Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Potty Regression | | | QUESTION | | | Dear Dr. Needlman,
My four-year-old daughter has regressed the past five months. She was potty trained at 2-1/2 for preschool and had no accidents for a year. Now she pees in her pants, enough to wet her pants but not enough for people to notice.
She hides this from everyone. She does not stop to go, yet she knows it is wrong. She will go into the bathroom and instead of going potty, she wets her pants inches from the toilet. We tried rewarding her for dry days. We're now in the punishing mode, which isn't working either.
Any thoughts/suggestions would be greatly appreciated.
We did not make a big deal out of it until it was constant. There are no new changes. She's not afraid of going potty. We give her tons of positive attention. The urine test came back negative. Her doctor is suggesting that we go to a child psychologist.
What would you suggest?— Potty Regression Daughter, Mental Regression Mom in Greenwich, CT | | | ANSWER |
March 15, 2001 | | | Dear Mental Regression Mom,
It sounds as though you've taken all the appropriate steps to deal with what is always a very upsetting problem. I think you are on the right track. I also agree that punishment in this setting almost never works since your daughter is not consciously deciding to wet her pants in order to be naughty (there are many far more pleasant ways for a four-year-old to do that).
Daytime wetting that shows up after a year or more of dryness often does have a psychological cause. You might not recognize what that cause is to begin with. In your case there don't appear to be any changes at home or in school. Not uncommonly, however, once you have begun to work with a skillful psychologist or developmental-behavioral pediatrician, a previously hidden cause becomes apparent. Often enough it is a little thing, from the adult point of view, but very important in the child's world.
On the other hand, I wouldn't completely discount a physical cause just because the urine test was negative. Constipation, problems with the bladder muscle or nerves, or even minor anatomical abnormalities can sometimes cause daytime leakage. Depending on the urine test used, a bladder infection also could be missed with a single test.
Not too infrequently there are both physical and psychological causes. Often the best approach is to work along both paths at the same time, under the guidance of a general practitioner, pediatrician, or family doctor. A referral to a child psychologist along with close follow-ups by the primary care doctor is a good idea. At some point, an additional referral (to a pediatric urologist for example) might also make sense. For more on daytime wetting, stay tuned for a new article on daytime wetting coming soon to our Bedwetting section.— by Robert Needlman, M.D., F.A.A.P. |
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