I'm Out of Ideas for My "Untrained" 6 Year Old

Are there any other issues that he has socially?

Because this sounds (to my uneducated lay person's ear) like a child who doesn't recognize the social ramifications at all... and it makes me wonder if this is the only type of social unawareness he has.

At 4-6 years old, it wasn't much of a argument. Every so often I just made an announcement, it is time to go potty. If she fussed, I just told her to go sit on the toilet and see if anything comes out. It was a little embarrassing to her in public, but she learned that I really wasn't playing. Eventually she just took care of her own business on her own time. Sometimes she even says it when we are traveling and I want her to try. She will begin to say she doesn't have to and sees my eyebrow go up and just says okay, I'll see what comes out.

There is something wrong at home. Yes, I said it. Your child is having emotional issues and if you don't get him help, this is not going to get better and will manifest itself in other ways.

You need to go to a child psychologist and talk about what's going on privately, and then bring your child in. The psychologist needs to work with you both.

Ignore the implications of the toileting being the symptom of a cause, and you will not get the cause figured out or fixed.

I reread your old posts and it looks like this has been a problem for more than two years and that things did get a little better with the help of an in school aide. You also mentioned something your son having low muscle tone. Have you taken your child to a pediatric nephrologist to check to see if he does have the muscle tone to know when his bladder needs to be emptied? If they have ruled out all physical problems, then I would have him evaluated by a child counselor to find out if there are underlying issues of him controlling his bodily functions. Also his lack of an appropriate response is troublesome (not caring, not being embarrassed) so perhaps the counselor can help with that issue too. Good Luck!

A lot of kids have issues with some neurological and behavioral components of toileting - and they often combine. If he were just having accidents at night, I would say that's developmental - many kids have it, especially boys. But this is during the day.

It's quite possible this has turned into a power struggle - and you are losing. Behavior modification can work, as it seems to on those occasions when you can get him to the toilet after the 30 second argument and then he pees. I don't think shaming him ("kids won't want to be near you") will work - it piles on a new issue. I wouldn't go the "unsanitary" route - there's definitely an odor problem, yes, but since urine is considered sterile (in the field, military medics are taught to pee on a wound if they have to, to clean it off - so says Dr. Oz, not that's he's right on everything but I think that probably is correct!). For sure you don't want urine odor in the couch cushions or car seats, but I don't think your son's focus is there at all. So it's ineffective as a modification technique.

But there may be something else going on and I think it's time to have a multi-discipline approach. Enlist the pediatrician (without your son being present) and find out if any tests are needed (ultrasound of the bladder and bowel, perhaps) to rule out other causes (I agree an intestinal blockage of any kind, from constipation to encopresis) can can pressures and problems. It may be wise to consult a psychologist as well, but you really need to do the legwork privately without saying to your child "we're going to see a special doctor to find out why you refuse to use the toilet."

When I was teaching, I had a student in middle school who had encopresis and was still wearing a pull-up - she had a mild seizure disorder too, and she had no clue when things were happening. There were problems with urinating as well as defecating, and when she started to menstruate it just got even more confusing. We teachers were trained to recognize symptoms and intervene, and we also had a secret signal between us so that she could leave the room instantly to go to the bathroom without asking. She worked with a medical behavioral therapist and it took years. It wasn't her fault, it wasn't her choice.

Try - as hard as it is - to put your frustrations aside, get away from the idea that this is a "training" and stubbornness issue, and just start from scratch about investigating causes. There are also some things you can do nutritionally to aid brain development and stabilize things intestinally so they don't get constipated - it's easier than forcing them to eat fruit and all that. Not that a good diet isn't helpful, but it's almost impossible to get all the nutrients in today's food climate, and there is something you can do with a soluble and insoluble fiber product that adds to a child's (or adult's) diet - that's very hard to find but there is a good patented product available.

have you ruled out medical problems??? are you absolutely certain your child can FEEL and recognize the sensation??? is it possible he doesn't feel the urine until it's coming out? there is something more going on here, either psychologically or physically - I'd be looking into it TODAY.

- I have a child with a physical bladder problem - he feels the urge and must go RIGHT THEN, toilet or not - it's a VERY VERY painful disorder, it's certainly not what's going on with your son(unless he doesn't feel pain) - but there are problems that can't be recognized without the aid of ultrasound, etc.

While I agree with the ideas below that there is possibly a power struggle over toileting (is he defiant or at least stubborn with you about other things too? If so, this could be part of that defiance)....

And I also agree that there may be emotional issues going on as well (are there changes/problems at home--new sibling, sibling with issues who gets lots of attention, stress between parents, or issues at school?)....

I want to say very loudly and clearly:

Please get him to a doctor first, foremost and immediately.

He may not be defiant or resistant or ornery or even having any emotional issues -- he may have a real, physical issue. Some kids lack the physical abiility to feel the urge to "go." They are not being willful; they genuinely cannot control their bodies like we assume they can. Please get any physical issues ruled out now, and don't wait. If your son has actually been having a physical problem but you have been treating it with discipline as a behavioral issue, you will need to change how you handle this instantly or it is going to leave him resentful and even more resistant -- and it won't do a thing to help him get to the toilet on time, either.

Once you rule out a medical problem (and it may take several visits, trip to a specialist pediatric urologist, etc., tests like ultrasounds, etc. so get your patience ready), then look at what to do next. You will need to be willing to pick apart your own lives to see whether there are stresses that make him so unconcerned about how he smells or how other kids react that he lets this happen. But again, that is only IF he "lets" this happen -- find out first if there is something medical going on and proceed from there. You very well may need to have him see a counselor and you might need family counseling as well, if this is a part of a larger issue. If he does not have a physical issue, it's clear that your discipline is not reaching him and you need some professional help to find out what will reach him, because a child his age in school is going to very soon have some serious issues and be taken out of activities and school if he cannot control pee and poop.

Meanwhile, please do not say that "kids won't want to go near you for fear you'll pee on them." That did not work so far, and is not going to work if you keep saying it. But it will be something he remembers and he will remember it as "mom thinks I smell and nobody likes me so why bother to be clean?" A counselor could give you other tactics to use with him that could work better -- after you rule out medical issues.

Have you ever purposefully not noticed, meaning you notice he's peed himself, but pretend to not notice? Allow him to stay in his peed in pants himself, let the pee get cold, and just wait for him to become aware of his condition? Does he notice? How long does it take him to feel the cold,wet pants?

And then when he does notice, just simply say, "Oh, I'm sorry you had an accident. Try harder next time to go sooner."

Maybe back off for a few days and stop bringing it up.

otherwise, ditto all the advice about going back to your doctor.

Do you see anything else that you are concerned about in his behavior? I ask because sometimes the child simply can't interpret the signals from their bladder and bowels, but these are usually part of other sensory issues.
Schedule an appointment with your pediatrician to talk specifically about these "accidents". Keep a log for 2 weeks before the visit so that you can be specific about the frequency and settings of the incident. Be prepared to answer questions about your child's environment and development that may make you uncomfortable, but are necessary.

Time to talk to the pediatrician. Some children do have a neurological condition wherein they don't 'feel' the urge to go. Their brain doesn't get that signal.

Or, it may be indicative of other stresses in his life. But you need to help him end this, because the older he gets the more socially stigmatized by his peers he is going to become.

Or, it may be that this is a great way to get attention-- albeit negative attention, attention nonetheless. Have you tried NOT telling him to go? Sometimes, it's that power struggle that causes kids to have accidents. They want to control something in their lives, and it's saying "no" to the adult who says "Do you have to...?" or is reminding them.

Either way, time for a pro to give you some help. Do get him evaluated by a doctor,though. If it's something he's not feeling, he may be suppressing some bad feelings about himself and pretending not to care-- but it might be upsetting for him nonetheless.

I went through this with my DS, who is 5.5.
Basically, the problem disappeared completely when I stopped acknowledging it.

If he had an "accident", he had to go change himself and clean himself up. I didn't react if he told me about it, I'd just say "go clean up" - without even looking at him or stopping what I was doing - and that was all. It ceased to be an issue after about a week of that.

(and FWIW: My ped told us that this was not something to be medically concerned about until he was around 8.)

yep, I agree with the other posters.....

after ruling out physical or psychological issues, i'd step out of it entirely. nagging and attempting to humiliate him aren't working, so quit.
if he's cleaning up after himself, and you teach him to separate his own laundry (he may be too young to actually do it himself), it's really none of your business. my money is on him making the effort when it stops being a way to engage with you.
find positive ways to interact with him instead.
khairete
S.

Have you talked to the doctor? Until you make sure this is not a medical issue, you need to stop getting on his case and find out. Some people actually can't feel the need to pee until it's ready to come out - adults and children. Make sure.

I would suggest you take him to the doctor.

Take him to the doctor. Maybe he can't feel when he has to go. Maybe there is a medical reason. Maybe just the thought of going to the doctor will make the "accidents" stop.

I think that making him clean up is a good thing, and simply stating that everyone will use the restroom before an outing or dinner or whatever. Perhaps go back to basics without stating that you are, and if you notice that things like TV time are a culprit, then limit screens.

My son started doing this in Kindergarten. It turns out he just didn't want to miss out on anything with the other kids and walk to the bathroom. Once we realized he was choosing to pee (or even poop) in his pants we sat him down and told him this was totally unacceptable and anytime he chose to do this he would get consequences. I believe it was no playdates and no computer time for 3 days. Both his dad and I were stern. We also talked to the teacher who said she would start reminding him to go use the restroom. The accidents stopped right away.