Factsheet 8: Children who soil or wet
themselves: information for parents, carers and anyone who
works with children
About this leaflet
This is one in a series of leaflets for parents, teachers and
young people entitled Mental Health and Growing Up. The
aims of these leaflets are to provide practical, up-to-date
information about mental health problems (emotional, behavioural
and psychiatric disorders) that can affect children and young
people. This leaflet looks at the reasons behind why children may
soil or wet themselves, and offers some practical advice about how
to cope with this problem.
Introduction
Most children under the age of 2 will wet themselves at night.
This is normal. Between the ages of 2 and 5, most children will
learn to be dry at night. You should think about getting advice if
you have a 6-year-old who still wets the bed at least once a week;
or if your child starts to wet their bed again after being dry for
a while.
What causes bedwetting?
Some children who still wet their bed after the age of 5 may
just be slow developers. You may find that your child is more
likely to wet the bed if they are very tired and sleeping deeply.
Some children who are usually dry may wet themselves when they are
overtired or unwell. It is more likely to happen if you let your
child drink a lot before they go to bed.
Wetting can often be a sign that your child is anxious or
unsettled, especially if they have previously been dry for 6
months. You may find that your child starts to wet again if they
are upset or coping with big changes in their life, such as when a
new baby arrives in the family or when they start school.
Is it ever deliberate or due to laziness?
No. You should never blame your child. Making your child feel
bad, ashamed or anxious will only make the problem harder to deal
with.
What can help?
There are some simple things to try:
- Make sure your child does not drink close to bedtime.
- Before you go to bed yourself, make a point of taking your
child to the toilet.
- Make sure that you tell them `well done' for any dry nights -
this often helps.
If your child carries on wetting and doesn't seem to be
getting better, go and see your general practitioner. They will be
able to refer your child to a specialist if they feel this is
appropriate. If bedwetting has begun again after a child has been
dry at night for a period of time, and physical problems have been
ruled out, your general practitioner might suggest that you see
someone from your local child and adolescent mental health service.
They will to try and find the reasons behind why the bedwetting has
started again.
Bell and pad
A very effective method of treatment is the `bell and pad' or
`enuresis alarm'. It involves putting a pad underneath your child's
sheet. This pad is connected to an electrical buzzer. You can get
one from your local specialist clinic. When your child starts to
wet the bed, the buzzer goes off. Your child should then get up and
use the toilet. Gradually, your child will learn to wake and use
the toilet by themselves. It may take your child weeks or months to
become completely dry at night. It is important to praise your
child for their dry nights.
Further help may be required if your child carries on wetting
the bed or starts again after a period of being dry.
Daytime wetting
About one in three children who wet their bed will also wet
themselves in the daytime. It can also happen on its own, without
bedwetting at night. The problem is particularly troublesome when
children start to go to school. They may be teased for being smelly
and find it hard to make friends.
What causes it?
When a child starts school they may not get to the toilet when
they need to. This may be because they are embarrassed to tell the
teacher that they have to go. They may be so busy with their work
or with playing that they just leave it too late. Some children
will try to hold it in for as long as possible because they just
don't like the school toilets. About half of older girls who
regularly wet themselves in the daytime have a urinary infection
needing medical treatment. It can also happen if your child is very
anxious, or has behavioural problems.
What can help?
You may need to sort out practical problems about using the
toilet at school. Have a chat with their teacher to make sure that
they remind your child to go regularly. Many children like a `star
chart'. Small rewards for dry pants at the end of the day can be
helpful. If reminding your child to go to the toilet doesn't seem
to be working, you can try using a timer which will give a signal
every hour or so to remind your child that it is time to go. If the
problem continues, ask your general practitioner to check out any
physical problems. They can refer you to a specialist if
necessary.
Soiling
Soiling (encopresis) occurs when a child does not reliably use
the toilet for a bowel motion. They may dirty their pants, or go to
the toilet in inappropriate places.
Obviously, this is normal in toddlers and younger children.
However, you should be concerned if it carries on after the age of
4. By then, your child should be able to use the toilet
regularly.
What causes it?
There are two main causes for soiling. A child can suffer from
both of them.
- Severe constipation causes the bowel to be blocked with hard
faeces. The child finds it painful to pass these, and so becomes
more constipated. Liquid faeces then leak around the blockage,
staining clothes.
- Not learning a regular toilet routine is a common cause. The
child may be reluctant to use the toilet. This may sometimes be
part of a general pattern of behaviour, where a child refuses to do
what you want them to.
You can help by encouraging your child to establish a regular
routine for using the toilet, and praise for their effort and any
successes.
If your child is constipated, make sure that they eat a lot of
fruit, vegetables and foods high in fibre. If going to the toilet
is painful, your general practitioner will be able to advise you
and, if necessary, can refer you to a specialist.
If your child is not constipated, the cause may be
psychological. If they start to soil or to smear faeces after no
previous difficulties, they may be emotionally upset. If you can
find out what is upsetting them and sort it out, the soiling may
then improve. If it carries on, your general practitioner may
suggest specialist help from the local child and adolescent mental
health service.
References
- Carr, A. (ed.) (2000) 'What Works with Children and
Adolescents?' - A Critical Review of Psychological Interventions
with Children, Adolescents and their Families. London:
Brunner-Routledge.
- Rutter, M. & Taylor, E. (eds) (2002) 'Child and
Adolescent Psychiatry' (4th edn). London: Blackwell.
- Scott, A., Shaw, M. & Joughin, C. (2001) 'Finding the
Evidence' - A Gateway to the Literature in Child and Adolescent
Mental Health (2nd edn). London: Gaskell.
Sources of further information
- The Mental Health and Growing Up series contains 36
leaflets on a range of common mental health problems. To order the
pack, contact Book Sales at the Royal College of Psychiatrists, 17
Belgrave Square, London SW1X 8PG; tel: 020 7235 2351, ext. 146;
fax: 020 7245 1231; e-mail: booksales@rcpsych.ac.uk, or
you can download them from this website.
© [2004]
Revised march 2009.
Royal College of Psychiatrists. This leaflet may be
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