It's Not Your Fault!: Strategies for Solving Toilet Training and Bedwetting Problems

It’s Not Your Fault!

It’s Not Your Fault!

Strategies for Solving Toilet Training and Bedwetting Problems

Joseph Barone, MD

Rutgers University Press

New Brunswick, New Jersey, and London

Library of Congress Cataloging-in-Publication Data

Barone, Joseph, 1959–

It’s not your fault! : strategies for solving toilet training and bedwetting problems / Joseph Barone, MD.

pages cm

Includes bibliographical references and index.

ISBN 978–0–8135–6992–5 (paperback) — ISBN 978–0–8135–6993–2 (e-book)

1. Toilet training. 2. Enuresis. I. Title.

HQ770.5.B37 2015

649'.62—dc23 2014017495

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2015 by Joseph Barone

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 106 Somerset Street, New Brunswick, NJ 08901. The only exception to this prohibition is fair use as defined by U.S. copyright law.

Visit our website: http://rutgerspress.rutgers.edu

Contents

Introduction

About Me

About This Book

Chapter 1. Toilet Training Ingredients

Understanding your child’s urinary system

The journey of a drop of water

The kidneys

How much water should my child drink?

The ureters

The bladder

How to determine your child’s proper bladder size

The urinary stopper muscle

Review of the basics

Chapter 2. Toilet Training

What You Need to Know to Toilet Train Your Child Successfully

Why is development important for toilet training?

The evidence behind breastfeeding and development

Evidence-based potty training information

The history of potty training

Why are children potty training so late?

The parent-directed versus child-directed method of toilet training

What is the ideal time to toilet train your child?

How to spot signs of toilet training readiness

The most important thing to know about toilet training

How to Toilet Train Your Child

The basic equipment of toilet training

Daytime potty training

What about day care?

Nighttime potty training

What to do when things go wrong

Chapter 3. Bedwetting

How to stop bedwetting and become a bedwetting slayer!

How common is bedwetting?

Can bedwetting be treated?

Why do some parents wait so long to treat bedwetting?

How long does it take to outgrow bedwetting?

Bedwetting fact and fiction

Bedwetting alarms

How does the bedwetting alarm work?

Types of bedwetting alarms

Bedwetting companies

Before you begin to use the alarm

My secret method for stopping bedwetting

Is your child a zombie?

Wake up your zombie

Give your zombie a code word

Chapter 4. Daytime Wetting Problems

Basics of day wetting

How common are daytime wetting problems?

Urinary frequency and urgency

Lazy bladder in children

Giggle incontinence

Daytime potty problems could mean toilet training is incomplete

How to stop daytime potty problems in your child

A timed voiding strategy that works

Chapter 5. Medications

Nighttime urinary control medications

Desmopressin

Imipramine

Medications for daytime potty problems

Anti-cholinergic medications

Oxybutynin

Tolterodine and solifenacin

Oxybutynin patch

Alpha blockers tamsulosin and doxazosin

Antibiotics

ADD medications

Anti-inflammatories

Chapter 6. Tests and X-Rays

Urine analysis

Urine culture

Ultrasound

Biofeedback

Uroflow

VCUG

Urodynamics

Chapter 7. Bonus Expert Interviews

Dona Schneider, PhD

Eileen Creenan, RN

Patricia Whitley-Williams, MD

Chapter 8. Alternative Treatments

Are there good alternatives?

Acupuncture

Enemas

Hypnosis

Chiropractic

Chapter 9. Common Questions from Parents

Toilet training

Daytime wetting

Bedwetting

Conclusions

Glossary

Additional Resources

Index

About the Author

Introduction

It’s not your fault! That is what I tell frustrated parents who visit me because they are not able to toilet train their child. In most of these cases, the parents followed well-meaning but generally bad advice they discovered in a parenting book, on the Internet, or during a popular TV talk show.

Once, a mother of a thirteen-month-old told me that her friend, who regularly beat her at tennis, trained her perfect eleven-month-old by holding the baby over the toilet until blastoff. When the losing tennis player tried that method with her thirteen-month-old, she was crushed because that method did not work for her. She felt like she did something wrong and somehow failed her child and lost to her tennis friend yet again. Of course, I told her, It’s not your fault. After all, she did not do anything wrong, she was just given well-meaning but bad advice from her friend. This advice may work well for one person but not for another.

In this book, I want to provide evidence-based advice and share my twenty-year experience as a pediatric urologist. Evidence-based advice means that the advice is based on science and facts. It means that it is more than just someone’s personal opinion—it is advice based on testing and research. Evidence-based advice is the best advice available, and you should demand the best advice for your child. When advice is evidence based, it should work for many people, not just for one person, as in the tennis player example.

I am not only a pediatric urologist; I am also a father of four with a perfect toilet training batting average, and that did not happen by accident. I know my recommendations for toilet training work because they have been tested and have proven to be effective in the real world, as well as in a research setting. In fact, for the last ten years, I have spent thousands of hours gathering the large amount of information that is contained in this book. I want to pass that information on to you. And because my recommendations are evidence based, they work for everyone, not just that one tennis player.

The reason a lot of information on toilet training is misleading (or just plain wrong) is because very few scientific studies have been performed to help us better understand toilet training. Did you know that there are thousands of scientific studies on asthma but less than a few dozen studies on toilet training? With that kind of knowledge gap, we should not be surprised that, each year, over seven million children develop some kind of toilet training problem, like delayed toilet training, day wetting, or bedwetting. All of these common problems are discussed here, and following the toilet training advice in this book will prevent many of these problems from occurring in your child. In many cases, these problems could have been prevented if parents had access to evidence-based toilet training information instead of someone’s personal opinion.

Even though toilet training is a natural process, understanding some simple but important facts will allow parents to successfully and quickly train their children and avoid mountains of problems and years of disappointment. I am excited to share the information contained in this book because it has resulted from a lifetime of work, study, experience, and fun. The message I want to get across is that all parents can successfully and quickly toilet train their children, provided they have the essential, evidence-based information I provide here. And, if things do not go according to plan and a potty training problem occurs, you are covered: this book will tell you how to deal with common potty training problems like bedwetting or daytime wetting.

About Me

I would like to tell you a little bit about my training and experience so you can understand where—literally—I’m coming from. I am chief of pediatric urology at Rutgers–Robert Wood Johnson Medical School, located in New Brunswick, New Jersey. This position allows me to research urinary control problems in children and to find and develop new ways to think about these problems. I am like a detective trying to solve a mystery. I am also surgeon-in-chief at the Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital, also located in New Brunswick. It is there that my colleagues and I have our pediatric continence center and where we have treated thousands of children with urinary control issues, from the most common to the most complex.

I think that a person’s background and experience can really influence how he views things, and they affect the way he responds to different situations. Understanding a little bit about me personally might therefore help you understand how I have developed the concepts and recommendations that are contained in this book. I also want you to be able to see me as a person, not only as a professional writing a textbook. I would like to connect to you on a personal level because the main purpose of this book is to help you properly toilet train your child and also to help you overcome any toilet training problems your child might have or develop in the future. I want you to feel confident and comfortable with my recommendations so you can take charge of the situation and make things better for you and your child.

As I mentioned in the introduction, I have real-life experience in toilet training as a father and husband. My wife Anne Marie and I have successfully toilet trained our children following the simple principles outlined in this book. I admit that we are at somewhat of an advantage since I am a pediatric urologist and Anne Marie is a registered nurse, but the purpose of this book is to transfer that knowledge to you so that you can be equally successful in your home with your family.

I am fully trained and board certified in adult urology and pediatric urology. But I practice only pediatric urology, and almost 40 percent of my practice has to do with the management of children with different types of potty training and urinary control issues. These potty training issues might include problems like delayed toilet training, daytime urinary wetting, and bedwetting. This means that I have treated thousands of children with all kinds of urinary control issues over the years. There is virtually no problem that I have not seen and treated. I will address the more common of these problems in this book, and I will provide you with the same information and detailed advice that I provide to parents who come to my office for a formal consultation.

For the last fifteen years, I have also been medical director of the Pediatric Continence Center at the Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital. I developed this center fifteen years ago because I saw a need to have a place where common toilet training problems and questions could be studied and treated. Toilet training problems are very common, even if they are not talked about that much. Let’s face it, talking about your child’s potty training problem does not make for the best teatime conversation. The Pediatric Continence Center provides a place where these very common problems can be openly discussed and addressed.

Our Pediatric Continence Center is now a major referral center for children with all kinds of urinary control problems, and we have specialized equipment and testing abilities at the center to examine children in more detail when necessary. You will learn about these tests later in the book, but I hope you will never need our services. The nursing director at the center who helps me care for our patients is Eileen Creenan. Eileen is a pediatric urology nurse with decades of experience treating children with different types of urinary control problems. We will hear more from Eileen later on this book, where I interview her and get a nursing perspective on common toilet training problems. She has managed thousands of children with me over the last fifteen years.

In addition to my experience as a pediatric urologist and clinician, I have written hundreds of scientific papers and done research on toilet training, daytime wetting, and nighttime urinary control problems in children. This is the evidence-based information that I mentioned in the introduction, and I often refer to it throughout this book. Some of my research provides the only evidence-based information available to help us understand toilet training and urinary control problems in children. It is truly valuable information because it is based, not on opinion, but on facts.

I started to do research in this area because there was a real need for good, solid evidence-based information on this topic. Even though toilet training is an important topic and a major milestone in child development, there have been very few studies done to understand how a child gains urinary control and what to do when things go wrong. I wanted to fix that situation by studying this topic and writing about my findings in this book. The research that I have done in the past has been evaluated and published in prestigious scientific journals. I would like to present that information to you using language that is understandable to moms and dads who may not be medically trained, parents who wish to properly toilet train their child or who want to help their child overcome a toilet training problem. I would like you to trust the evidence-based information that is presented in this book because it is backed by high-quality research and is not just a statement of personal opinion.

Because I have treated so many families whose children have different types of potty training issues, I understand how difficult these problems can be. I understand that hearing someone say that your child will outgrow a potty training problem can be frustrating. I know that most children and parents want these problems to go away as soon as possible and don’t want to wait years and years for the child to outgrow the problem. I have also seen parents become frustrated simply because there was no place to turn for good solid evidence-based advice or reliable information.

I have seen thousands of potty training problems cause difficulties for families, problems ranging from teasing between siblings to arguments between parents that have led to divorce. Yes, it can get that frustrating. Understandably, parents can grow apprehensive when their child cannot toilet train, and they may start to blame the child, themselves, or each other for the problems they are experiencing. These types of feelings are not abnormal, but they are not appropriate, either. It’s not your fault, but it’s not your child’s or spouse’s fault, either. I hope that by reading this book you will be able to successfully toilet train your child and to also better understand why your child might be having a potty training problem. The information that is contained in this book will put you in a better position to help your child potty train; it’s that simple. As you read this book, remember that the title is It’s Not Your Fault. I selected this title because, if your child is having a toilet training problem, I want you to remember that it’s not your fault. It’s not your fault because you did not do anything wrong, and it is likely that no one ever told you what you needed to know in order to train your child properly. It’s not your fault if no one ever told you what to do if a toilet training problem occurred in your child.

You will learn in this book that your child is not having these problems because he or she is lazy or acting out. Your child does not want to have these potty training issues, but he or she may just not be able to train from a developmental standpoint. This book will help you understand what’s going on so you can direct your energy on making the problem go away, rather than focusing on things that don’t matter and can be potentially hurtful.

I don’t really want to spend much more time on my background, but I do feel it is important to at least briefly describe myself to you. I want to share my experience with you so that you understand that this book is based on years of scientific and clinical experience and not just my personal opinion or another review of the information that is available on the Internet. This