Toileting Challenges in Preschoolers
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Dr Laura..... I'm struggling with helping
our three-year-old be successful in using the potty. Our DD began toilet learning in Mid-May. At first, she was
very motivated to use the potty. We went straight to underwear, and she
got stickers frequently throughout the day for keeping her panties
dry. She did very well at the start, but would often have 1 or 2
accidents a day.
And so that pattern has continued. For SEVEN
months. DD's accidents do not include her emptying her bladder; just
"leaking" a bit. Her accidents are more frequent toward the end of the
day – between naptime & dinnertime is the "danger zone." She can
*very easily* have an accident 20 mins after she uses the toilet.
DD attends school 5 mornings a week, but her
accidents there are much more infrequent; she will only have 1 accident
there about every 10 days. Her track record is much worse at home. 1-2
accidents a day is typical, 3-4 is not unheard of.
She will poop in the potty, but only when she goes
w/ me. (I work 32 hours a week). If I am not available, she will hold
her poop until a sleep period when she has a diaper on.
I have tried to be casual & not pressure her.
I've tried stickers as as a reward for being dry; also prizes she
selected from the dollar store. I do not want to use food as a reward.
I read that using panties is best, so that the child has the feeling of
being wet. However, we do use a pull-up at night (she still sleeps in
her crib) and we use a diaper or pull-up for naptime as well. Both are
usually quite wet after sleep time is over, even though her nap is only
1.5 hours at most.
Since things are worse in the afternoon, I thought
getting rid of the diaper at naptime might help. I tried that last
month. It took her a couple of days, but then she was able to stay dry
during her nap. She got a prize from the dollar store that she picked
when she was successful. However, when we were traveling over
Thanksgiving, she went back to having difficulty. Since she was
completely emptying her bladder AND often having a b.m. during nap –
without a diaper/pull-up, in my sister-in-law's home, I retreated.
I have questioned that there may be something
biologic wrong, but when I discussed this w/ her pediatrician at her
three-month check up, the MD told us that this is a "process" & that
some children take longer. I have avoided talking about "big girls"
using the potty, or "babies using diapers." I try oh so hard to be calm
& nonchalant when there is an accident.
I will confess, however, that I am getting
increasingly frustrated & annoyed. In the past week, I have had two
conversations that have involved much more "shaming" than I've used in
the past. This, of course, has backfired & the accidents seem to
have increased in the last few days. She has been wet at school the
past three days & yesterday she had FOUR accidents total! The
babysitter tells me she peed on her upholstered rocking chair this
afternoon for the first time!!
What can I do? How can I help my daughter be
successful ... and keep from loosing my mind? I'm especially frustrated
because her pediatrician & preschool teachers don't seem concerned,
but her peers seem to have caught on much faster than she. I'm told
that she won't be walking down the aisle in a pull-up, but I'm starting
to wonder if this is true!! Please help!! Thank you!
What a frustrating situation — for you and for your daughter.
The first thing to remember is that she wants to be successful. Children this age don’t leak urine because they’re lazy, manipulative, or unmotivated. If she’s not succeeding, something is getting in the way.
Before we treat this as a psychological issue, we need to consider something very common at this age: constipation.
I’m a psychologist, not a physician. But over the years, I’ve seen many cases like this where frequent “leaking” — especially small amounts soon after peeing — turned out to be related to stool retention.
Here’s why.
When a child holds poop, the colon can become stretched and full. Even if she poops sometimes, she can still be backed up. A full colon presses on the bladder. That pressure can cause small amounts of urine to leak, particularly later in the day when muscles are tired.
Several details in your letter point in this direction:
- She leaks small amounts rather than fully emptying her bladder.
- It can happen 20 minutes after she has just peed.
- She tends to hold poop unless you are present.
- She soaks diapers during sleep, when her muscles fully relax.
None of this means she’s doing anything wrong. It may mean her body is working overtime to compensate.
I strongly recommend speaking with her pediatrician again and specifically asking whether constipation or stool retention could be contributing to the leakage. Since many pediatricians don't know a lot about stool retention, I suggest asking if a pediatric GI could evaluate further. Many children who appear to be “potty struggling” are actually dealing with this very fixable physical issue.
Addressing that first is important. No amount of sticker charts can solve a bladder that’s being compressed.
In the Meantime
-
Drop the pressure.
Leakage that is physically driven is not within her control. Shame will only increase anxiety, which can worsen holding. -
Consider whether she may be holding stool.
A child who waits to poop until nap or bedtime in a diaper is often trying to maintain control. That pattern can unintentionally contribute to constipation. -
Focus on daily, relaxed pooping.
The goal isn’t “no accidents.” The goal is helping her body empty comfortably every day. -
Use play to reduce fear.
If she resists pooping with teachers or sitters, playful role-play with stuffed animals can help her discharge tension. Keep it light and silly. Laughter reduces anxiety and increases cooperation.
About Readiness
You also mentioned that she still wakes very wet from naps and nighttime sleep. Many children who are physically ready for daytime toilet learning still aren’t ready for dry sleep. That’s developmental and not something children can control.
It’s completely appropriate to use pull-ups for sleep as long as needed.
A Word About Your Frustration
You are human. Seven months is a long time to deal with daily accidents. Of course you feel worn down.
But if this is constipation-related — and very often it is — your daughter is likely working incredibly hard all day to hold things together. Imagine trying to carry a full bladder and bowel and still concentrate at school. That takes enormous effort.
If we address the physical piece and lower the emotional pressure, most children make steady progress.
And no — she will not walk down the aisle in a pull-up.
But she may need her body supported before her behavior can change.
Warmly,
Dr. Laura
