What to Expect the Toddler Years (151 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
But no matter what’s precipitating your toddler’s toileting accidents, chances are that they are at least as unpleasant and embarrassing to him as they are to you. In most cases the setbacks will be temporary. To help speed an end to these episodes:
Be sensitive to his situation.
Having an accident can be a real blow to a child’s ego, particularly at school. So go out of your way to be understanding, empathetic, and reassuring about what’s happened. Don’t scold, don’t pressure, and don’t insist that your child explain or
talk about the incident if he’s reluctant. A child is often so unnerved by toileting accidents that he’ll deny them, even with the evidence in clear view. Don’t demand your toddler own up to the accident—you know about it, he knows about it, enough said. If you’re with him at the time of the accident, just change his clothes while changing the subject—chat casually about something unrelated and distracting rather than commenting on the mess he made, or worse still, telling him what a baby he is for making it.
Acknowledge all of his achievements.
Continue to applaud him whenever he does manage a bowel movement in the toilet instead of his pants. But also look for other accomplishments to acclaim—offer praise when he gets his coat on by himself, when he draws a self-portrait, when he remembers to wash his hands before lunch. The better he feels about himself, the better his chances of making it to the toilet next time.
Ease up on him.
Sometimes too much pressure—whether it’s pressure to use the bathroom, to eat what’s put in front of him, to have model manners, or to perform academically or socially—can cause a toddler to unravel. And one way that the unraveling can manifest itself is in toileting accidents. So make sure that you’re not heaping too many demands or too many expectations on your toddler.
Counter constipation.
If hard-to-pass bowel movements seem to be the root of the problem, take the steps on page 600 for dealing with constipation.
Deal with diarrhea.
If frequent soft movements seem to be inducing your child’s potty accidents, examine his diet. The most likely dietary factor is excessive fruit juice. If your child is drinking more than 8 ounces of juice a day, cut back. Dilute the juice with water, substitute all water or milk at some snacks. An excessive amount of dried fruit and high-fiber foods is another possible, though less likely cause of the problem. Cut back some on such foods for a week or two to see if the number of accidents is reduced.
Get some help at school.
Speak to your child’s teacher about his problem, but do so in private, so his embarrassment won’t be compounded. Find out if there’s been a change in routine that may have triggered the accidents, or if the teacher thinks he may be shy about using the toilet around other children. Ask the teacher to remind him to go and to offer him the opportunity for privacy, if that’s what he needs.
Get up earlier.
If you’ve been rushing your toddler from the breakfast table out the door each morning, that could be part of the problem. Giving him breakfast (preferably one that contains a high-fiber food and some fruit juice) half an hour earlier than usual and then letting him do something active, maybe even go for a short walk, may enable him to use the bathroom before he leaves home.
If your toddler’s bowel movements are loose, watery, bloody, or contain mucus, or if the soiling continues for more than a couple of weeks, discuss the problem with his doctor to see if there is an underlying medical reason (also see page 603).
RINE ACCIDENTS
“Our daughter, who’s been using the toilet for quite a while, has been wetting her pants almost every day for the last week. We keep trying to remind her to use the toilet, but she always says she doesn’t have to; two minutes later, she’s wet again.”
Between drawing, trike riding, block building, playing house, and at least a hundred other exciting pursuits, life has become very busy for the toddler. So it’s not surprising that being otherwise occupied is the most common reason why young children have toileting accidents. They may also backslide because they are stressed by an upheaval of some kind in their schedule or routine, or because they are emotionally upset. Sometimes, however, a bladder infection is responsible, especially in girls. So it’s important to check with your toddler’s doctor if the wetting continues or if your child’s urine is cloudy, pink, or blood-tinged, or there are other signs of infection or irritation (see page 613); a urine culture may be in order. If infection or another medical problem isn’t the cause, you can expect that the accidents will stop in time. Meanwhile:
Don’t blink an eye.
Overreacting to a wetting accident with exasperation (“You wet your pants—again?”) or humiliating punishment (“I’m going to put you back in diapers!”) will further upset your child and may prompt encores. Instead, respond casually, with a reassuring, “Oh, you didn’t make it to the bathroom, did you? Well, next time I bet you’ll make it in time.”
Nix name calling.
She’s all dressed up for a party and as you’re about to walk out the door, a river starts flowing right down your toddler’s clean white tights. At moments like these, it’s easy to forget you’re the adult and to start tossing childish insults (“I thought you were a big girl!”). But insinuating she’s a baby won’t encourage grown-up behavior, so keep such belittling thoughts to yourself.
Respond positively.
Tell her that accidents happen to everyone, and that next time she’ll use the potty. If she’s willing (never force her), foster grown-up feelings by having her help change her clothes as well as clean up the puddle she’s leaked on the kitchen floor or to flush away the bowel movement she’s produced in her pants.
Evaluate her fluid intake.
Toddlers, like everyone else, need an adequate fluid intake. But more than six cups of fluid a day (except when it’s very hot outside or when a child has a fever) can lead to an increase in wetting in toddlers. Some kinds of fluids are more likely than others to contribute to incontinence, for example: beverages containing caffeine, because they are diuretic, and citrus juices, because they can irritate the uri-nary tract in some children. (Beverages with caffeine are inappropriate for a young child for other reasons as well; see page 534.)
Reduce stress.
If you believe the recent spate of potty accidents may be due to excessive stress, examine your child’s life and reduce stress as much as possible. Also be sure she’s getting adequate attention and affection.
Keep her bathwater pure.
Bubble baths, bath oils, and harsh bath soaps (as well as harsh detergents used on a child’s underpants) can all lead to uri-nary tract irritation, a common cause of wetting. Avoid them, and see page 465 for safe bathing procedures.
Invite her to join you.
A parent of the same sex can encourage a child to take potty breaks by making toilet going a parent–child activity. If you sense your child is in imminent need of a toilet, but she flatly denies it, ask her to come along with you to keep you company while you go. The camaraderie of sharing the bathroom may move her to participate, too—as may the sight of the toilet and the sound of you using it. If she still refuses to go, however, don’t force the issue.
HANDLING SUCKING HABITS NOW
Many children abandon sucking on a pacifier, thumb, or bottle somewhere around their third birthday. If yours doesn’t, you will need to decide whether you think it would be best to try to end the habit or habits now or wait another year or two to take action. In making this decision, consider the following:
Does your toddler suck on his pacifier, thumb, or bottle for a good part of the day? All-day sucking is much more deleterious to the mouth and teeth than is occasional sucking.
Is the habit negatively affecting your toddler’s oral development? This is a call that only a dentist can make (see page 490). Though mild oral changes will correct themselves when the sucking stops—as long as it stops before the permanent teeth come in—more severe changes may be permanent.
Is the habit interfering with your toddler’s communication skills, his pronunciation (the changes in the mouth brought on by sucking can lead to lisping), with social interaction, with learning other ways of coping with stress, or with play? (It’s not easy to build a block tower or catch a ball with your thumb in your mouth.)
If the answer to any of the above questions is “yes,” then it would probably be wise to try to end your toddler’s habit now, or at least to work on cutting it back. Here’s how:
Enlist a professional.
Parents can nag day and night and fail to move a toddler to break any habit; but a pediatrician or pediatric dentist may only need to say, “It’s time to stop using the pacifier (or bottle, or thumb) because it is going to make your teeth and mouth crooked,” in order to inspire a toddler to quit. Often the pediatrician or dentist will ask the child to call and report in, for example when he or she has abstained for two or three days. It may also be a good idea for the child to call Grandma or another special person with a progress report. The more people involved, the greater the motivation.
Enlist your toddler.
Children can’t be forced to abandon a habit; they have to want to. Motivation can be inspired by the words of a professional, a parent, or another adult, by the teasing of friends, by a sense of embarrassment over the habit, or even by a desire to be more grown-up, but there must be motivation. Ask your child about quitting; discuss with him or her when would be a good time and whether a cold-turkey or a go-slow approach is more appealing.
Emphasize the grown-up
. Don’t put down your toddler’s sucking habits as “babyish,” but do take every opportunity to call attention to “big boy (or girl)” behavior, such as using the toilet, buttoning a shirt, climbing up the jungle gym without help. The more appreciation garnered for being grown-up, the more incentive to be grown-up—and to kick the habits left over from babyhood.
Hold the pressure.
Young children are more likely to respond to nagging by rebelling than by knuckling under. Threats, too (“If you don’t stop sucking your thumb, you won’t be able to go to preschool”), will make your child less likely to cooperate.
Supply substitutes.
Keeping your toddler’s mouth occupied—with conversation, song, a musical instrument that’s played with the mouth, juice or milk from a straw (use one of those wild, roller-coaster-shaped ones for extra intrigue, if you can figure out how to get it clean), for example—may satisfy some of that need for oral gratification and will help distract him or her from cravings for the bottle, pacifier, or thumb. At the times of day when your toddler tends to like to suck
most, provide nourishing snacks that require a lot of chewing—but be careful that you don’t overfeed or replace one oral habit with another.
Offer a reward.
A three-year-old may be willing to try to give up a sucking habit in exchange for a special treat. But even with the promise of a reward, a toddler needs plenty of help in quitting.
Begin to limit pacifier use.
Work out a withdrawal plan with your toddler. For example, first limit pacifier use to the house. Then, put the living room off limits; then, one by one, all rooms but the bedrooms. Next, limit use to your toddler’s bedroom only, and finally, to when he or she is in bed or sitting on a particular chair. Or set time limitations, limiting pacifier (or bottle) use to only after meals or only before nap and bedtime, then only after breakfast or only before bed. Or limit use to thirty minutes (set a timer) at a stretch, then twenty, then to ten, then five minutes, then two. Limitations will be most effective if they require your toddler to sit while sucking; toddlers find sitting still harder than practically anything—including giving up comfort habits. Present the limitations as a challenging game (“Let’s see if you can stop using your bottle and pacifier in the kitchen”), rather than as obligatory restrictions. Whenever your child succeeds in meeting a challenge, be lavish in your praise.
Take some of the fun out of the bottle.
Fill the bottle with water rather than milk or juice. Explain that sucking on a bottle filled with milk or juice could make cavities (or “holes”) in his or her teeth. When offering beverages, give your toddler a choice between a cup of juice or milk and a bottle of water. This may significantly reduce the allure of the bottle.
Take the air out of the pacifier.
Poke holes in or clip the end off the pacifier nipple; if sucking the pacifier brings no pleasure at all, your toddler may just toss it.
Lose It.
The bottle or the pacifier, that is. If you’re lucky, your toddler’s favorite sucking object will disappear on an outing. At that point you can explain that you’re not going to buy a new one because the doctor said “you’re too old for a bottle (or a pacifier).”
Replace the comfort of sucking with other comforts.
Children being deprived of a comfort habit need a lot of extra comfort from other sources during the withdrawal period and for a while thereafter. Hold your toddler’s hand while he is upset, lavish attention and affection on him or her, spend extra time playing and going on outings together.
The sucking habit that is the most difficult to break is thumb or finger sucking. While you can limit where your toddler can take a bottle or a pacifier, you can’t limit where your toddler takes his or her fingers. If your toddler is unable to stop finger- sucking, even with the help of the above measures, don’t demand and don’t despair. If necessary, more drastic measures may be recommended when your toddler is older—anywhere between three and five, depending on the condition of his or her mouth and your dentist’s point of view. Possibilities then will include applying a foul-tasting preparation to the sucking finger (to make the habit unpalatable), and temporarily installing a metal reminder bar across the palate (to make sucking uncomfortable and remind the child not to do it). You can also recommend that when the urge to suck comes on, your toddler make a fist with the thumb inside. Instead of constantly saying, “Take your thumb out of your mouth,” develop a silly secret code (such as, “Eeny, meeny, miney, mo” or “Fee, fie, fo, fum”) that you can use as a reminder not to suck.
If a child uses a thumb or a pacifier obsessively, and seems withdrawn or depressed, the sucking may represent more than a bad habit. Consult with your child’s doctor in such a situation to try to uncover and resolve any underlying problems.