There are few other subjects that are more difficult to talk about, more confusing to deal with, or more frustrating to a parent than a child who is still bed wetting or having ‘accidents’ after being potty trained for some time. It seems being able to teach your child to control their bladder must be written into the imaginary ‘good parenting’ handbook and if your child is over a certain age then he shouldn't be wetting the bed or having accidents pretty much EVER.
But we all know that just isn’t the case. It is not how typical kids work and it sure isn’t how sensory kids work.
I got into a conversation with a friend of mine just the other day about this exact thing. His daughter, who is typically developing (although I suspect some minor non-responsive and/or under-responsive sensory issues) turns 5 in just a few weeks, and had ‘regressed’ from his point of view (OMG I hate that word) and started peeing her pants again. He wasn’t happy. As a matter of fact, he was kind of angry with her. So, you know I intervened – respectfully and in private – but I had to bring some things to his attention.
The biggest thing here is that it is part of NORMAL development for kids to have bedwetting or pants-peeing episodes after they’ve been potty trained (even for years without accident). In my experience, it is extremely common for this to occur around age 5-6 or just about Kindergarten. Why? A couple of reasons I think…
First, children are growing physically. Their body is getting bigger, including their organs (and bladder) and the signals that they have grown accustomed to recognizing – the ones that let them know they have to pee, or are hungry, or are tired – are changing as they grow. Every growth spurt = new signals. This is for all kids - typically developing or otherwise. Add sensory issues, where signals from the child’s Interoceptive system are already a little jumbled up and having accidents or bed wetting should be expected. It is key to remember that the signals are interpreted by our children’s brains subconsciously. Meaning the signal may register in your child’s head that he/she has to pee, but perhaps the usual interpretation of that signal is that the child can wait an hour or more (so they can finish their Lego project or do ten more monkey bar runs), but since his/her body has been growing, they may not recognize the ‘you have to pee but it can wait’ signal and only clue in when the ‘it’s an emergency’ signal comes in. Interpreting new signals is like adding new words to their vocabulary – it takes time to get it right.
Also, this Kindergarten-aged developmental stage is a big step mentally; our kids are focused on new ideas as their neurology expands to include larger concepts of not just academics but social life outside of their immediate home or neighborhood. Often when children develop quickly in one area, they are apt to let other areas stay stagnant – or even slide backwards (the Mexican Cha-Cha!). Think about your child as a toddler: perhaps when they started to walk their language was no longer the priority. Yet, once they mastered the new skill of walking, then they started chatting it up again. It is part of healthy development. (If you have concerns about your child’s development, remember I am not a doctor and I don’t even play one on TV, so talk to your child’s physician to determine what is normal for him/her.)
Given that my friend’s daughter hadn’t ‘regressed’ and that the pants-peeing episodes were true emergencies, as opposed to willful disobedience or lack of concern for where or when she urinates (I think Dr. Greene’s books should be MADATORY reading for all parents), it meant my friend shouldn’t be angry with her, but rather handle the situation with care and concern for her emotional state, including protecting her from being embarrassed or ashamed. I’m fairly certain she’ll simply outgrow this stage.
Bed wetting and accidents aren’t just a problem for kindergarteners or the newly potty trained, this is even a bigger challenge when your child is older – say 8 or 9 or more. Parents of these school-aged kids feel even worse about their child’s bed-wetting or day time accidents. That same ‘good parenting handbook’ seems to suggest that we are not only bad parents if our child is having accidents at these ages, but that our kids are somehow defective. And trust me when I say this, our kids are feeling the shame and worry themselves.
After age 7, or second grade, typically developing children become more aware of the social structures around them. This isn’t always the case for our kiddos on the spectrum, but that awareness does come, usually just a few years later. But don’t underestimate your child’s concern for how others will see their bedwetting and/or day time accidents. This can be hugely damaging to our kid’s self esteem.
Why do older kids have these accidents too? In my house I attribute them to stress. Just like everything else in their lives, once there is simply too much going on for our kids to handle – right now those are changes in season, schedule, routine, school pressures, social pressures, anxiety or anticipation of next year, or summer schedules – when their stress tolerance level has been exceeded, that’s when my kids have the hardest time regulating or recognizing Interoceptive signals. All of them, temperature, hunger, sleep, and definitely those bathroom signals. And that means it is predictably when Gabriel, my oldest son, is going to have bed wetting and day time accidents. Even at 11 years old.
It has happened virtually every year since he was about 6, usually in the spring time when things are most stressful for him, right around his birthday when he is growing mentally and physically, and lasts a few weeks at best. The good news as his mom, is that I not only understand why it is happening, I know it will be over soon. Gabriel isn’t mindful of the fact that it happened last year, so it is harder for him to believe that it will stop soon, so it is hard on him every year. But we get through it. And so will you!
Here’s my advice to for getting through bed wetting and accidents for kids who are already ‘potty trained’.
Patience. For you and for your child – this too shall pass.
Bathroom use requirements. Must pee before and after all transitions: to/from school, to/from bed, to/from meals, to/from errands, etc.
Listen for new signals. Talk to the child about ‘listening’ for new signals. Give them a clue as to what is happening, and how they can work at recognizing the new signals.
Create a secret signal for help. Come up with a ‘secret’ signal for when your child has an accident (especially in public) so you can get your child’s clothing changed without making a scene. Be sure to share it with their caregivers, too (babysitter, teacher, family members, etc).
“Good Nites” at bed time. These are essentially pull-ups for older kids. We’ve used them in the past, when bed wetting was virtually daily and Gabriel was really self conscious about it.