Pee Accidents in 5 Year Olds

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Archived Q&A and Reviews

Questions

5-y-o with frequent pee accidents

Aug 2012

One week from starting kindergarten, our 5-year-old is having multiple pee accidents daily. In preschool he went days staying dry, but now that he's on vacation, he won't go to the bathroom when we remind him. I'm worried about how he'll do in kindergarten. He's on the daily laxative recommended by the pediatric nurse practitioner we saw, which has helped put an end to the poop accidents she thought were caused by constipation, but the pee accidents have returned. We'd appreciate any recommendations about therapists that might help him be more willing to use the toilet when it's suggested and when he feels he needs to go, or other approaches.

i understand how upsetting all this can be. my daughter had pee accidents until she was, wait for it, yes, about 11 or 12. she is about to turn 14 now and it all seems behind us finally. i tried many things, but in the end just decided to live w/ it until her body (and mind) grew out of it. that meant waking her up at 2-3 am every night to take her to pee to at least prevent that horrible wet-bed scenario. but frequent wet, smelly undies, irritation on her bottom due to sitting in pee for many hours (at pre-school, school, camp, etc.) were just part of our lives until (i think) HER BLADDER JUST GREW INTO BEING STRONG ENOUGH TO HOLD IT AS LONG AS NECESSARY.

of course this flies in the face of conventional wisdom (oh, every kid has perfect bladder control at age 2, 4, 5, whatever, but certainly not much longer than that). but my take is that every kid is different (no matter the national averages or whatever) and all you can do is the best you can do w/ each situation. oh, and, again against conventional wisdom, the first thing I would do (and of course you are not me) is to get rid of that laxative and any other ''drug''-type solutions. those things have nasty side-effects with which i wouldn't want to have to deal at any cost. your boy already has a pee issue--i wouldn't want to give him a bowel issue as well.

good luck. i know it's hard to be patient w/ things like this, but...nature has its own ways. ''relieved'' dad

Many ''pee and poop accidents'' (otherwise known as Enuresis and Encopresis, respectively) are caused by feelings of anxiety in young children, especially when beginning something new (e.g., new school year) or experiencing a significant change in routine (e.g., new sibling, parental separation). I encourage you to continue working with a medical professional to address any medical issues related to these problems. From a psychological perspective, though, I would begin to address the anxiety. Specifically, I would recommend that you talk with your son's kindergarten teacher about the class policy for when children can use the bathroom and how they indicate that they need to go. For example, some teachers have all of the students go to the bathroom at the same time and ask those who have to go in between to wait. Other teachers have a nonverbal signal (e.g., waving one finger in the air) to allow students to tell the teacher they have to go at anytime of the day. However the classroom is structured, try to keep an open communication system with the teacher so that you know what's happening at school. Also, I suggest setting up a reward system where your son can earn a ''prize'' after a certain period of time without an accident. As with any reward system, be sure to choose a prize that is of value to your son. The prize does not have to cost money (e.g., trip to the park, have a friend over). Also, don't make the prize too big because you may need to offer bigger prizes for awhile until the problem is resolved. Also, in the beginning he may earn a prize after just one dry day. But, soon you'll increase the challenge and explain that he will earn a prize after 3 dry days, or something like that.

I encourage you to talk people (e.g., teachers, other parents) to get more ideas about how to help your son not have accidents and, more importantly, feel good about himself and happy and safe at school.

Best of luck to you! Megan Flom, Ph.D. meganflom [at] gmail.com

Oh, I really feel you! In fact, I was going to write the EXACT same question today. Our son potty trained himself just before he turned 3, was good for six months, and since then it's been constant accidents. He's turning five next month and just started kindergarten. He can write his name, read the comics, do some math...and he can't stay dry. It's so frustrating.

A few months ago I read this Slate article about constipation and pee accidents: http://www.slate.com/articles/life/family/2012/03/bed_wetting_the_simple_cause_your_doctor_probably_missed_.html#comments

I bought the book. We'd already done a bunch of medical tests to rule out problems, but no one had x-rayed our son to see if he was constipated. Although he was asymptomatic, his x-ray showed he was full of poop and gas. We gave him Miralax for a few months. They say that a full colon presses on the bladder nerve to the brain and triggers spasms. It can take a few months for the nerve to stop triggering spasms after the constipation is relieved.

We have had mixed results. Our son was able recently to stay dry on a drive to Los AngelesC,bwith similar issues. I'm telling myself that this will be over one day. I hope someone else can help. tired of a mound of wet clothes

I am a pediatric nurse practitioner with lots of experience in this area and I would encourage you to check in again with your PNP about your son's accidents. If he has had a history of constipation he may still be holding in his BMs, even if he is no longer having accidents. The number one cause of pee accidents after a child has been fully toilet trained is bowel movement backup! That's because if a little kid's colon is filled with poop, there is less room for the bladder to expand to hold urine and the pressure in the area can interrupt the nerve signals that tell a child he has to go (that's why some children will say they don't feel anything when they have pee and poop accidents).

The ''gold standard'' for seeing if there is a back up is an Xray. I usually suggest that parents start with a simple ''24 hour transit test''. It should take about 24 hours from eating to the time undigested food comes out in a BM. If your child eats about 1/2 cup of corn or raisins, you can watch for them the next day. If they don't show up, keep looking--at the time they arrive you'll know how much back up there is in his colon.

It's really important to figure this out before you assume that it's all behavioral. Your son may need some extra help in school no matter what since kindergarten rules about where or when children can go to the bathroom vary. You can let the teacher know that your child may need extra reminders or quicker access to the bathroom.

I've written about these issues and you can find more information about what to do on my website, www.bringingupkids.com Best, Meg Zweiback RN/CPNP

Ditropan for wet kindergardener?

April 2010

My kindergartener has a history of wetting his pants frequently. He goes through short phases of keeping his bladder under control, but they never last. We were hoping that the peer pressure of kindergarten would give him some incentive to pay more attention to his bodily needs. Unfortunately, that hasn't happened and we've come to the conclusion that this is not something he can will his way into controlling.

After ruling out UTI, diabetes and an abnormal bladder, his urologist has recommended we try a few months on ditropan to see if his bladder will calm down. I'm eager to help him get to the other side of this problem -- it's not fun to be the kid with the wet pants -- however I'm leery of giving him a drug that seems to have many potential side effects for what is not a dangerous condition.

Has anyone else gone this route? Did your child experience side effects? Did ditropan help? Hoping to stay dry

Our 6-year old daughter, now in first grade, still wets her pants. She has also gone through short periods of time in which she stayed dry, but then reverts back to the wetting. I pulled my hair out for a couple of years, trying to figure out what would help. After a lot of reading (including BPN archives) and exams and discussions with various healing practitioners (both conventional and holistic), I realized this is not something we can ''fix'' for her. She, like your son, will undoubtedly grow out of it (who still wets their pants in high school?). They just need more time for the brain and bladder to talk to each other more fluidly; for whatever reason, those neural pathways between the bladder and brain are not fully functional/reliable yet. Before taking a pharmaceutical drug (which will always have side-effects, whether noticeable immediately or not), please consider a gentler approach, like homeopathy. Many children have overcome this issue with the right homeopathic remedy, and another good route is acupressure (acupuncture without the needles). Also, I have heard Body Talk (a treatment program) is often helpful. I have not fully pursued these paths myself, but will in another year or so if the problem hasn't resolved by then. You've got a few years... kids don't start being mean and teasing one another about this kind of thing until second or third grade. Until then, I would relax--your son will pick up the nervous energy about the issue from you, which won't help. A homeopath you might like to consult is Christine Ciavarella, in El Cerrito. Best wishes, Tracy

++ Ditropan for wet kindergardener?

I think there are other things you can try before you take what to me is a drastic measure. If you read T. Berry Brazelton (see Touchpoints), he goes into ways to increase awareness of the NEED to pee, and offers other helpful advice. Awareness of the need to pee is probably the main problem because if he had to go to the bathroom a lot to pee, that would be a different problem, right? Actually, my son had the latter problem when he was 4 and it went away. I learned that that sometimes happens at times of stress, and, in this case, he was starting a new school. But his bladder did eventually ''calm down.'' Remember, that kindergarten is a big step--and therefore adjustment--for most kids, and that in itself might aggravate the problem, and the peer pressure you thought would help eliminate the problem might be aggravating it as well. It is probably humiliating for him when he wets his pants in school, but you can help by not freaking out about it and having confidence that it is a temporary situation. Likewise, I hope the teacher isn't making a big deal about it. The most obvious temporary solution of all: is to keep him in a diaper under his pants as you're working with him on bodily awareness and getting to the bathroom asap. If he becomes aware of his need to pee, he can always go to the bathroom and undo the diaper partially in order to pee into the toilet or urinal. Finally, if he does sometimes know that he has to go, you have to talk to the teachers and make sure that it is quick and easy for him to get out of the classroom. Let's hope the bathroom isn't too far away either when the urge to pee arises. And he has to know that it's perfectly fine. You can work out with the teachers that he doesn't have to raise his hand and wait, but he can go right away. These little details can make a big difference with some kids with these kind of problems. Good luck! Mark K.

My son who is 6yo and in kindergarten has had at least three waves of wetting his pants - first at school and then just everywhere. I found it mortifying. After one of the waves lasted two weeks, I took him to the dr to rule out UTI, etc. The doc talked to him about just trying to go every 20 minutes, because of the brain body disconnect. It helped for like a week. I finally bribed him with computer time, if he stayed dry, he could go on the computer. It has worked for over a month now.

I agree with all the posts. I was so embarrassed when I would pick my son up from school and his pants were all wet in the front, I thought I would do anything to stop this - but - put him on medication? Personally, I think my son is a sensitive child, and was having fears of using the bathroom at school alone, etc. That said, I would go to a child counselor before I would go the drug route. anon

I'm a pediatric nurse practitioner with a lot of experience in toileting issues. You've probably investigated some other causes of the wetting, but just in case, I'd like to mention a few that are sometimes overlooked:

Partial emptying: lots of little kids are in such a hurry to ''go'' that they only let out some urine. That means that their bladders are often slightly distended which can make it hard to notice the feeling to go when it's really urgent, and they wind up not having as much storage capacity. It can help if they learn to sit, ''go'', count to 5 and then ''go'' again.

Liquid type: I'm sure you've been asked this already, but does your child drink very sweet or caffeinated beverages? Have you ever noticed different patterns based on what he has eaten?

Constipation: Many children have hard or infrequent bowel movements. The pressure in their colon can get in the way of the signals from the bladder to ''go'' and the full colon reduces the space in the bladder to hold urine. If your child doesn't have a good size soft BM every day I would talk to your pediatrician about this.

Ditropan is used with some children with frequent bladder emptying. Like all medication it has side effects which you should weigh against how severe this problem this is for your child right now. Meg Zweiback R.N., CPNP

5 year-old boy still having pee accidents

May 2009

I have a 5 year-old boy who still has pee accidents, sometimes several in one day. He had a urine test at his pediatrician's office and he does not have a UTI. I think that he gets engrossed in what he's doing/playing and doesn't always hear the signals that his bladder is sending to his brain. We have a star chart and rewards for dry days that he gets to choose himself. This definitely helps. I also think that he will probably grow out of this as he gets older. I am looking for other suggestions for things that we might be able to do to help him to hear what his body is telling him now. He will be starting kindergarten in the Fall and I am a little bit worried about him getting teased by other kids for having accidents at school. Thank you. Molly

Start worrying when he's 15, but for now, don't even give it even the smallest bit of thought or worry. Don't even expend the energy required to read the rest of my post. sean

This is highly unlikely, but....is it possible your son is having seizures? Loss of bladder control often follows a seizure.

We didn't realize that our son was having absence seizures until his kindergarten teacher noticed them. Absence seizures often last only a few seconds, where the child just spaces out. They are ''absent'' for a few seconds. So they are quite subtle, esp. if you don't know what they look like already.

Now that our son's seizures are under control, he no longer has accidents. I feel horrible about all the times I nagged or scolded for wetting his pants, when all the time it was the seizures! Now accident-free

My son also went through a long phase of peeing in his underwear - not a big accident, but enough to have to change his underwear and sometimes his pants. I found that he was just holding it far too long and wasn't responding to his body signals. He said he did not even know he was peeing ... we would just see it in his underpants, etc. Since he wasn't noticing it, rewards for dry days, etc. would not work and would simply be the wrong approach since it did not seem to really be within his control.

The best solution just seemed to be to teach him to pee at routine times throughout the day. He went upon waking, again before school, as soon as he gets home from school, once in the afternoon, and again before bed. I did not make it an option, he just goes whether he feels he needs to or not. Turns out that he realized that his body did need to go, even though he wasn't feeling the signal, and I think this made him more sensitive to his body signals. I wonder if he didn't think he needed to pee unless he felt that ''emergency'' signal, and now he feels the less urgent fullness and now recognizes that this is the time to go. I remember him often being surprised at how much urine he would produce and we would remark that it looked like his body really needed to go even though he didn't feel like he did. Over time, this method caused him to be more sensitive to his body signals, and I think it is good to teach routines about the bathroom - i.e. using the toilet before you leave the house. Seems counterintuitive, but overriding having him listen to his signals for awhile caused him to end up being more sensitive to his signals in the end. Now we are always dry. By the way, we had a short episode of the same thing with poop in the pants during his sixth year, and the same method worked. We developed a few times a day where he would just sit on the potty and relax to see if he needed to poop. A few weeks later, the issue was over. I throw out poopy underpants

My now-8-year-old also had pee accidents in kindergarten and I just wanted to reassure you that it is not uncommon. Several kids in his class had an extra pair of pants and underwear in their backpacks just for this purpose. My son was potty trained by three, including making it through the night without ever wetting the bed. There were few accidents in preschool. But when he got to kindergarten he just could not get the rhythm of the day down. He would wait until the very, very last minute to go, even though the kindergarten had its own bathroom. Sometimes the very last minute was when they were outside, or in the auditorium, or some other inconvenient place. So he did not make it in time to the toilet. For us, it really was just kindergarten - he didn't wet his pants in 1st grade, and now in 2nd grade this problem is just a distant memory. One thing that seemed to help is his big brother telling him ''When your bladder says pee, don't wait. Go now.'' I remember my son telling me ''I have to go to the bathroom now. My bladder says pee, and like Joe says: don't wait, go now!'' So it might be the same with your son - he just needs a little trick to remember to go. G

5-year-old with frequent pee accidents

April 2009

My 5 yr-old daughter started potty-training at 2 1/2 years of age. It has not been easy right from the start.

At 4, she was still having as many as 4 accidents on bad days. Her doctor suggested that constipation which she often has, causes the intestine to pressure the bladder causing drip accidents - a kind of incontinence. The remedy for this was drinking water and eating vegetables and fruit. She doesn't drink much water, but eats good variety of vegetables and fruit. This helped a bit with the constipation but the accidents continue.

Now at 5 1/2, I can explain the facts to her about digestion and how a bladder works. We have talked to Dr. Lee, urologist referred to us by her pediatrician. He seems to think that the leaky bladder accidents were caused by delay in using the bathroom, i.e. her bladder was stretched out by repeated forgetfulness to use the toilet. His suggestion to fix this was to have her use the toilet every 2 1/2 hours. She has been on this 2 1/2 hour regimen for 3 months. This helped to decrease the number of accidents, but has not helped her in knowing when she needs to use toilet. If her teachers forget to get her to the bathroom, she has an accident but these have not been the drippy frequent accidents.

My concerns are that 1) she is going to kindergarten next fall where the teachers will be more involved with teaching and may forget to remind her to use the bathroom. Will an alarm wristwatch be helpful in getting to the bathroom at the required time? Or will this delay her independence in learning to use the toilet?

2) her peers will make fun of her for needing reminders or wetting her pants.

3) MOST IMPORTANT, by age 5, she should be feeling her full bladder and be able to get to the toilet before wetting. Why hasn't she learned to do this and why hasn't she learned from the many accidents she's had?

4) LEAST IMPORTANT, but on my worry list is night-time training. If she is not independently able to stay dry during the day, should I bother her and me to wake up to use the toilet once in the middle of the nite?

Has anyone had similar experience with toilet-training? Thanks for reading.

Hi. I am sorry to hear about your daughter's pee accidents. I am sure this is a struggle for you and her. Have you looked into her diet? I have read and heard from friends many times how some children are sensitive to certain foods and this sensitivity can show up via incontinence. In fact, my 2.5 year old son, whom I have ec'd since he was born and is nighttime potty trained, only pees in his sleep if he's eaten too much bread or grains over the course of a couple of days.

I remember reading about a teenager who overcame nighttime incontinence by doing the Feingold diet, which removed some specific foods, particularly foods w/ additives. A friend of mine is doing the Specific Carbohydrate Diet w/ her son and is seeing results re rashes and daytime incontinence. Please look for Breaking the Vicious Cycle by Elaine Gottschall and /or Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride. Both books discuss the effects of diet on gut health and give diet recommendations for healing. Google SCD or scdiet to get started now. Your daughter's constipation could be an additional indicator that she is having bowel issues. The body will talk to us in mysterious ways! Please don't try to just control the accidents w/ a timed wristwatch! Something is interfering w/ the signaling in your daughter.

I would also recommend seeing a different doctor.

good luck, Nita

My son had the same problem. We realized he was drinking gallons of water in the shower before bed. The accidents haven't stopped completely but are way down now. JodyT

5-year-old's accidents after birth of sibling

April 2009

Hello, My 5 year old son has recently started having pee accidents. I've noticed that this has coincided with the recent birth of his sister and realize that kids often regress at the birth of a sibling. These accidents tend to happen at school, parties or during playdates -- not so much at home or when he is doing something low key. When asked, he tells me that he is not aware that he has to pee. My son has always had a problem disengaging from activities to use the toilet -- he has a really hard time stopping things that he is deeply involved in. Is it possible that he really may not feel the urge to go?

I understand that this may be his way of reminding us that he is still little and needs us. I'm just not sure how to handle this in a way that meets my son's needs while also getting him to the toilet in time. Will this just correct itself if we continue to make special time for him and assure him that we know he still needs us? Right now, we are reminding him with non-verbal cues like a tap on the shoulder, as he is embarassed for us to verbally remind him in front of his peers. But obviously we are not there during the school day or other times to do this. What makes matters worse is that sometimes I get really annoyed at him for having accidents (and then I feel awful for showing him my irritation) -- which doesn't help anyone! Any advice would be most appreciated! Thanks. anon

You are right that it is perfectly normal for a sibling to regress after the birth of a baby. It will figure it self out. In the mean time you should continue to remind him to go. Have him go right before the playdate or party and depending on how long it is, remind him to go during also. Non-verbal communication is probably good as to not embarass him. He probably hates is as much as you do! He just forgets, that is why they call it an accident. Talk to his school and see if they can make sure to remind him to go at school too. I am sure they would understand that this is just a phase and be willing to help him overcome it. Just be patient with him and you will have to put some effort in just like when he was originally potty trained and this too shall pass. I am sure it does get frustrating, but showing your frustration to him may make matters worse, so try your hardest to keep them to yourself. Understanding mama

Five-year-old regularly pees in his pants

March 2007

My son is in kindergarten and regularly pees in his pants at home, at school, pretty much anywhere, every day. After he stopped using diapers (at over 4) he had occasional accidents. A few months later the accidents became more and more frequent. We have ruled out physical problems. We have tried a sticker chart which he didn't seem to care about. If I remind him to use the toilet he usually says he doesn't have to or gets angry at me for asking. Right now, I'm trying not to say anything at all, to just let him decide to stay dry. So far, no progress. Any suggestions? Tired of all the laundry

Is he doing this because he's lazy? You said you've ruled out physical issues. Is it anxiety? Emotional issues? One way, possibly, to stop is to make him do his own laundry. Don't change him (I know, it's wet and stinky)...let him be wet and stinky and if he can't stand it he can go change him self. My now teen at one time would poop in his pants at an age when he knew better, because he didn't want to bother going to the bathroom. I made him change and clean himself and wash his soiled underpants in the sink. That stopped REAL fast. Good luck. anon

Our now 12 year old peed in his pants til he was six and a half. We worried about it a lot. Then he stopped on his own at six and a half and there has been absolutely no problem since. Our son is a little slow to learn some self regulation issues, but he is very bright and does get it a little later than some kids. Other things he gets earlier than other kids. Good luck.

Once I heard a friend of mine telling her then 4-year-old that it was time for a ''surpise pee.'' We've been using that term ever since: ''It's time for a surprise pee.'' ''I don't have to go.'' ''Well, see what happens --- that's why it's called a surpise!'' AB

My now 9 year old son wasn't really and truly completely dry until he was 7. Even though you have 'ruled out' physical problems one thing his ped. suggested which did help was giving him a Metamucil cookie every day (or maybe 2x day, I don't remember). He believed that my son was having trouble sensing when he needed to go. An xray confirmed lots of back up. It did indeed help but took a few weeks. The other thing which kept him peeing (after having been mostly dry) was stress at school. There was a lot more stress than we realized. For a variety of reasons we eventually pulled him out and put him in an independent school. He was almost completely dry after that. Anyway two things to consider. anon

My kid potty-trained himself early, and still had some accidents in Kindergarten. The solution suggested to me was to take away his ''backup'' clothing in Kindergarten, and to tell him this: If he peed in his pants, he didn't have clean ones to change into. (I did sneak a set to his K teacher when he wasn't looking.) That was it; he stopped. It turned out he didn't like stopping what he was doing and he knew he had a backup. When he realized he didn't, getting to the toilet was a higher priority. (The teacher also helped by noticing the ''potty dance'' and reminding him to go.) Jennie