Potty training at school

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Specializes in Peds, MH, Corrections, School, Tele.

I have a 4.75 year old preschooler girl who has selective mutism and public bathroom phobia. She has been coming in to the health office for scheduled toilet training since the start of school with little success. At first when she started coming in she would demand the bathroom door to be wide open which caused privacy issues and I could not have other students in my office. We have since worked our way up to having the door slightly ajar so now other students can receive medical treatment while she is in the bathroom. The problem is she refuses to actually urinate in the toilet. She will urinate on the floor or in her pants and is not embarrassed or anything about it. I have tried positive reinforcement measures however nothing seems to work. She continues to have 2-3 accidents a day. It has gotten to the point where she has even urinated in the cafeteria on the bench at lunch. The school nurse has referred her to the counselor. Today the school nurse told me that the mother is insisting that she uses a pull up which at first seemed like a good temporary solution however slightly counter productive to our potty training efforts. When she came into my office for her regular scheduled training I was expecting her to be wearing a pull up but to my surprise she was not. Instead she had one in hand went into the bathroom, put it on, urinated into it, took it off and then threw it into the trash. She has complete control over her bladder. I feel like I'm in bizarre town and have no idea what to do about this. Has anybody ever experienced anything of the sort or have any advice?

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Specializes in school nursing, ortho, trauma.

Is she uncomfortable in the wet clothing or is she contented to sit in it until prompted to change? Perhaps the pull up isn't a bad idea, but it needs the addition of the cotton underpants between the skin and the pull up to get the uncomfortable negative feeling, while still having the protection of the pull up to save for messes.

The next thought on my mind is who is training her? Is she coming with a classroom aide or are you expected to be responsible for the toilet training? Also, if she has regular times and pulls the business of urinating into the pull up, then perhaps the pull ups should not be available to her during a training time. On the reverse of my initial question, perhaps there is some sort of internal positive feedback or stimulation she may be getting from the feeling of urinating in her pants.

On a more controversial note, I worked for a few years in a special ed school with an autistic population. When faced with similar issues, particularly the issue of wetting on the floor or not in toilet, the behavior seemed to turn around quickly when the student was obliged to clean up after themself. This didn't mean exposing the child to cleansers, but rather giving them towels to have a hand in being accountable for their actions. Of course the area would be cleaned properly with cleansers by a custodian. The students would quickly get the idea that using the toilet was a lot easier on them than having to clean up every time. Granted, depending on your admin and the students's parents, this may not fly, but then again i don't see why not - as long as you don't expose them to chemicals, they are in no danger. My daughter was recently having a lot of accidents in pre-k - mostly due to waiting too long. I told her pre-k teacher to hand her a towel and have her help clean up.

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Specializes in School Nursing, Public Health, Home Care.

I think a conference or a plan from the student's psychiatrist would be helpful. Hopefully you are doing the same plan as at home, but do you know that for sure? Consistency would be key.

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Specializes in Peds, MH, Corrections, School, Tele.

Thanks for the great advice guys (especially having her clean up her own mess). for now we have her sitting on the toilet with her pull up on for 5 min until we can think of a better plan :(

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I have a kinder that is afraid of the flushing noise of toilets. Unfortunately, every toilet in our school has an automatic flush. Poor thing has at least an accident a day. I've talked to her mom numerous times but "it's just the way she is about toilets everywhere but home so that's why I keep spare clothes in her backback".... She doesn't feel there is a severe issue and just let's it fly and flushes the toilet for her daughter at home. She refuses to put her daughter in pull-ups because "she's potty trained". I'm just so tired of these accidents. Her teacher sends her every hour to the bathroom but she just sits in the hall. I've showed her a million times that flushing isn't scary and she always says it wasn't that bad but the next day is doing the same thing...

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Specializes in Maternal - Child Health.

bleemadden,

I read your post and had to respond. You could be describing my oldest daughter. When she was pre-school age, she was absolutely terrified of auto-flush toilets and hand dryers. She was very sensitive to noise in general, and absolutely would not go into a public bathroom anywhere. Trips to the mall or shopping had to be kept brief. She would not use a bathroom in a restaurant, at church or any public place. While incredibly inconvenient, her behavior was based in a genuine fear.

We took her potty chair (which she had outgrown) and kept it in the back of our van, along with a sanitizing solution. When we were out, we would go back to the van for her to use the potty. We lived a a distance from family members and traveled a lot by car, so we had to work something out!

Eventually, she outgrew the issue. She is now a poised 17 year-old, preparing for college and would die a thousand deaths if she knew I was writing this today :)

I understand your frustration, and agree that this is not really a nursing issue, but I wonder if there is a private place that could be used to store a commode or potty seat that this child could use for the time being. I bet the problem of wetting would be solved instantly if she could "go" without fearing the toilet itself.

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That's a great idea! I hadn't even thought of that and will definitely bring that up with her mom. Hopefully we can figure something out for school time for this little kiddo!

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Wow! Maybe she enjoys the extra attention? Are there issues at home? The fact she can put on a pull-up, pee, take it off and throw it away says a lot. That's better than peeing in her clothes or the floor! I second the cleaning up by herself. I would even give her wet wipes and make her clean herself up. I would try saying as little as possible with her during accident time and have the teachers ,as well as the nurse, praise her during the day when she's dry. I would also ask the teacher to praise other students in front of her when they come back from the bathroom that don't have issues. I think I would continue to let her do the pull-up thing for a while too. She has control this way and is able to take care of herself. Hopefully she will progress to pulling them down first. The students afraid of automatic flush toilets-I would try having them wear earplugs or cover the sensor up with something before they use the toilet.

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Specializes in Complex pedi to LTC/SA & now a manager.

Post it notes are great to cover the auto flush sensors.

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Specializes in OB/peds (after gen surgery for 3 yrs).

I work with PreK's also. We have a policy that children being trained must wear training pants and rubber pants over them. The pull ups do seem counter-productive. The kids also are expected to "help" clean up after themselves. Children with special needs are exempt and our staff (teachers) change diapers for those special needs kids.

Have you spoken with this child's doctor? Is there any medical need or do you feel that it is more a behavior?

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