My 4 1/2 year old daughter, who had been completely potty trained, is now having accidents on a daily or even multiple times in one day basis. As a result she has been getting some pretty serious Urinary Tract Infections and has had to undergo all kinds of testing. The good news is there doesn't seem to be any scarring in her kidneys as a result of all the infections, but the bad news is as long as she continues to poop in her panties she is going to keep getting the infections back. She has been on low dose antibiotics specifically for Urinary Tract Infections for about 3 months now and her doc. wants her to stay on them until we get these accidents under control. I don't like the idea of her being on antibiotics for this long, nor do I like the fact that I can't keep up with her need for clean panties or the fact that I have to clean up the bathroom sink and counter after she has cleaned up after herself. The best I can tell is that she is just too busy playing or doing something to stop and go to the bathroom. We are going to try a sticker chart where she gets a sticker for each 2 hour period she goes without an accident. At the end of a perfect week, or two or whatever time frame we decide on, she will get a prize of some kind like a toy or new dance shoes. Does anybody have any other ideas on how to motivate her to use the potty?
I should add that she is currently on Miralax, as prescribed by her doctor, to keep her from becoming constipated, she takes probiotics daily, consumes a minimum of 9 grams of fiber each day, drinks a minimum of 18 oz of water each day and either eats cranberries, craisins or a cranberry supplement daily. All of these things have been prescribed by the doc. Unfortunately I really feel like the problem is more in her head. She just doesn't want to get up and go when she needs to.
I think that she may have Enecopresis , as some of you mentioned. At one point in time they urologist did mention that the softer stool is probably squeezing around the blockage but never gave it a name. She seemed to be better, no accidents for a while there, so I figured the constipation was gone (we have been on the Miralax for 6 months now). When the accidents started up again, I just figured it was her being too lazy to stop what she was doing and go use the bathroom. But after reading a couple articles of Enedopresis last night, it really does describe her symptoms exactly, and they did specify in the articles that you can have relapses...which is probably what is happening. She has even told me that sometimes she doesn't feel the poop coming out. SO, now I feel completely horrible that we have been getting after her for having these accidents. Oh well, as usual hindsight is 20/20. I am supposed to do a followup phone call with the urologists PA in a week and a half so I will definitely be talking to her more about Enecopresis then. For now we will continue their advice of miralax daily, laxative on weekends, antibiotics to prevent further UTI's, lots of water, probiiotics, fiber and cranberries. Thank you everyone for all of your ideas and advice. I will try to repost again when/if we see some changes.
I'm thinking that at her age and given she was already potty trained that it is more a health issue and less something that will get better with rewards. Read my thread constipated child dirty underwear which resulted in me calling the pediatrician and getting a medical diagnosis for my son.
First off, I would start giving her a good quality probiotic to help replinish the good bacteria that was killed off by the antibiotics. If you have a Whole Foods Market or Sunflower Market near you, they have a refridgerator case with a vast selection on antibiotics.
Also, you may want to think about purchasing the book Gut Solutions: Natural Solutions to Your Digestive Problems. The fact that she is having accidents may meant that she has possibly some constipation issues going on; the soft stuff that is coming out is the watery stuff (diarrhea) that is able to make it through the blockage. If that's the case, then her body probably isn't signaling her with enough time to make it to the bathroom before she had to go. This was the situation with my son (he had taken a lot of antibiotics earlier in life also for repeat infections) and, after giving him mega doses of probiotics and Nordic Naturals Jr. 3-6-9 omega 3 capsules (we were working with a doctor on this), we were able to heal his gut within 6 months and he has been completely accident free ever since.
Hope this helps.
Hi,I don't have an answer to all of your questions but I have something I'd like to share about UTIs. My niece had constant UTIs and was on antibiotics for most of the first 3 years of her life and it has caused complications. When my daughter developed a UTI a couple of months ago I was nervous about the course of action to take (I try to stay away from antibiotics). She tested positive for a UTI and had a fever and was in pain. I did a little research and found a natural product called D-mannose. I got the powder at Whole foods, mixed it in juice and gave it to her for two days. It completely cleared it up - this stuff is amazing - you should google it. People with long-term chronic UTI problems have been helped tremendously from this product, and it is 100 % natural so it can be taken as a preventative as well. I'm only commenting on this because I wish so so much we had known about it for my niece. Good luck!
Hi, this is a tip I learned recently. When they have an accident after being cleaned up, get a clean pair of underwear soaking wet and make them wear it for an hour, everytime they have an accident. It makes them hate having wet/messy underwear.
As for the reward chart. I've learned in psychology that you need the reward to be random and unpridictable so they never know when it'll happen and they have to keep up the good behavior because they never know when the reward will happen.
I hope this helps, good luck!
I wonder if she's having trouble reading the signals that she needs to have a BM. Because she's on Miralax, her stomach may be in a constant state of feeling like she has to go, even when she doesn't. I know as an adult, this happens to me with Miralax. I always feel the urge.
On the other hand, she may not feel like she has to go until it's too late. It hits her suddenly and by the time she realizes it, she's already messed up her panties. I think you (and your doctor) may need to investigate how her bowels are actually working.
You mention you've been dealing with constipation. Has her ped talked to you about the possibility of ENCOPRESIS? This is when there is bulk built up and partially blocking the large colon (as Laurie D. suggests below), and newer stools that are still liquid push past the blockage. But the nerves have been numbed by the constant pressure, and the child can not feel the poop until it has leaked out and soiled the underwear. As frequently as your daughter is having "accidents," this could very well be the cause. If so, she has no control over it because she can't feel it coming.
This is a fairly common problem in kids who have had issues with constipation. It needs careful oversight to correct it, a process that can take weeks. Since she's prone to UTI's, it's even more important that you ask her doctor whether this could be the root problem.
Well I don't have a lot of advice since my own daughter still poops in a pullup...a whole different issue than yours. :)
I do have a bit of advice reguarding the rewards. I an elementary education student and in a couple of my child psychology classes we have learned that at this age children need much more immediate rewards/punishments. While setting up some kind of consistnat system in relation to her behavior with bm is good having it go on a week basis is far to long at that age. To have an impact it has to have some kind of tangible relationship with the behavior for the child, and a week is just not in their logical scope.
Good luck! I always read all the questions about this topic incase I come across something new I have not heard! lol
Maybe stop thinking about "perfect week" for a while.
Is she at home with you (as opposed to at preschool)?
If so, then once an hour (or whatever interval seems right)
take her to the toilet and sit her down.
I like that you've got her cleaning up after herself.
However . . . this may, in fact, be the pay-off.
I'm guessing that maybe she feels like a grown-up
because she has to wash her panties in the sink.
What if, instead, you have a bucket of sudsy water
(+ whatever, Lysol or something) in the bathroom
and the panties just go into the bucket,
for you to deal with later on.
Your assumption that it may be "more in her head"
than a real physical problem may get in the way
of solving the larger problem.
With all that fiber and miralax and fruit, she should,
I think, be having a (relatively) solid formed BM regularly.
You said "potty", not toilet.
Is she using a little potty chair or the big people's toilet?
If she's on the big people's toilet, is there a step-stool
or something like that where she can put her feet?
If her feet are dangling without any support,
it is more difficult to push out a BM.
She may have some resistance to having a BM
in the potty or on the big toilet for any number of reasons.
I think before you can reward her for clean panties,
you need to re-teach her to have her BMs only in the appropriate place.
Good luck.
S.
Would she wear a watch? If you could find a (fairly cheap) one that had a timer on it you could set it for hour increments. Possibly being reminded by something that isn't you (or another authority figure) will help her go.
Good Luck!
