Getting Toilet Training Back on Track

Laura Markham's picture


Dear Dr. Laura,
Help! My four-year-old little girl has been potty trained since the week prior to her turning three. Never an accident up until a few months ago. Now, she is wetting her pants daily. Sometimes emptying her entire bladder, sometimes, just enough to wet her underwear.

I have taken her to the doctors twice -- when it first began she had a mild urinary tract infection. The second time -- nothing! Now it seems all behavioral. I tried time-outs at first, then I tried ignoring it. Now I make her wear a pull up after she has an accident for the rest of the day until she gets a bath. Nothing is working! She will sit in wet underwear ALL day without saying a word.

I really don't think it's physical because she has yet to wet the bed during the night or nap time. Everyone keeps saying it's a phase but for months at a time? Thanks for your help,



Dear Krieta,
What a frustrating situation for both you and your daughter. After her having mastered toileting, to have her begin having daily accidents is upsetting for you, not to mention inconvenient. It is also upsetting to her, even if she doesn't show it.

I agree with you that this is not a physical problem. Let's look at things from your daughter's point of view. She got a urinary tract infection, and naturally began having accidents. She has not been able to recover from that situation and once again master her own body. That is not unusual after a toilet-training lapse caused by a medical condition, stress (like a school change), or anything else. After all, adults have spent years using the toilet. A four-year-old has only been dry for a year. And many, many four-year-olds do have accidents and phases where they go back into pullups.

Unfortunately, in your concern about helping her learn again to stay dry, you began punishing her. There's been a lot of research on this, and punishing kids about toileting ALWAYS seems to result in more accidents. We aren't sure why, although probably this is because the child stops seeing toileting as an opportunity for mastery -- which all kids want -- and starts seeing it as a power struggle with the parent, where the parent is in charge of the toileting and the child is no longer responsible. The reason she sits in wet underwear is is probably that she is afraid to tell you when she's had an accident.

So what can you do now? Love your daughter unconditionally, and remove the stress. Treat this as you would the beginning of toilet training. I would sit down with her on your lap for a nice snuggle, and then say something like "I notice that you are having accidents a lot. I know it can be hard to notice every time you have to pee. Would you like to wear pullups for awhile, until you're ready to remember to use the potty every time?"

If she wants to use pullups, let her, with your total support. Then ask her, once a week, if she is ready to start wearing underwear again. Keep your tone light and approving, regardless of her decision, and let her be totally in charge of when she makes the move. I guarantee you that she will decide she is ready very soon.

However, if she refuses to go back to pullups, the situation is more challenging for you. You might say something like "I can see you really want to wear underwear. But lately I see you have a lot of accidents. Can you be in charge of your own body, and take yourself to the bathroom when you need to pee?" If she says yes, let her do it. Then, when she has an accident -- and she will, almost certainly -- you need to keep your tone very light: "I see you're wet. I know it's hard to get yourself to the toilet on time every time, but soon you will remember. But it's not good to stay in wet clothes, and you're in charge of your body, right? So go to your room and pick some clean underwear and pants out, ok? And drop your wet clothes in the hamper so we can wash them."

Try to set up her clothes so she can access them herself and you aren't involved. That way, she isn't getting attention from you when she wets herself, and you aren't inconvenienced. Soon, she will decide that changing clothes is more trouble than using the toilet. If you can keep your tone light and approving, no matter what, you'll be amazed how quickly your daughter will be dry again. She just needs to see that you love her and approve of her regardless, and that you really mean it when you say she's in charge of her own body.

Please write and let me know how it goes. I wish you and your daughter every blessing.

-- Dr. Laura