Potty Training Pitfalls: When to Start and What to do When Things go Wrong

When it comes to helping kids develop healthy bathroom habits, most parents are eager for the day that potty training is over and their child can manage going to the bathroom on their own. But what happens if your child isn’t on schedule? What can you do when they have to pee all the time, wet the bed, or won’t poop? When is it time to make an appointment with a pediatrician, or seek out specialty care from a urologist or pelvic physical therapist?

When can I start potty training my child?

While it isn’t recommended to start before your child is 18 months old, you also shouldn’t start just because they reach a certain age. Some kids are ready at 2, and other kids aren’t ready until 3 or even 4. You have to decide what is right for your child and your family. If your child is 2, but you just brought home a newborn, it may be better to wait until they adjust to having a new sibling. Potty training will be faster and more successful if your child is interested in doing it. Starting too early usually just leads to both the parent and the child being frustrated and feeling defeated.
In order for kids to be successful, they have to have sensory awareness of their bowel and bladder. If your child knows they need a new diaper, or they are toddling away to hide to poop, it is more likely they are ready to start potty training. Another important signal is how long they stay dry for. If your child stays dry for more than 2 hours, or wakes up from a nap with a dry diaper, it’s a good sign their bladder is able to store urine for a while and potty training can begin.
Lastly, communication is key, if your child can’t follow directions, can’t sit still on a toilet, or doesn’t have the language skills to understand potty training, it may be better to wait to start. Kids will have to be able to tell you they need to go, undress themselves, and sit still on a toilet for potty training to work. You also want them to be able to start taking directions about how to clean themselves and wash their hands when they are done.

My child pees a lot…they have a “small bladder”

It is normal for kids to need to pee every 2-3 hours while awake. How much a child has to pee can be impacted by their fluid intake, but restricting fluids doesn’t always help. In fact, this can make the urine more concentrated and irritate the bladder which actually makes them have to pee more often. While peeing frequently can be inconvenient, it can also be a sign of health problems like urinary tract infections or diabetes.
Frequent urination accompanied by excessive thirst is one of the early signs of diabetes. The body demands you drink extra fluids because it is trying to get rid of extra sugar by peeing it out. If your child is peeing too often, it’s best to talk with your pediatrician.

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If they’ve ruled out any concerning illnesses, bladder retraining programs are the next step. While generic programs are available online, pediatric pelvic physical therapists can customize them for your child if you need help.

Why does my child seem to constantly have a UTI?

While many people get occasionally UTIs, they can be painful and frustrating. In terms of anatomy, girls get them more often than boys because the germs have a shorter distance to travel to get into the bladder. One common trigger for UTIs is bubble bath. The body adjusts it’s pH level to the soapy water and lowers it’s defenses against germs. When you get out of the soapy water, the germs find their way in.
The other most common factor is bowel problems. If your kiddo has streaks or small poop pellets in their underwear, these germs can cause UTIs. Kids who are constipated, or stool hoarding are more prone to UTIs. Some studies also suggest the direction that you wipe makes a difference for girls especially. Teaching your kids to wipe front to back can help keep the stool away from the urethra and reduce the risk of infection. If the problem is persistent, your pediatrician may want your child to have a culture taken of their urine to find out what kind of infection they have, or to see a urologist for specialty care.

My child won’t poop!

Some kids struggle with constipation. When this happens, pooping can become painful and uncomfortable. As a result, they may not want to poop because they are afraid it will hurt when they do. This can lead to a condition called stool hoarding. Unfortunately, stool hoarding often makes constipation worse, and the stool becomes larger and harder to pass. Helping your child break the cycle may require some dietary changes, and kid friendly books with education about pooping.
Your pediatrician may prescribe stool softeners for a short period of time, but if the problem is persistent, a pediatric pelvic physical therapist might be needed. Pelvic PTs can work with your child on pooping posture on the toilet, and how to use their muscles correctly to avoid straining to poop. They can also teach kids bowel massage on their bellies, and use TENS units to help reduce constipation as well.

How old is too old for bed wetting?

While night time accidents are common for young children, if a child is still wetting the bed after the age of 5 it is cause for concern. It’s important to talk to your doctor to decide the best course of treatment. Your doctor may first want to make sure that the bed wetting episodes aren’t related to seizures, or diabetes. Afterwards, they may recommend bed wetting alarms, changes in lifestyle habits, or pelvic floor physical therapy. While brands that sell night time disposable undergarments attempt to normalize this, it’s best to get treatment for these issues early.
As they age, kids become more embarrassed and reluctant to talk about it. The time to address the issue isn’t when they are old enough to want to start having sleep overs with their friends. If your child is still bed wetting at age 6, it’s worth making an appointment.
Do you have other pelvic health questions for your kids? Let us know and we’ll ask Dr. Swain, or you can email her directly at dr.heather.swain@allytotalpt.com

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