3 rd grader wetting herself

[Gampopa]

Hi:

Any suggestions how to help a 9 yr old 3rd grade girl who continually wets herself in class and does not clean herself up?

Her mother has taken her to the doctor who prescribed Ditropan but it isn't helping. She says she can feel when she has to go but doesn't have enough time to get to the bathroom. He mother has her wear pull-ups at night and the school has requested she have pull ups here too but Mom hasn't supplied them. The girl says she feels well, doesn't hurt when she pees, isn't loosing weight nor hungry and thirsty all the time. Any ideas? The "family" has numerous issues and has been identified to CPS.

[caliotter3]

A return visit to the doctor would be in order.

[mustlovepoodles, RN]

There is no way i'd put a normal 9 year old in a pull up at school! As if it's not enough that she wets herself, she's going to walking around in a diaper?? She might as well be wearing a sign that say "Kick me!" I think there needs to be further medical evaluation, for sure. I wonder if this student has some kidney ref lux causing chronic UTI.

Time to institute a trip-training process where the child goes to the bathroom every 2 hours or so, whether they feel the need or not. It is very important to get her teachers and parents on board with this, for consistancy. At her age, she should be able to strip out of her wet clothes, put them in a bag, wipe down with a wet wipe, and put on fresh clothes. You shouldn't need to do anything but hand her the clothes. Keep it low key and don't bring any attention to the situation. Let her handle it to the best of her ability. If she truly cannot manage her hygeine, then I'd say there's a whole lot more going on here than incontinence.

[Sudsy]

Mustlovepoodles: I agree w. everything you said except your first few sentences. If you have wet pants in 3rd grade, that's pretty much the same "kick me" issue.....I'd say try the low-profile pull-ups while the other suggestions you made get implemented.

Gampopa: good luck!

[Cat_RN, ASN, BSN, RN]

You say the family has 'issues'; do you think she could possibly be a victim of sexual abuse at home?

[Flare, ASN, BSN]

Cat_LPN - that was one of my first thought too. Especially if this behavior is relatively new. a toilet trained child does not simply lose sensation for no reason. Granted, we have no history that would confirm this. In fact the OP indicated that she does have sensation.

Other reasons to consider:

Attention seeking behavior

anxiety (especially related to missing content in class)

classroom avoidance (student may have realized that if she wets her clothes is gives her more time out of class to change, clean up, etc)

I agree with mustlovepoodles - the best place to start is a timed schedule whether she has to go or not. The big trick is getting the family to comply at home (this is the issue with managing my student with spina bifida's incontinence). But don't let that stop implementing that plan.

[rnsrgr8t]

I works as an APN in peds urology and treat patients like this all the time. If you are not seeing improvement and the parents are not helpful with following up....see if you can get the mom to sign a release for you to talk with her MD in more detail about how she is doing. I do not like the idea of her having to wear pullups if she is a normal, walkie/talkie kid, the wetting needs to be addressed and treated if the ditropan is not working. I have had school nurses call me to let me know one of my patients is not doing well (family had been lost to f/u etc) and that has helped kick start the process in getting the child better. If the family is already known to CPS, I would get them involved too. Often there is many factors going on with kids with voiding dysfunction. The timed voiding idea is a great one. Good Luck!

[Kim O'Therapy, BSN, RN]

I would be curious regarding the doctor's visit. Do you think they are telling you the truth about taking her? Unfortunately, I have parents lie to me all the time when I advocate for the student. Last year, I had a second grader that kept defecating on himself and I had to go through CPS to get anything done about it. Had to do it this year for a little one who had the worst tooth decay I have ever seen. Good luck with your student. I know you will find the best way to solve the problem.