube is inserted and have been suprised at the flexible capacity of the opening of his penis.

The best advice I can offer is to see a pediatric urologist instead of a general urologist. Not only are they more adept at working with small bodies but they also have access to the appropriate sized tools. Their offices are decorated in such a way so as to make the children more comfortable and their personalities are more suited to working with small children.

An ultrasound is one of the tests used to find problems (we have had a number of them) and may indeed be a good first step. Then, if an irregularity is uncovered at least you know that having some of the other tests which do require a catheter are really necessary. Best of luck to you.

I think the advice you got about consulting with a urologist sounds very extreme for a four and a half year old who is wetting his pants or wetting the bed. It is not that uncommon even in children twice his age - see the advice on the BPN website. If I were you, I would get a 2nd opinion - I think it's been quite a while since bedwetting has been considered a behavioral problem. Everything I've read in the last 5 years says it is an inherited hormonal deficiency that they eventually outgrow. a mom

Challenging 4.6 year old still having pee accidents

August 2006

My 4.6 year old boy has been semi-potty trained for about a year and is still having accidents (pee pee only) almost daily. They usually happen because he is busy at play and doesn't want to get up to use the potty. Sometimes it is one accident and sometimes up to 3 or 4. He doesn't want to wear a diaper and often times gets very upset when I ask him to change his wet pants. He is also a very picky eater (almost no fruits and veggies) and can be rigid, stubborn, and has occasional tantrums. Most of the time he is sweet and loving and plays well on his own for long periods of time. Is the potty behavior and picky eating a 4 year old thing? He was a very sweet and easy going baby, then became more challenging around 18 months, peaking around 3, now getting somewhat easier going. Any advice would be great
frustrated mamma

I learned this one for our sons care giver: when ''do you need to go potty'' is met with a no she says, ''Let's try, you might be surprised.'' and when they do go she asks ''Were you surprised?'' It has had a good success rate. Helping him develope physical ques may be of some help too, i.e.,setting a timer for every 2 -3 hours or so as a reminder to check-in for himself when he is absorbed in self-play. Our son has night time accidents from time to time, I try and remember to have him empty his bladder right before bed & acknowledge his fustration when he has an accident and not put any energy on it pam

I just did a bunch of research related to this regarding my almost 6yr old daughter - definitely check out the pee accident relationship to constipation. I recently picked up some edible fiber tablets (they are relatively natural, not chemical, and are orange flavor - one of the flavors my daughter will tolerate) and some chewable acidopholis (doesn't need to be refridgerated like most). Next I'm adding in magnesium to her diet (found a fizzy drink that's pink lemonade flavor) that will soften her stool. It's kinda working - her constipation is less and we're also working on a 'potty' schedule - 5 minutes after every meal or snack. In order to get that going, I put a library of fun books in her bathroom for her, right next to the potty on a stool at arms reach.

If this going on longer, take a look online at a diagnosis called ''enuresis'' for more info on what might be a bit further down the line...

I also got on a yahoo group parent board that discusses these issues with children - it's been *very* reassuring!

Best of luck. Anon