My five-year-old son is hav­ing ‘ac­ci­dents’ go­ing to the toi­let

The Irish Times - Tuesday - Health - - Family - Ask the ex­pert Send your queries to health@irish­ Dr John Sharry is a so­cial worker and psy­chother­a­pist and co-de­vel­oper of the Par­ents Plus pro­grammes. See so­lu­ for de­tails of his books and cour­ses.

QMy son, who is just five, has been hav­ing ma­jor prob­lems go­ing to the toi­let and, in par­tic­u­lar, “hold­ing on” to his num­ber ones and num­ber twos so much that I feel it is hav­ing a ma­jor im­pact on his life and well­be­ing.

There is noth­ing med­i­cally wrong with him, in that once he goes ev­ery­thing is nor­mal but it’s the go­ing that’s the is­sue.

He can go for hours with­out do­ing wees and a cou­ple of days with­out do­ing num­ber twos. He has a healthy diet and loves his food so again it’s not re­lated to that.

He has de­vel­oped a habit of squeez­ing in so much that his body is rigid and he holds his hand up to his face and clicks his fingers as if to dis­tract him­self. This can go on for hours and he will do it when he is sit­ting or stand­ing.

I try to sit him down and talk to him in case some­thing in par­tic­u­lar is both­er­ing him. There has been a lot of change in the past few months such as hav­ing trou­ble set­tling into school in Septem­ber and find­ing the yard hard.

I went back to work for three days a week and he is be­ing looked af­ter by a child­min­der for the first time ever.

Also, he has a 2½-year-old brother who is very de­mand­ing and go­ing through the ter­ri­ble twos with a vengeance and this def­i­nitely up­sets him.

I feel the prob­lems have es­ca­lated in the past six months in par­tic­u­lar and is now lead­ing to ac­ci­dents in his un­der­wear.

I will be hon­est and tell you that I am not good at cop­ing with the “ac­ci­dents” es­pe­cially from a soon-to-be five year old. The ac­ci­dents have never hap­pened at school or with the child­min­der, just at home.

I would re­ally ap­pre­ci­ate your help and ad­vice on this as I don’t know how to help my son and I feel it will lead to med­i­cal is­sues if it con­tin­ues.

AOn­go­ing toi­let­ing is­sues for chil­dren over five years are a very com­mon, though not much talked about, prob­lem. Un­for­tu­nately, lots of chil­dren get into habits of “hold­ing” and avoid­ing us­ing the toi­let, mainly for bowel move­ments though some­times for pass­ing urine also.

In my clin­i­cal ex­pe­ri­ence, the cause is al­most never to do with emo­tional re­ac­tions to po­ten­tially stress­ful events such as you de­scribe in your ques­tion – changes in child­care, or jeal­ousy about a new brother, and so on.

While toi­let­ing prob­lems can of course be emo­tion­ally stress­ful (not to men­tion messy) for both par­ent and child, stress is the re­sult and not the cause of the prob­lem.

Why chil­dren have toi­let­ing prob­lems

Chil­dren can get into a habit of “hold­ing” and avoid­ing the toi­let for a va­ri­ety of rea­sons. Some­times, they have a mem­ory of dis­com­fort or pain mak­ing a bowel move­ment due to con­sti­pa­tion, which means they sub­con­sciously “hold on” to avoid re­peat­ing this painful ex­pe­ri­ence.

Some­times they have spe­cific fear of us­ing the toi­let in cer­tain places (school or home) or they have very “rigid” rit­u­als of how they go to the toi­let (al­ways want to do it in a nappy, and so on).

Fre­quently, some young chil­dren are not yet fully toi­let trained and thus are still learn­ing good toi­let habits. Once a child gets into a habit of “hold­ing”, it can cause se­condary prob­lems such as con­sti­pa­tion, which can lead to ac­ci­dents. In the case of bowel move­ments, ac­ci­dents are usu­ally the re­sult of se­vere con­sti­pa­tion where the child has lost con­trol of his bow­els so that the fae­ces leak out – at this point he can no longer man­age when he goes.

In help­ing your son, the first step is to ap­pre­ci­ate that the prob­lem is not his fault and to be very un­der­stand­ing in how you re­spond. The sec­ond step is to ad­dress the un­der­ly­ing con­sti­pa­tion and then to work at pos­i­tively en­cour­ag­ing good toi­let habits. This can take a lot of pa­tience over an ex­tended pe­riod.

Treat­ing con­sti­pa­tion

Dr Steven Hodges, a pae­di­atric urol­o­gist, be­lieves un­di­ag­nosed and un­treated con­sti­pa­tion is the num­ber one cause of on­go­ing toi­let­ing ac­ci­dents in chil­dren old enough to be fully toi­let trained (eg aged five and on­wards). In his book, It’s no

ac­ci­dent, and on his ex­cel­lent par­ent­ing web­site – bed­wet­tin­gan­dac­ci­ – he de­scribes how you can as­sess and treat con­sti­pa­tion, which usu­ally re­quires the sys­tem­atic use of lax­a­tives over an ex­tended pe­riod of time (usu­ally sev­eral months).

Con­sult your pub­lic health nurse or GP about hav­ing your son re­viewed and treated. Some of the chil­dren’s hos­pi­tals in Ire­land run spe­cial­ist toi­let­ing clin­ics that might be able to help

Help­ing your son get into a good habits

In par­al­lel to ad­dress­ing con­sti­pa­tion, it is also im­por­tant to en­cour­age your son to have good toi­let habits. In your ques­tion, you say he does not “hold on” in school, does that mean that he some­times uses the toi­let in a nor­mal way there? Would it be worth ob­serv­ing or find­ing out what hap­pens in these successful times? When he uses the toi­let nor­mally at home, what specif­i­cally hap­pens then? How does he do this? This might give you some clues as to how to help him.

In a nut­shell, the goal is to in­crease his com­fort when he goes by help­ing him re­lax. Set up a good rou­tine about us­ing the toi­let, per­haps hav­ing a fixed time in the morn­ing af­ter break­fast when there is no pres­sure.

Make it a fun re­laxed time by maybe read­ing on the toi­let to­gether or even play­ing mu­sic. Help him have a re­laxed pos­ture by us­ing a foot­stool for his feet so he is in a re­laxed squat po­si­tion.

Think what would make the ex­pe­ri­ence of be­ing on the toi­let fun and re­lax­ing. I of­ten rec­om­mend that par­ents keep special bub­bles in the toi­let and you can blow one or two to­gether when he sits down. Bub­bles can dis­tract a child from any dis­com­fort and the mo­tion of blow­ing can even help them re­lax and let go in the toi­let.

There are some good books such as Bed­wet­ting and Ac­ci­dents Aren’t your Fault by Steve Hodges which you can read with your son to help him un­der­stand what you need to sort the prob­lem out to­gether.


While toi­let­ing prob­lems can of course be emo­tion­ally stress­ful, not to men­tion messy, for both par­ent and child, stress is the re­sult and not the cause of the prob­lem.

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