Fear of flushing

Why is my toddler afraid of flushing?
Toddlers may be frightened by the sound of a toilet being flushed. They may also be puzzled and upset to see the bowel movement disappear down the toilet.

How can I stop him from being afraid to flush?
At first, it is best to delay flushing until your toddler has left the bathroom. You can gradually get your child used to the sound by allowing him to listen from a distance. As the child becomes more comfortable, you can decrease the distance until he is willing to listen, look, and eventually try operating the lever.

Bedwetting

Is it common for children to have bedwetting problems?
Most children continue to wet at night for a considerable period after they are consistently dry during the day. It has been estimated that at 5 or 6 years of age, 10% to 15% of children, the majority of them boys, will still be wetting at night.

Some children wet the bed because their bladder is immature or small. In other cases, the signaling system that arouses them from sleep is not mature.

What can I do to help my child stop wetting the bed?
Whatever the cause, you should never scold or punish your child for bedwetting, which is unintentional. Keep in mind, too, that nighttime wetting up to a given age can run in families.

You can reassure your child by hearing about his or her feelings and explaining-in language a child can understand-that it may take a while for the bladder to mature and for him or her to be able to awake in time.

The following steps may be helpful:

• As an aid to bladder control, ask your child to hold in his daytime urine a little longer.
  
  
• If your child is willing, wake him before you go to bed. But don't carry your child to the potty or toilet; it is important for him to take charge.
  
  
• Place a special nighttime potty by your child's bed as a sign of support.
  
  
• Reject social expectations regarding a "deadline" age for complete dryness.

In some cases, such as when bedwetting continues beyond 7 to 8 years of age or leads to emotional and social problems, it is advisable to consult a pediatrician or specialist.

Urine accidents

What causes urine accidents?
You can expect setbacks and accidents during the training process, but they cannot always be explained by developmental unreadiness.

If your child wets both in the day and at night after 5 years of age, the causes may include

• Immaturity of the full-bladder signaling system
  
  
• Urinary tract infection or irritation of the urethra (eg, from detergent in bathwater)
  
  
• Structural abnormality in the urinary tract
  
  
• Pressure on the bladder from a constipated rectum

If bedwetting recurs suddenly after your child has been fully trained for at least 6 months, you may need to look for a psychologic or physical cause.

Consult your pediatrician if a child who has been successfully trained for 6 months to a year wets frequently both in the day and at night, or has any of the following symptoms:

• Continual wetness despite regular use of the toilet; constant dribbling of urine
  
  
• Weak urine stream
  
  
• Straining or pain during urination
  
  
• Bloody or cloudy urine
  
  
• Redness or rash around the genitals

Withholding bowel movements

What might be causing my child to withhold his bowel movements?
Your child may feel so much stress and pressure during potty training that he begins to withhold bowel movements. This can result in constipation.

If a toddler is constipated, the stool is likely to become large and quite hard, possibly causing a painful anal fissure (crack) when it is finally passed. The child may then hold back the next bowel movement to avoid discomfort. The injured sphincter (the circular muscle above the anus) may also clamp down reflexively to retain the stool.

Because constipation both results from and leads to withheld stools, a cycle of chronic constipation, anal fissures, and withholding may develop, along with some other unpleasant effects. Leaking around the retained and hardened stool can cause soiling of the pants that sometimes is mistaken for diarrhea. And over time the child could develop an enlarged colon.

How can I help him to stop withholding his bowel movements?
Take steps right away to break the cycle. It is important to reassure your child that he can have a bowel movement without pain. Have your child return to wearing diapers at night and during naps to remove the pressure of potty training.