By Steve Hodges, M.D.
Kids who have potty accidents shoulder a lot of blame.
Parents, at a loss to explain how a 6-year-old can poop in her pants or a 12-year-old can wet the bed, often assume their children are rebelling or angling for attention or are simply too lazy to get out of bed at night and walk to the toilet.
These assumptions are off base, but I do understand where they come from. The actual cause of accidents, chronic constipation, isn’t well known, even among pediatricians. And behavior this seemingly troubling — a 4th-grader wetting his pants, for goodness sake! — would seem to defy explanation. Kids, whose behavior often baffles us grown-ups, make for an easy scapegoat.
So, the first thing I tell my patients is, “Accidents aren’t your fault.” When kids hear this, they brighten up immediately.
When they hear that loads of other kids have accidents, too, they feel even better. And when they realize my job mainly involves talking to kids about poop all day, they may even crack a smile.
Of course, I can only reach so many patients in my clinic. That's why I teamed up with Suzanne Schlosberg, my co-author on The M.O.P. Anthology, to write a children’s book titled Bedwetting and Accidents Aren't Your Fault: Why Potty Accidents Happen and How to Make Them Stop.
Our 40-page book is illustrated by Cristina Acosta, a talented artist whose bright colors and wacky drawings absolutely nail the fun, silly, upbeat tone of the book.
Don’t get me wrong: The book tackles important issues and is highly informative. Kids will learn what’s going on inside their bodies in frank and accurate terms, and how treatment with laxatives and enemas can help. But I’m a goofball at heart. I set out to write a book that would make kids smile, even laugh, about a topic that normally bums the heck out of them.
The book tells parallel stories — one that’s nonfiction, one fictional — and so should appeal to kids in preschool through about age 10. For more mature kids, ages 7 to 12, our novel Emma and the E Club offers similar messages in a more sophisticated manner.
Parents report that both books help kids get on board with the Modified O'Regan Protocol, though neither book mentions the treatment by name.
READ: Kids Shoulder Shame and Blame for Bedwetting and Accidents: How Therapists and Counselors Can Help
Our message to children is simple: None of this is your fault! And guess what? We can get it all fixed.
Sadly, many kids internalize the opposite message, often because parents are hearing something different in the media. For example, in column that ran in 250 media outlets, parenting “guru” John Rosemond wrote “there is no better motivator” for staying dry overnight than “waking up on cold, wet sheets.” The implication: If only your lazy kid were more motivated, she would stay dry overnight.
In a radio interview, an enuresis nurse told an Australian interviewer that “the child must desperately want to be dry. If you have the cooperation of the child, you will have success.” Again, the implication: Your unruly kid isn’t cooperating.
Sometimes, children are blamed in subtle ways, like when a parent flashes that “Again — are you kidding me?” look when the child comes in at 2 a.m. for help changing the sheets.
Other times, the blame is more direct, like when a parent says (or yells), “You’re 10! You’re old enough to know better!”
On occasion, parents or caregivers lash out at kids in criminal ways. I have a large collection of news reports on cases of physical abuse, including several children beaten to death for accidents. One teenager was punished for bedwetting by being forced to sit on an electric cooker until she sustained severe vaginal burns.
Several teens with enuresis have emailed me asking for help, after their parents beat them for wetting their sheets or withheld video games or even breakfast as punishment.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
Yes, these cases are extreme, but even when children are on the receiving end of accusatory glances rather than beatings, they suffer. I see this daily in my practice. A young patient will sit on my exam table with shoulders slumped, staring at the ground, while Mom or Dad tells me, “He claims he doesn’t even feel it when he poops in his pants. That doesn’t seem possible.”
I get the skepticism. Unless you understand what causes encopresis, it's hard to believe a child can’t feel poop falling out of his bottom. (A stretched rectum loses sensation, so the child can no longer feel the urge to poop or notice the accidents.)
Sometimes the blame comes not from the parents but instead from teachers or school directors. My former patient Zoe Rosso, the Arlington, Virginia, girl suspended from preschool for exceeding the "allowable" number of accidents, clearly got the impression from school that she was somehow responsible for her wet underwear.
One day when Zoe’s mom, Betsy, picked up her daughter from school, Zoe told her, “I had four accidents. Don’t get upset at me.” The Rossos had repeatedly told Zoe, “We know this isn’t your fault.” But apparently that wasn’t the message she was receiving at preschool.
Children feel crummy enough about accidents even when they are not blamed by adults. They miss out on slumber parties and school overnights and sleep-away camp, and they get teased by other kids. Gradually, they may lose self-esteem, and many teens who struggle with bedwetting slip into despair or depression.
I hope our children's books, including Bedwetting and Accidents Aren't Your Fault, will help children regain lost self-esteem as they work through treatment.
As one mom emailed me, "When my daughter felt frustrated with accidents, we'd get this book out and read about her body and what was happening. It was very empowering."