Q: My son is 7 and has frequent bowel and urine accidents. He's been checked by a gastroenterologist who had us put him on a toileting schedule. This worked for a while. Now he's having accidents again every day. Whenever there's a change in schedule, the accidents reoccur. An example is the change of him attending camp. His summer camp teachers are saying he will not be able to attend because of this problem. How do we handle this? Will withholding something he likes or likes to do make a difference?
We adopted him from overseas, and he is an anxious, active child. He also has a speech delay, which is getting better. We don't know how to proceed. He attended kindergarten for two years and is now going into first grade. Thanks so much.
A: You've proceeded correctly by first checking with a physician to rule out medical issues. Your next step should be to visit a psychologist for an evaluation. There are two issues that you've included that suggest potential psychological problems, but there isn't any way that I could know from your letter how serious these issues are.
First of all, adoption from another country presents many unknowns. It's possible that your son was traumatized before you adopted him. You haven't mentioned your son's age at the time of the adoption, but sometimes children have been in orphanages or foster placement during their early years of potty training — some cultures are more demanding of their toddlers than others. It's also possible that your child's separation from his mother was difficult. Both of these variables could have affected your son's present problem.
The second clue to emotional issues that you mentioned was that changes in his life often initiated a series of wetting accidents.
Anxiety often increases with change and could be implicated in your son's problems. Some children have more difficulties with change than others, and your son may benefit with therapy directed at helping him make changes.
It would be counterproductive to punish your son for his accidents. Although punishments are sometimes effective in the short run, they complicate anxiety issues and may feel to your son like rejection, especially because he has been adopted. Schedules and rewards are often very helpful and effective. If your son's problem is more complicated, they are not likely to provide a long-term solution. Since schedules and rewards are unlikely to do harm, you can certainly try them immediately in hopes of encouraging improvement. Hopefully, as your son enters first grade, the school schedule of providing regular bathroom breaks will serve to prevent accidents and encourage regular toileting habits. Nevertheless, a psychological evaluation is likely to provide you with ongoing insights about your son, and a psychologist can guide you if his problem continues in school. My book, "How To Parent So Children Will Learn" includes information for parents who adopt children (Great Potential Press, 2008).
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Dr. Sylvia B. Rimm is the director of the Family Achievement Clinic in Cleveland, Ohio, a clinical professor of psychiatry and pediatrics at the Case Western Reserve University School of Medicine, and the author of many books on parenting. More information on raising kids is available at www.sylviarimm.com. Please send questions to: Sylvia B. Rimm on Raising Kids, P.O. Box 32, Watertown, WI 53094 or srimm@sylviarimm.com. To read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.
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