Tips and Tricks for How to Handle Potty Training Regression
February 4, 2019
The teeny travel potty is packed away in storage. The M&M rewards are done with. The leftover daytime diapers have long been donated. You thought potty training was behind you. And then—boom—a pee accident. And then another. And, gasp, still more! Is it a to-be-expected hiccup on the road to total potty independence, or could it be potty training regression? Either way, don’t panic. You and your little one can—and will—get right back on potty-trained track. Here’s what to know about potty training regression.
“Parents often believe that accidents mean a child is experiencing a potty training regression, but really, it might be that the child hasn’t been fully potty-trained yet,” says Steve J. Hodges, MD, associate professor of pediatric urology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and author of the book, It’s No Accident: Breakthrough Solutions to Your Child’s Wetting, Constipation, UTIs, and Other Potty Problems. In fact, to be considered an honest-to-goodness potty training regression, the seemingly potty-trained child would start having accidents about six months or more after being done with daytime diapers. Those before-six-months piddles and puddles? That’s all part of learning.
“Potty training is a natural process with starts and stops,” Hodges says. “While it takes some time, there should be a regular progression of skills.” However, if you see it’s taking a lot of time for training to click, or your child just isn’t making progress, maybe you simply started too soon. “In my experience, between the ages of 3 and 4 is the ideal time to begin potty training,” Hodges says. During that third year of life, kids are more cooperative, more communicative and more physiologically able. “It’s difficult to teach a younger child because potty training isn’t just about learning to hold pee. It’s about teaching the child to empty their bladder in a timely manner,” he says.
Bed-wetting vs. potty training regression
Learning to use the potty during the day is different than waking from sleep to go use the bathroom at night. “It often takes longer for kids to acquire that skill,” Hodges says. In fact, 20 percent of potty-trained 5-year-olds continue to have night-time accidents, according to the American Academy of Pediatrics. When a child is snoozing, the following factors can hinder their ability to get to the potty in time:
• A small bladder. A child’s bladder is still growing and likely still not big enough to hold urine throughout the night.
• Ongoing brain development. Nerve communication between the brain and bladder is still a work in progress.
• Deep sleep. Kiddos who are deep sleepers don’t awaken as easily to the signal of a full bladder.
• Excess urine. Sometimes the child’s body makes too much nighttime urine.
• Constipation. Fecal impaction can put pressure on the bladder, causing spasms and night-wetting.
Dry nights take time—and patience. “Bed-wetting is still very common up to about age 4 or 5,” Hodges says. “As long as your child is doing okay during the day, I wouldn’t worry about it much—yet.” But if nighttime accidents continue past the five-year mark, talk to your child’s pediatrician or a pediatric urologist.
First and foremost, you want to make sure out-of-nowhere accidents aren’t due to a physical issue, such as a urinary tract infection or other disorder that may require a doctor’s attention. If you’ve ruled out a medical cause, here are some other reasons your child might be experiencing potty training regression.
• Stressors. “One of the main causes of potty training regression is stress and anxiety,” says Adriana Vermillion, a professional potty training instructor in Charlotte, North Carolina, known as the “Potty Whisperer.” These stressors can encompass things like sudden changes or transitions, such as getting a new sibling or babysitter, an illness or parents’ divorce.
• Constipation. This isn’t quite the not-enough-fiber kind of constipation (though that certainly has wetting consequences too). “Instead, it’s when a child decides not to poop when they need to,” Hodges says. Here, kids squeeze their sphincter and hold in poop, thinking it’ll just come out later. “But that’s not how it works,” Hodges says. Holding it in dries out the stool to the point where it becomes impacted and then pushes on the bladder. “The whole process stretches the colon too, and starts to deaden the child’s got-to-go reflexes,” Hodges explains.
• A new school. When a child is introduced to a new environment where they don’t feel totally comfortable using the bathroom, accidents can happen. “When there are more barriers to pooping and peeing, like when a child needs to ask permission to use the bathroom or they’re nervous about going to an unfamiliar bathroom, problems can start,” Hodges says. Here, kids withhold all day, leading to accidents later.
• Distractions. When kids are busy playing or engrossed in Paw Patrol, for example, they can either do the old sphincter-squeeze and set off the domino effect for later accidents, or straight up not notice the urge to urinate until it’s too late.
Punishment will get you nowhere. “It’s very important for parents to stay positive at all times, especially since potty training regression is often rooted in shame, stress or anxiety,” Vermillion says. “Being negative will only make things worse and possibly make your child shut down.”
Another don’t: offering rewards. While giving a sticker for every tinkle in the toilet may have generated excitement in the past, it can easily backfire now. “It can create more anxiety,” Vermillion says. “Plus, real change can’t happen if it’s conditional on rewards. Your child needs to learn to self-motivate.” Use verbal rewards instead.
Here’s what else you can do to address potty training regression:
• Zero in on stressors. If you suspect stress or anxiety might be what’s triggering your child’s potty rewind, talk about it. (Are you nervous about your baby sister’s arrival? Did the news of grandma’s move to Florida upset you?) “While not all children will be able to accurately use their words to express how they feel or what they may be going through, kids do show how they feel in their body language, sleep patterns and dietary changes, so it’s important to pay attention,” Vermillion says. Help your child communicate their feelings and offer reassurance.
• Investigate a new environment. If the potty training regression coincides with the start of a new school or daycare, get a bathroom tour. Ask how and when children are allowed to use the potty, and talk to your child (and your child’s teachers) about how to make using the bathroom during the school day less stressful.
• Share your expectations. “Be gentle, clear and honest. Note what you’ve observed, how you feel and what you specifically need, and then make a request,” Vermillion says. Try something like, “I see you’re having accidents and that you’re wet, honey. I feel a little sad. I’d like you to stay dry and I want to know how I can help you do that. Would you be willing to go potty in the toilet rather than in your pants?” As Vermillion explains, “This helps the child think and take responsibility.”
• Look at your kid’s poop. “If your child is passing bitty balls or thick logs of poop, there’s a good chance constipation could be behind your child’s potty issues,” Hodges says. Drinking lots of water and consuming high-fiber foods is a good start, but also consult your pediatrician about possibly using a stool softener, such as MiraLAX.
• Reinforce potty rules. Set specific times your kiddo needs to go to the potty. “Follow the natural schedule of your child’s day, such as a morning routine that includes using the potty; using the potty before and after an activity, like going to the park; using the potty before and after a meal and before bedtime,” Vermillion says. “I also think it’s wise to encourage restroom use every two to three hours between morning, afternoon and evening use.”
• Reassess. “If after re-adjusting your child’s routine, diet and support, potty training regression is still occuring at 12 weeks—and your child is between the ages of 18 and 36 months—it may be best to step back,” Vermillion says. “This can offer relief to everyone involved. Just don’t go backward by putting the child back in diapers.” Instead, Vermillion suggests saying less and observing more. “Continue to encourage underwear, but be prepared with extra towels and a change of clothes. Allow your child to create their own pace,” she says.
• Seek help. If you’ve taken the time to give your child the necessary attention, support and encouragement and the potty training regression continues after 12 weeks, it may be a good idea to either work with a potty training professional or schedule an appointment with the pediatrician or a pediatric urologist.
Published February 2019