By Steve Hodges, M.D.
Kids who have toileting 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 malarkey, but I do understand where they come from. The actual cause of accidents isn’t well known, even among pediatricians, and behavior this troubling — a 4th-grader wetting the bed, for goodness sake! — would seem to demand an explanation. Kids, whose behavior often baffles us grown-ups, make for an easy scapegoat.
Sadly, some “experts” pile on, abetted by the media. In a column that ran in 250 media outlets, parenting “guru” John Rosemond insists “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.
And in a recent 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 kids are blamed in subtle ways, like when Mom or Dad 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 7! You’re old enough to know better!”
On occasion, parents or caregivers lash out at kids in such horrific and criminal ways that it’s simply mind-blowing. I have a large collection of news reports on these cases, including a 2-year-old beaten to the point of multiple fractures because she was “slow” to potty train, a 3-year-old boy beaten to death for the same reason, and a teenager punished for bedwetting by being forced to sit on an electric cooker until she sustained severe vaginal burns.
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 totally get the skepticism. Unless you understand what causes encopresis, it truly is hard to believe that a child can’t feel poop falling out of his bottom. (It’s because the child’s rectum has been so overstretched that the child has lost sensation. Children who have accidents typically can’t feel it when a test balloon inflated to the size of a tangerine has been inserted into their bottoms.)
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. (Betsy is one of the most patient, compassionate, and unflappable parents I’ve met; I can tell you she and her husband, Randy, were not the source of Zoe’s distress.)
Incidentally, it’s not just children who are blamed for toileting accidents. Sometimes, it’s the parents — blamed by other parents who feel smug that their own children stay dry and somehow take credit for that fact.
When Zoe’s case was reported in the Washington Post, the story incited a slew of hostile comments. Betsy was called a “lazy person who wants to dump the kid off so she can shop and drink Starbucks” and told to “quit blaming others for her failures.” One commenter ranted, “It’s narcissistic for parents to insist that their untrained child has to be indulged. A parent’s job is to raise a well-socialized, functional member of society.”
Wow. Why is it so difficult to muster compassion for families who deal with wet underwear?
Look, 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 lose self-esteem, and many teens who struggle with bedwetting kids slip into despair or depression.
Trust me: All kids hate having accidents. All kids are motivated to stay dry. Nobody wants to wake up with wet underwear.
And, as you yourself probably know, parents of these kids suffer enough exhaustion and embarrassment without being judged by parents lucky enough to avoid these problems.
Here’s what I hope: By educating parents, teachers, and physicians about the actual causes of toileting problems, I can help minimize the blame and stigma connected with these issues.
But I also want to reach kids directly. One of the first things I tell my patients is, “Accidents aren’t your fault.” When kids hear this, they brighten up immediately. When they hear that other kids have accidents as well, 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.
But I can only reach so many patients in my clinic. So, I’ve teamed up with Suzanne Schlosberg, my co-author on It’s No Accident, to write a children’s book called Accidents and Bedwetting Aren’t Your Fault: Why Potty Accidents Happen and How to Make Them Stop.
Our 32-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. 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 both to young kids (3 to 6) as well as to elementary-school kids.
Accidents and Bedwetting Aren’t Your Fault will be published in October. If you’d like to receive an email alert when the book is available for order, please subscribe to our website.
Our message to kids is simple: Hey, none of this is your fault! And guess what? We can get it all fixed.