357. Q&A: How should I handle potty regressions in my older child?

Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:44):

Welcome back. We are doing our Beyond the Session segment of the Securely Attached podcast and we’re going to answer a listener question and we have Dr. Emily Upshur here.

Dr. Emily (00:55):

Hi.

Dr. Sarah (00:55):

Hello. I’m especially excited that you are here for this question Em, because as some of our listeners probably already know, you are our resident poop expert, our resident P expert, all things potty related. And so I have a good question for you.

Dr. Emily (01:16):

I’m so ready. Should I go to the bathroom to prepare?

Dr. Sarah (01:21):

I need to get you a pin or a hat or something that’s like bathroom master.

Dr. Emily (01:24):

I know, I’m not sure. Yeah.

Dr. Sarah (01:29):

Okay. So we’ve talked about bathroom stuff a lot on here. I’ll link all those episodes, but this question I felt is like it’s a different question. So I’m excited that this was what we have to answer today. So this parent writes in and she says, hi, how do you handle potty regressions in older kids? My 6-year-old has been experiencing a regression longer than we’d like. No medical issues homeschooled. So school isn’t an issue, but what do you do with friends? Mention it, hide it.

Dr. Emily (02:06):

Potty regression. The hardest for parents. Like I nailed it. I’m done. Why do I have to keep doing this? Yeah, I mean listen, I think this comes up a lot in our practice, especially around social awareness of this kind of a lot of the shame if there’s an accident or if there’s sort of a lot of frequency in the bathroom at school and those types of things. So I mean I think first and foremost we have to try to approach this from a non-shaming standpoint. It can be really tricky, but I think that’s where we have to start. This is something that’s happening now. I think that we as psychologists or people who are potty training, we really do have to balance this medical emotional land because they become really intertwined and we all know, I mean maybe you guys know from all the social media and stuff out there that the gut and the brain are really related. And so we really do have to give honor to that. I like to be stay in my lane, but I do also want to assess what’s going on medically. And sometimes we’ll work with a pediatrician or a gastroenterologist to make sure that we’re all in sync on the same page with figuring this out.

(03:29):

That’s my first step, always assessing what’s happening. Is this really a regression? Is this constipation? Very, very, very common beginning school aged children. And so we want to get a sense of what the landscape is before we jump into problem solve. And that’s what makes these things kind of tricky

Dr. Sarah (03:52):

I think. And so now this parent wrote specifically no medical issues and they didn’t give a whole lot of information. So she doesn’t mention what types exactly of potty regressions we’re dealing with, whether it’s urinary incontinence or poop accidents. I think there is a little bit of we’re flying kind of blind on this particular question.

Dr. Emily (04:19):

That’s true.

Dr. Sarah (04:19):

It’s broad. I do think if it’s definitely not medical, which I always am, double check, triple check because even when you don’t think it’s medical, sometimes it could be connected to something more medical.

Dr. Emily (04:37):

And also what is medical? I think constipation is sort of still kind of medical. It’s not medical scary, but it is sort of not psychological entirely. So I just want to put that out.

Dr. Sarah (04:49):

Totally. When I think of medical, I think constipation, if you say to me there’s no medical issues, I am going to read that as we’re not dealing with constipation.

Dr. Emily (04:58):

That’s a tricky one.

Dr. Sarah (04:59):

But, maybe that’s not the case. It’s a tricky one. So who wrote this question in just something to think about? Because Emily, can you talk a little bit about why we’re going to get real deep into the nitty-gritty on this because when a question is vague it almost makes us get more specific. Why is constipation have a bearing on both pee and poop accidents? Because it does.

Dr. Emily (05:23):

Yes. I mean the thing that’s so important about constipation and to your point, this parent, it’s kind of hard to detect too unless you’re paying a lot of attention to how many times your child is having a bowel movement and how many times they’re going on the potty, which at this child, I believe in this writer, this questions from a 6-year-old, they’re pretty independent with some of that. So you might not know they’re constipated. You might not be like, or you have other children and you’re like, I can’t remember if you pooped yesterday. These are a lot of, so I think to your point that constipation is one of those things that can be a little tricky because it can also mean not full evacuation, meaning not all the poop comes out. So it is really important and it doesn’t always so obvious, but constipation can lead to children feeling full and holding it in a little because they don’t know how to manage that feeling and it’s not coming out when they try.

(06:20):

So they get a little bit, how do I say, gun shy to try to sit on the potty and it feels really unsatisfactory as you as an adult imagine you feel bloated, you feel discomfort and that bloating and discomfort is really expansion within your body as well. And so there can be actually either urinary frequency increase with a pushing on the bladder from sort of backed up colon stuff or it can lead to that sort of muscle because remember these are all muscles and little that are kind of learning about what it feels like and when it can relax and when it tenses up. And so sometimes that can lead to holding in urine as well if everything feels really tight in there and held in. So again, it’s this, is it a real medical problem? No, but it can have a little bit of a feedback loop and they relate to each other and that’s really confusing to a young body.

(07:21):

It’s confusing to us as adults. So it’s sort of, I know Sarah and I always talk about there’s a poop window where I always talk about it. And so I think your body as an adult learns how to go within that window. And children, if they miss their window, it gets confusing and then it’s physiologically harder as well. And so there’s a lot about, I always sort of say first step, like you said, rule out medical, but then I really do try to do a lot of tracking detective work just to sort of figure out what are some of the variables that might be contributing to this. I don’t know. That was a very roundabout way.

Dr. Sarah (08:03):

No, but I think it’s helpful because especially because one, this question’s not super clear of the details, so it’s kind of guessing, but also just to generalize, this is very, I just want to normalize too, this is not that unusual. I mean, yes, it is less usual for six year olds to have bathroom accident regressions than it is to have someone who’s just learning 3-year-old, 4-year-old, but I see this in 8-year-old sometimes it’s not like I’ve seen this in. So I want to normalize that. I think there’s another layer when they get older that this parent is definitely speaking to, which is it starts to become a little bit more in the realm of shame, embarrassment. They might hide it more so they might not be telling you as much. You might just be finding soiled clothing places.

(09:06):

So we want to help them feel like they can come to us, they can talk to us about it. We want to give them some options to sort of troubleshoot social situations like this mom’s talking about what do you do with friends? It can be really uncomfortable to be on a play date or at the park or at a friend’s house, especially if you’re not in your own environment at school. I know this kid doesn’t happen to go out to school, but this is to try to generalize this school can be really, really tough because if kids do have accidents, we want to give them, we want a ton of help them cope ahead and have a plan so that they can save face, have they can know what they can do so that they can do. We want to make sure that they have a way to get a change of clothes and just save a little bit of their privacy and their integrity around their peers.

Dr. Emily (10:08):

Absolutely. And I think another really on the other side of that is, again, I know this child doesn’t go outside to school, but going outside at all, lots of kids don’t like to have a bowel movement at school or at a restaurant or outside of their home. Lots of adults don’t, frankly. So there’s also withhold a holding in that becomes, again, part of that recursive cycle. So it can be accidents holding in. So we’re sort of going around all the different things that can be presenting and how can we help, again, precisely with the cope ahead. I love with a 6-year-old actually to empower them to, that’s always an intervention I test out and see if it’s developmentally appropriate for that particular child. But I love part of the intervention being you can clean yourself and I’ll teach you i’ll how to clean yourself really well when you have an accident because it’s different than cleaning yourself when you just go to the bathroom regularly and we’ll always have your backpack that always has your change of clothes and I’ll put a Ziploc bag in it for the soil.

(11:19):

You can really help even a six-year-old gain competency over at least the fallout from this as we start to try to treat the origins of it. So we want to give you both the skill while you’re going through it and begin to treat how this is happening, why and sort of get to the source as well. But I do love to get your exact point. I do love to give kids that because even if they feel a little bit of shame, they also feel competence that they can handle it if we teach them those skills.

Dr. Sarah (11:50):

So we want to have a plan for helping them become more of their poop window and their pee. So I think it is help. And again, I think just to be clear, an optimal poop window is in the morning when they wake up before school or maybe right after they’ve eaten. So it’s like, can we get, if that’s not happening, we want to try to figure out how to retrain the body to be able to do that. So again, working with your pediatrician, that might look like a laxative or MiraLax or excess. But again, please, if you’re going to do any of that, please do it with your pediatrician.

Dr. Emily (12:33):

Absolutely.

Dr. Sarah (12:33):

Because that’s not always the best strategy for all kids. And so I think a lot of people just assume that’s what you do. And I don’t recommend just blanketly doing that, but if that’s the case, you could do that in the evening before later. And you also have to kind of figure out your kids’ windows.

Dr. Emily (12:56):

That’s the detective part at first.

Dr. Sarah (12:58):

Yeah, you really have to track. There really is. And if they are six, they can really participate in that tracking because not going into the bathroom presumably with your 6-year-old every single time they go to the bathroom. So you want them to be reporting if they pooped what kind of poop it was describing it, was it little rabbit pellets or was it a log or was it like an explosion of liquid we need to know and get. It’s like, ah, this is where it comes to the beauty of parenthood. We just going to be totally desensitized to the yuck of this stuff.

Dr. Emily (13:37):

That’s right.

Dr. Sarah (13:38):

And that’s nother thing that just made me think of this is if we are yuck by this, we need to process that elsewhere. We don’t want to talk about how icky it is. We don’t want to talk about how smelly it is. We really want to be very careful not to shame our kids when they are having accidents because just like when you’ve got a baby, I always would tell people with brand new babies and they’re doing their diapers, your language matters even then and being like, Ew, this is so gross and stinky can be internalized to some degree and we really want to normalize bowel movements and all the things our body does, so we really just don’t want to, whatever possible, we can be grossed out by it, but we can keep that to ourselves and just be very objective. Matter of fact about it, it’s like, oh, we can, we’re going to wrap this up, we’re going to throw in the garbage, we’re going to wash it and clean it. But I don’t know, am I being making sense when I talk that don’t want to make people bad, bad if they’re grossed out by this? But like…

Dr. Emily (14:54):

Yeah, I think you’re just really protective of not shaming, right? Because shaming only leads to more hiding, which leads to less progress. And so I think that’s sort of where your brain is going. We really can’t shame these kids that makes, it’s a barrier to getting better. So I think that’s probably where you’re coming from in this. But I would also say tracking, just to sort of balance that out, I would say that tracking also should be about food and water. So it doesn’t have to just be about poop and you’re very pee and poop and oh my gosh, and I can’t do this all the day. It can also be like, did you drink any water today? Let’s look at your water bottle. Did you have an apple? Did you have three bananas? Right? These are some really important sort of things to figure out as we’re doing this tracking assessment phase to figure out how we can intervene.

(15:46):

And you’re exactly right. I always say kids don’t know this about our bodies. Maybe adults don’t too, but it’s just like it’s great for you to poop after you’ve eaten a little bit and taken a little walk, move your body around a little. And then for this parent, like you said Sarah, an ideal is in the morning. It might take time to get there, but I always say, you might need to slow your morning down. You might need to wake up earlier so you’re not rush, rush, rush everybody out the door. I know mornings and households can be very quick paced and stressful sometimes and that’s a really hard, that makes your poop window really small. So I always say for anything for this parent, slowing down at optimal, if you’re tracking and you see like, oh, my kid usually has an accident at 3:00 PM maybe at two 30 you’re slowing things down a little, you’re home bound, you have a little snack, you take a little walk and then you try the poop window. So I think it’s a little bit about relaxing the system actually and giving it space and time so that your child can learn to feel their body and learn to relate to what’s happening on the inside of their body, which is a complex system and it’s a skill you have to practice.

Dr. Sarah (17:01):

Yeah, I think my one last thing I want to think about from this person’s questions is what do we do with friends? Do we mention it? Do we hide it? And I think on the one hand we sort of talked about this in terms of helping a child have a game plan for what they do, should they find themselves with an accident on their hands that they deal with in a social situation. But I also think there’s just a kind of a peer social skills element to this that maybe we could speak to.

Dr. Emily (17:37):

I mean, I am going to jump in only because my strong feeling is that the more a child tries to hide this and is ashamed of it, the more there’s sort of blowback from peers because they are maybe walking around for an hour or in a setting for an hour, which is, I feel like the more we can get our kids comfortable feeling like, oh no, I had an accident and other kids are really good candidates for that, they’re like, oh no, go to the bathroom. They don’t have judgment. I think that comes in as the shame comes in because then it’s more like that kid always smells or that kid keeps, so it becomes, I think the more we can get confident and de-stigmatize and sort of be able to appropriately address it and help our child do that more quickly, the less there is stigma actually.

Dr. Sarah (18:33):

Yes, because the accident, the problem socially, the problem with the accident is less that there was an accident.

Dr. Emily (18:39):

Correct.

Dr. Sarah (18:39):

And it is more when truthfully the kid does not address the accident quickly and then we start the odors start to become a little bit more solidified.

Dr. Emily (18:50):

That’s right.

Dr. Sarah (18:51):

That’s actually And helping our kid understand that right at home with you to be like, actually the accident part can be fixed very quickly. And then it’s gone. But when we don’t deal with it right away, it actually can become sort of more noticeable to other people.

Dr. Emily (19:12):

Yeah, that’s my gut with that is right back to your shame thing, which is the more we can reduce the shame, and you have to remember also back to your adult IC thing, is we really have to work on that because another 6-year-old actually isn’t that traumatized by that. They’ve had their own experience, they’re closer to accident life than we are. So it’s really, again, it goes back to if they’re not ashamed, usually the peer pushback. I don’t know that I get back to this listener’s question. I dunno that I would announce this to your friends that I feels not the right approach, but I do think being very just matter of fact, like you said like, oh, we had an accident, we’re just going to run to the bathroom. We’ll be right back. And sort of having that competency and taking care of it. And you can always say, this is something we’re working on. Oh, I know these are hard things, but I think that’s us worrying as adults more than it is the kids socially worrying. I don’t know how you feel about that.

Dr. Sarah (20:19):

No, I agree totally. I think kids are actually so chill about a lot of this stuff. Yeah. I hope we answered your question. I know that we kind of had to take some guesses, so if we didn’t get those quite right, apologies, but hopefully other families will have also found this to be helpful because again, you and your 6-year-old, not alone, not alone at all.

Dr. Emily (20:46):

Nope.

Dr. Sarah (20:48):

Alright, well thank you for sending your questions in. We will get back to you guys soon with another Q and a episode shortly. Thanks Em.

Dr. Emily (20:57):

Bye.

Dr. Sarah (21:00):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.