Day Treatment Facilities for Retro Potty Training?

Discussion in 'General Parenting' started by hopeful2, May 2, 2008.

  1. hopeful2

    hopeful2 New Member

    I am new to this board and thought it would be a good place to ask this question - haven't heard an answer from new therapist yet.

    Dot is 8 yrs old, adopted at birth, seemed normal until 3.5, when Dad died from cancer. She was potty trained at 3, but started wetting every day through to now. She does keep dry at night, been examined, has everyone trying to help her be successful, kicked out of preschool for wetting, yada, yada, yada. Definitely disconnected from her physical warning signs, but refusing to get on a regular preventative schedule. (Long, boring, frustrating, confrontational/tantrumatic story). She pees on her bedroom carpet all the time when she's mad at me, too.

    I think the only way she will get beyond this is to sign her up for some kind of day-treatment at a facility where I check her in every morning for a week and they only focus on this until she stays dry herself. Even if she just goes along with it, it would be an improvement.

    Has anyone heard of such a thing or done something this drastic? It's been going on so long and seems to have no end....

    Thanks for any guidance!
  2. Christy

    Christy New Member

    My son also has toliet issues, he's 9. We had to train everyone around him to get him to use the toilet because he refuses to stop what he is doing to go. He has no embarassment factor and would often come home from school with two or three sets of wet clothes. The other day he pooped in his pants rather than coming inside to use the bathroom because he was having too much fun playing with the neighbor. It's a struggle and I feel you pain.

    I have never heard of an inpatient or day treatment facility dealing with this issue. Usually admittance is based on the criteria of a threat to self or others and while toileting is certainly important, it isn't a danger.

    There are many reasons for enuerisis but it sounds from your description that your daughters is emotionally driven. have you considered or tried counseling?

    Good luck and welcome to the board!
  3. slsh

    slsh member since 1999

    Hi Hopeful and welcome.

    Hmmm... I agree with Christy that this sounds like it's more than just a potty training issue. Peeing on the carpet when she's mad at you is flat out behavioral, in my mom opinion. If I'm reading between the lines correctly, sounds like she's fought you at every turn when it comes to being potty trained (the preventative schedule). Possibly a battle of wills? What is your reaction when she does wet herself? Are you emotional, angry? Is this a big huge deal with punishments, etc?

    Unfortunately, we really have have zero control of what comes out of our kids' bodies or when. If it's purely a matter of control (as in who is in charge), you are not going to win this battle. I think that logical consequences need to be used and completely without any emotion at all on your part. She wets herself, she cleans it up. Does her laundry. If she's peeing on the carpet, if at *all* possible, I'd get the carpet out of her room. If you can't do that, I'd have her clean that up as well. Of course, that still opens you up to the battle of wills over clean up but... you might have a better chance of winning that one.

    I'd strongly recommend first (since it sounds like you've already had her checked out physically) a full psychiatric evaluation - the timing of her loss of "control" certainly is concerning, but also because she's continuing to do this intentionally and as a result of being mad at you.

    I would be very hesitant about heading for a retro potty training program because it doesn't sound like that would really address the underlying issues. While I totally understand (and remember) what a mess this kind of problem is, I really don't think any effort at pure "training" is going to be the solution and if you've got a kiddo who is into power struggles, I would be very worried that forcing the surface issue of toileting might actually make things worse.

    Just my mom opinion. ;) Glad you found us.
  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I agree that this is just one symptom of something going on, but I'd recommend a complete neuropsychologist evaluation. They are the most intensive and complete evaluators and can pick up both neurological and psychiatric problems. Some kids have sensory issues and don't know when it's coming. Peeing all over, if not sensory, is just not a normal way to react to being angry. Do you know anything about her biological parents to give the evaluators biological information? That is very key to getting things right.
  5. hopeful2

    hopeful2 New Member

    Thank you all for your responses. I agree that her behavior is emotionally driven. She's been in therapy for a while with different types, and we've started with a Reactive Attachment Disorder (RAD)/ODD therapist. Just had another psychiatric assessment today who suggested some light medications to support the therapy.

    I've got a neurpsych evaluation scheduled for late Sept, but he had referred to the psychiatric evaluation today thru another doctor to help bridge the gap.

    It's just gone on so long. She was kicked out of one preschool for wetting (they wouldn't let me use pullups) and subsequent schools have been very patient with multiple clothes changes a day. But now it is truly impacting her schooling (disruptions), field trips, and the hygene issues are a problem with shared furniture, carpets, etc.

    I try not to react, but I'm a single parent with lots of pressure (like others) and I'm only human. When I don't react enough after a while, that's when she goes to the next level, then the next, then the next. At some point she's bound to get me to react - there's only so much pee and then poop a person can take.

    Therapist suggested a respit care referral who could focus on that, but he believes supportive medications can help us break through whatever the barrier is for her. Then we can really get somewhere with the behavior therapy for both of us.

    We had a pretty good weekend (rare these days) and had some truly touching moments to talk about our love for each other and letting me be her Mom; to trust in me. I think she wants the break-through, just doesn't know how to scale, break thru, let go or whatever it is she needs to do to this wall.

    I truly appreciate that there is a site like this to allow for exploration, sharing of info, and just knowing others can relate. I'm so tired of people giving me advice or saying I'm not tough enough (if they only knew!) or that she's just a normal kid. They truly don't see what goes on behind our door.

    If I can just keep balanced...
  6. Christy

    Christy New Member

    It sounds like you are on the right track for getting the help your daughter needs. I hope things begin to improve.

    What type of medication was suggested?
  7. Star*

    Star* call 911

    Hi and welcome,

    Enuresis is a pain. My son was encopretic for YEARS. And we, like you did all the doctors, testing, etc. And we went further with retro-potty training at least 2 or 4 times. No matter what we did with the pooping of his pants, when he was angry and anyone he would poop on demand in his pants and sit in it, hide his underwear (as if I didn't have a Mom nose) and leave it in the tub, his room it was awful.

    He even hid soiled underwear at Residential Treatment Center (RTC) - they would take his underpants and give him ONE pair and he could have a fresh pair when he gave them his clean ones - and he was handing in OTHER kids' clean underwear he stole. I figured it out when he got a home visit and had someone elses underwear on - and I washed his clothes. So then they marked them and he found a marker and marked OTHER kids' underwear. At that point - they gave up and told me he'd just have to grow out of it.

    The smell, the aggrivation, the money I spent in lysol, gloves, hand sanitizer, sprays, pills, Tide, Borax, washing HIS clothes twice and then washing the washer out with bleach, Mirlax you name it ? I could have had a newer car.

    What I do understand about bodily functions and for my son was that he was abused. And this is how he had control over the one thing in his life that NO ONE could tell him when, how, here, there, no, yes. If it's not a medical problem it IS a control issue with her. And the more big of a deal you make out of it - the WORSE it will get.

    Even if you stop paying her attention and have her clean it up? She's still going to do it. So be prepared for that. Which is about as much fun as eating uncooked spaghetti. She most certainly needs a complete psycho. battery of tests and in my humble opinion observation away from you by a really good clinical psychiatrist and some psychiatric. nurses and staff.

    I'm adopted myself and can tell you that there is SO much that goes on behind the scenes in your head over/because of being adopted that you don't even know about or can do nothing about. I was in my 30's before a therapist helped me understand that. A good book to read is Primal Scream.

    As far as her enuresis? Put plastic on her bed, mattress, and get a light blanket that you can wash easily daily. 20 muleteam borax helps with the smell. As far as peeing on the carpet? Take it out of her room and replace it with linoleum. Easier to keep clean. Short term goals and rewards for days of dryness. And instead of a punitive punishment for urination - address the problem by saying very little. Does she do it an then scream things like "How do you like that?" or does she just do it and sneak it?

    I'm wondering if you cut out all drinks but milk, real juice and water -and had her drink LOADS of stuff so she has to pee a lot if that would help her at all?

  8. Marguerite

    Marguerite Active Member

    A few suggestions - don't use plastic on the mattress, use vinyl instead. It doesn't make that crinkly sound and doesn't feel lumpy so easily. We bought a length of vinyl and found because it is so wide we had enough for two beds. Or to put it another way - we had a spare piece so we could hose off a wet one and give it an airing, while we had another to put to use.

    I'd also be putting her back into Pull-Ups. Any school objecting - THEY can take her into their home for a few days and THEN tell you you can't. Maybe if you get a letter from her specialist explaining that if they don't use Pull-Ups then she is liable to need to be cleaned up.

    If she objects to Pull-Ups - then she has a choice. I'd also be making her help clean up. This isn't a punishment, it's natural consequences. I did it with ALL my kids as they were being toilet-trained - they helped with the clean-up. It was part of learning personal responsibility. No sense of punishment at all, just simply working as a team to get the clean-up done. After all, I hadn't done anything wrong and yet I was pitching in too.

    To clean up - first we removed the child from the environment that was soiled. If there was a fast spill to mop before it soaked into stuff, then I would throw a towel or something at it. If the child was clean, I would get the child to help me mop up. We'd get a bucket of warm soapy water and a couple of cloths. We'd mop with the cloths, wash them in the bucket, squeeze them out and mop some more.
    If the mess is not going anywhere, I'd clean the child first. In the shower recess, clothes and all, then strip. That way any mess is contained to the shower recess. We had a telephone shower head installed so we could hose the children down easily. Really good for hosing down soiled rear ends. Soiled clothing - lumps got removed (either down the drain or tipped into the toilet). The clothing then got put in the washing machine, or into a nappy bucket (depending on quantity). Never let it dry out.
    I always got the child to help tip out lumps and put the stained clothing into the nappy bucket or washing machine. I taught them how to use the washing machine.

    Once the child is clean, I put clean clothes on them. I found I couldn't leave on any clothing items which had been worn when the "accident" happened - they still smelled, even if they hadn't been touched by excreta. The child does need to be smell-free, at least for a little while. They need to enjoy the clean smell and the clean feel, in order to learn to not do this.

    With clean clothes on, it's time to clean the floor/bed/walls. Again, teamwork. Two people changing a bed is much easier than one. I've given the kids a spray bottle and scrubbing brush to clean the walls if they've been 'painting' them. With a cement-rendered brick wall, I can trust the kid to not do damage.

    Urine is sterile. We tend to go, "oh, yuck," but it's not an infection risk. If left though, it will smell as bacteria in the air convert it to ammonia. You don't need to wear gloves to clean it up, although washing hands afterwards is a good idea because immersion in urea can damage your skin over time. To clean it out of carpet - we sometimes flush with about half a cup of water after we've mopped, to rinse it out. If any smell remains you can use various preparations including some essential oils.

    As for clothing costs - I've been buying second-hand where I can. Nice new clothes don't get put on children who are likely to soil them.

    And Star's idea of getting her to drink lots - that gives her plenty of opportunity to practice.

    Helping to clean up plus wearing Pull-Ups - these are natural consequences. If she's still doing this as an adult, she will need to do exactly the same things so she may as well start getting used to it now.

    With helping to clean up - I got my kids involved from about two years old. My sister did the same thing. I remember one day she found one of her sons rinsing out his soiled underpants. He had left it too late because he was too busy playing, so he came inside and started cleaning himself up, all by himself. She praised him and helped him from there.

    But while ever you're being a martyr, announcing, "For heaven's sake!" and grabbing mops etc in exasperation, you're creating a spectacle she enjoys seeing, especially if she's angry with you.

    The other thing you need to do - you must do other, more fun, tasks together too. That way she won't continue soiling just so you can work together on something. Instead, go bake a cake with her, or make biscuits with her. Let her have some choice in what to make or what flavourings to put in. difficult child 3 likes to make tiny biscuits with shapes, so I found a simple recipe and some small biscuit cutters. It's fiddly and tedious, but he feels some ownership in the result. And as long as he is doing the fiddly bits, I don't mind at all. It's like craft that you can eat. Any biscuit recipe that uses plain (all-purpose) flour with no raising agent can generally be used to make shape biscuits.
    And here's a couple of tricks to try - make two lots of biscuit dough in different colours. You can substitute up to half the flour with cocoa powder, for chocolate flavour (I don't substitute more than a third). You can then roll out two thin lots of dough, cut them into the same size long strips and layer them together. Then roll up the two layers into a spiral shape. You should have a log whose cross-section is a two-tone spiral. You can keep this in the fridge, then carefully roll the log so it's slimmer, when it's about the right size you cut about quarter inch thick slices and bake them.

    Or you can roll it out to about quarter inch thick, cut out large shapes then use small shape cutters to punch out a shape. You can then swap the punched out shapes so you have a dark star now sitting inside a white biscuit and vice versa. Or you can bake the biscuits with half with a small punched out bit missing, then when they're baked sandwich them together with butter cream or jam so you have a little window on one side peeping at the filling.
    Or you can bake them with a cut out - but before baking, fill the hole with some coffee sugar or pieces of boiled sweets, and they will form a candy window (you need to use GOOD non-stick baking paper underneath though).

    These are good things to do together, mother and child, as well as getting the child to work with you to clean up their messes. You need to do both.

    I hope it helps.