Pressures of potty training can lead to accidents

My four-year-old daughter, who was potty trained when she was 16-months-old, has had problems with wetting her underpants and the bed. It's gotten so bad that sometimes it happens more than once during the day and three to four times a week during the night. I've taken her to see her pediatrician to be certain there is not a medical problem. Her doctor thinks that it is just something that happens and that she'll grow out of it. I try not to make a big deal of it, but its driving me absolutely crazy.


Gayle Peterson

Gayle Peterson, PhD, is a family therapist specializing in prenatal and family development. She is a clinical member of the Association... Read more

Your daughter may be under too much pressure to grow up fast. Inadvertently or otherwise, you may have encouraged her playing with the potty so much when she first showed interest in it. She then developed in her potty training to gain approval instead of proceeding at her own pace. It is possible that her partial regression and forgetfulness is due to being potty trained too early.

Babies at 16 months of age are not considered developmentally capable of physical control to the degree your daughter performed at that young age. Areas of the brain that are involved in controlling the sphincter muscles are thought to be too underdeveloped at this age to perform potty training. Your daughter's early potty training was a remarkable feat and no doubt largely forged upon your positive reinforcement of the process.

Perhaps your daughter is currently experiencing some exciting activities that absorb her attention in a new way. It is often the case that children regress in one area of development when progressing in another. For example, research shows that when children challenge themselves to learn to read, it is helpful if they have something to return to intermittently that was mastered earlier (such as building blocks). It is thought that this gives them a period of rest to assimilate new information and that the return to something mastered lends confidence to the ability to learn something new.

In your daughter's case, a period of developmental challenge in which she is trying to master greater control in some area may be putting stress on an earlier part of her development that was weakly, or precipitously established. Like a foundation brick that was placed correctly, but not surrounded with mortar, an earlier building block is pushed out under pressure.

Do not panic. Although you are trying to not make it a big deal, your daughter is probably picking up your disapproval and tension around the situation. You may need to work with yourself in truly accepting her difficulty right now in a compassionate, not just neutral, manner. Begin to look at the fact that your daughter succeeds in not wetting her bed almost half of the time. She also uses the toilet successfully all but once in a day. Instead of viewing your child as doing something "wrong," consider how much she is doing "right."

Become curious about this little girl's development and what is so intriguing to her that she is sometimes forgetting to use the bathroom during the day. How wonderful that she is capable of such concentration and engrossment. Give her positive support for her interests and lovingly wonder with her. Try to find out if she is aware right before she does go to the bathroom successfully. This may help her identify sensations of a full bladder more acutely. However, do not pressure her about it. Simply wonder out loud, occasionally. Laugh with her about how she becomes so involved in what she is doing that she forgets. Join with her in a loving, even humorous way that invites her attention to the problem without pressure.

Mostly, focus your energies on what new development she is doing and establishing an attitude of compassion and acceptance for working her way through this earlier phase of development. Some reflection on your childhood and the nature of toilet training that you experienced might also prove fruitful in helping you to relax your concern. Were you trained early? Was humiliation a part of your developmental experience? Did you learn toilet training with pleasure or dread? Remember that many theories of child rearing have changed over the past generation. It is your job to sort through what your parents did in raising you that you want to keep and what you want to throw away.

Your daughter "grew in" to potty training quite early according to today's standards and knowledge of child development. Your pediatrician's advice to you that she will "grow out of it" may be more accurate than you realize.

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