If your child’s pediatrician has ruled out physical causes for your child’s problems with toilet use, it is time to consider possible environmental factors. Your child’s daily interactions with you and other adults, as well as her siblings and peers, can have a decided effect on her bathroom behavior. Issues centering around child care can create complications, for example—particularly when both parents work full time and the child is cared for by other adults for long periods of time.
Sometimes the difficulty is caused by conflicting attitudes among the adults involved in monitoring bathroom behavior. Perhaps you have no problem with the fact that your four-year-old is not yet toilet-trained, while his baby-sitter resents having to change diapers. Or you may be battling a recent rash of accidents by keeping your child on a regular bathroom schedule at home, only to find that she’s wet her pants at school because she wasn’t sent to the bathroom after lunch.
Finding a solution to such problems requires discussing what is happening with all the adults involved in your child’s care. Describe any problems and the plans you have created to solve them. Solicit the other adults’ opinions about these plans, and listen to their objections or suggestions. Then come to an agreement about a course of action, so that your child will meet with a consistent response everywhere she goes. Ideally, because you are the parent, your decision should be the final one, but there may be times when it’s more practical or productive to follow another caregiver’s lead. If the child-care center schedules five bathroom visits a day, for example, you can schedule visits to the home bathroom at the same times.
Be sure to follow up such discussions by asking for feedback about how the techniques used seem to be affecting your child. If she is increasingly resisting a rigid bathroom schedule, it may be better to allow her to choose when she goes—even at her child-care center or preschool. If her accidents seem to occur when she is engrossed in story hour, perhaps she can be taken to the bathroom before the story begins.
No matter how embarrassing you believe your child’s problem is, it is necessary to seek out this kind of support. Rest assured that caregivers are accustomed to dealing with everything from fecal soiling to genital exploration to frequent experiments with potty talk. There is little your child can do that will shock or even surprise a professional caregiver or educator. By asking for their support and advice, you may receive some welcome support for your own efforts as well.
Problems stemming from inconsistent or conflicting approaches to bathroom use may also arise for children who move between two separate homes—usually as a result of parents’ separation or divorce. Again, it is vital to communicate with the other parent about the rules and routines you intend to maintain. Such negotiations can be much more difficult in this case, of course, since both parents have equal authority and may have sharply divergent opinions. Still, it is important for your child’s sake to keep the bathroom routine as consistent as possible between the two homes—using the same type of potty when possible, for example, and keeping it in the same room in each home— and to respond to new challenges as a team.
A change in environment caused by a vacation or other travel is another common cause of bathroom-related problems among young children. Travel plans that call for a break in a child’s routine, or that take the child away from a familiar bathroom or potty, may create anxiety that then leads to accidents or constipation. While most such responses are only temporary and disappear once the child is used to the new routine or has returned to the old one, some lead to negative learned behavior, such as withholding stool or delaying urination, that takes weeks or months to correct.
To avoid such complications, it’s best to keep your child’s bathroom experience while traveling as similar as possible to the routine he follows at home. If you are traveling by car, consider taking your child’s potty along. When flying, take your child to the bathroom at the airport before you board the plane, and bring along familiar stuffed animals or other favorite objects that may make public or hotel bathrooms less frightening. Plan to accompany your child to the bathroom and expect to prompt him toward bathroom use more than if you were not traveling.