Laura Gets Real About Caregivers’ Expectations Regarding Kids’ Toileting Training

I find most people are surprised that physical therapists work with pelvic floor concerns and even more surprised that I work with kiddos and their pelvic floors. I want to educate and inspire adults (and children) to think differently about pediatric pelvic health, ‘accidents’, wetting the bed, pooping in their underwear/pull up and other toileting issues. First, I would like to change the language that we use to ‘bladder leakage’ and ‘bowel leakage.’ This describes what is happening and changes the language to a neutral connotation.

👧🏽Bowel and bladder control is actually very complex, and yet our society often expects children 18 months- 3 years to have full control and become independent so they can go to preschool. The average 18-month-old child has 10-15 words and only has been walking for 3-6 months. By 3 years old, they have mastered their foundational motor skills (if not currently delayed), have started talking in short sentences with many age-appropriate articulation errors (i.e. adults can’t understand what they are saying), and do not yet understand or interpret many body signals.

🧒🏿We all know children at this age who have major melt downs when they are hungry. They do not come to an adult saying I need to eat, they are crying and kicking because they are waiting in line at the grocery store or their sibling took a toy away. Yet, we expect them to recognize a bowel/bladder urge, stop what they are doing, go to the toilet, wipe, flush, wash, and return to playing. In addition, in the middle of the night, we expect the bladder to hold through the night, or the urge alone should wake the child up. When the child wakes up, they should recognize the uncomfortable feeling in the lower abdomen is a bladder urge, so they get up and void…. however, this is not to be expected.

👧🏻The pelvic floor muscles do not mature until 4 years old. Therefore, staying continent or being ‘toilet trained’ may take until after 4 years old. I understand this puts parents in a difficult situation when kids have to be trained by 3 years old to go to preschool. Just like every skill we master as a child, bowel and bladder control can happen at different ages for different children. Pushing a child who is not ready to toilet train, so that they can go to preschool, can have negative consequences for years to come. 

​I have so much more to share in upcoming newsletters! I work at both Therapy Solutions and Children’s Developmental Center (CDC). If you know anyone with a child struggling with urinary incontinence, constipation, fecal incontinence, bed wetting, pelvic pain, or any other pediatric pelvic health concerns, they can contact me at lauramc@childrensdc.org or 509-578-4037. CDC is a non-profit and welcomes donations and participation in our fundraisers. We take every insurance; I have a fund that anyone can donate into to support the work I do at that clinic. If you want more information about our fundraisers or donating you can contact me or Diane Turney through our clinic number 509-735-1062. We are also on Facebook.

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