Continence Issues

This week’s post has been inspired by a fairly innocuous seeming comment from a friend. He said, in reference to his newly adopted 2 year old, “he’s fully potty-trained now, day and night!”, with just the teeniest hint of competitive parenting lacing his voice. He’s rightly proud of the achievement but I have to confess that part of me thought “oh FFS!”. I think I managed a polite smile and no eye-rolling…

It is just that toileting is something of an ongoing situation here with Little Bear and, at 5 years old, we are fairly far from reaching the golden pinnacle my friend speaks of.

When Little Bear arrived, aged 3 and a half, he wasn’t toilet trained. His foster carers claimed it was because he “wasn’t ready” but in all honesty I don’t think they had really tried. Obviously tackling toileting wasn’t very high on our agenda in the first weeks of placement either, as bonding and behaviour issues were much more pressing. We also identified fairly quickly that we would need to sort out Little Bear’s digestion before attempting to get him out of nappies.

On his arrival he was taking prescribed Movicol for constipation and he created several very effortful and repulsive nappies each day. It was distressing to see the discomfort he was in and at night he seemed to be suffering from stomach cramps (he would writhe about in his bed whilst asleep and sometimes fall out). On reading the Movicol packet we established that this could be the cause of the pains.

We also observed that Little Bear barely ate any fruit or vegetables which might well be accounting for his sluggish gut. It was strange because I always assumed that during Introductions we would be given a list of food likes/ dislikes but we weren’t. When I pressed the foster carers on it they were vague, as though they didn’t really know what he liked. Either way, fruit and vegetables weren’t really mentioned or visible and whenever we gave them to Little Bear he certainly didn’t appear familiar with them.

Another observation was that when we first met Little Bear his tongue had a very unusual appearance: kind of lined and cracked looking. It looks normal now so in retrospect we have concluded he was dehydrated. We certainly didn’t really see him drink and if we tried to give him something he would only take tiny sips.

It became a fairly major priority of mine to get him to eat and drink properly, with the end goal of getting his digestion working properly without the need for Movicol. It was possible that there was a physiological reason for his constipation of course but we just weren’t convinced, given the other things we had noticed.

Tackling Little Bear’s diet wasn’t easy as we also had issues with getting him to sit at the table and actually eat. It turned out though that Little Bear would eat pretty much anything if it was mashed or pureed or hidden by gravy and if one of us would feed it to him. Looking back, it seems we might have still been at the weaning stage. The benefits were that I could get vegetable soup or pureed casserole or pasta sauce with hidden vegetables into him and he was having lots of tastes of different foods without knowing it. I also tried smoothie lollies which worked well until he got fed up of them.

It was difficult because Little Bear did and still does use food as a means of control and whilst I felt it was in his best interests to improve his diet, I was also wary of putting too much pressure on him to eat. I did do things like withhold chocolate or pudding until he had at least tried his proper food or eaten a few bits of veg. I know there are a lot of opinions out there about whether this is the right/wrong way to approach things but it turns out that healthy eating and the wider impact of it on health, alertness and behaviour was a big deal for me. It wasn’t something I could overlook.

I also found Little Bear’s behaviour at mealtimes one of the most challenging things to manage in a calm way. Everybody finds certain behaviours particularly triggering and for some reason this is what really pushed my buttons. I have had to work hard at finding a happy balance between meeting Little Bear’s nutritional needs and working on his table manners. As much as it pains me that he gets up every 3 seconds and will do anything but eat at the table, I have recognised that sometimes it doesn’t matter what else goes on, as long as he has eaten something. Little Bear is perfectly capable of feeding himself and sometimes he does so without issue but there are other times where no matter how infuriated I get, he just won’t. On those days it is more important that I swallow my issues and feed him, as then he will eat and if he has a full belly the world is generally a better place. I can just thank my lucky stars that he no longer screams, throws his food about the room or head butts the table.

Anyhow, after a couple of months, we had managed to successfully wean Little Bear off the Movicol and he had developed a regular, healthy bowel habit. It was around this point that we turned our attentions to toilet training. Little Bear knew when he needed a poo and was able to say so, so it didn’t take long to get him into the habit of using the potty. It would have been good, given he was nearly 4, to go straight to the toilet but he was quite wary of it so I went with what he was comfortable with and made that transition later.

It wasn’t long into potty use that Little Bear wanted “big boy pants” so we just went for it. In the early stages everything seemed to be going well. Little Bear was sorted with his bowel movements from day 1 and if we prompted him to go for a wee regularly we didn’t have too many wetting accidents. It was only when we tried to move on to Little Bear going off to the loo as and when he needed it that it became apparent there was a problem: he didn’t ever seem to need it. However, he clearly did as he was wet all the time. Little Bear didn’t seem bothered by this and didn’t tell us. I wasn’t always sure he was aware he was wet.

It feels to me as though some sort of developmental window has been missed so Little Bear has never developed the sensations warning him he needs to go and has grown so used to sitting in a wet nappy that being wet feels normal.

We have had to manage this by going back to regular prompting to help Little Bear stay dry, even though he is not always keen to comply with the requests. We have bought him a special watch, which you can set to vibrate at certain times to remind him to go to the loo and to help him become more independent in his toileting. I do think it’s good and I would recommend it but ideally your child would want to be dry and would be more motivated to do what it tells you than Little Bear. It worked well for us for a while but then he couldn’t help pressing all the buttons (even though it does have a child lock system) or constantly taking it off and losing it. As he is a little bit oppositional the fact that it was telling him to do something just made him want to do the opposite.

However, we have persevered and worked on Little Bear telling us when he is wet. If he does tell us, we praise him for that and try not to comment too much on the actual wet pants. He has made lots of progress with this and mostly does tell us now if he’s had an accident rather than us having to detect it from the smell!

We have also figured out that the first warning sign Little Bear gets is when a dribble of wee comes out. It appears that he can then stop the rest from coming until he chooses to release it. We are working on Little Bear taking himself to the toilet after the first dribble rather than just doing it in his pants. This is definitely improving and just this week, over a year into toilet training Little Bear has said a couple of times that he needs a wee and taken himself off for one. This is a big deal for him and I’m grateful that signs have started appearing to suggest we will eventually get there.

As we are not yet secure in day time dryness, we haven’t even thought about attempting night time dryness. Little Bear’s pull up is completely sodden in the morning and occasionally overflows during the night so I know he isn’t ready.

As with many things I write about Little Bear, none of this is his fault and I can’t help feeling sorry that he hasn’t been afforded the same chances as his peers, who were probably beginning their toileting journeys 12 to 18 months before he was. So, whilst I’m glad for my friend that his little one is gifted with exceptional bladder control I do wash a lot of urine-soaked clothes and bedding and hopefully you will forgive me for also being a teensy bit irritated by his comment.

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Continence Issues

4 thoughts on “Continence Issues

  1. Well done Little Bear. Sounds like he’s getting there in his own time. Potty / toilet training can be so hard, and when it is, it can feel like you’re very alone trying to cope with it while everyone else seems to be finding it a breeze. The thing that annoyed me the most when our daughter was struggling was people saying “she’ll get there when she’s ready”. But actually it’s true. Little Bear will get there with your help and guidance and it sounds like you’re all doing a brilliant job.

    Liked by 1 person

  2. Hi there. We had loads of toileting issues and food issues. We had shares in Movicol and the issues afterwards. Things did take a long time to settle, because they were deep rooted and trauma related. We now have the teen issues of food being an inconvenience and wanting to eat rubbish all the time and late at night. It’s an on going saga, but am trying to put routines in place and family meal times – difficult when they are never in! Well done and hang in there.

    Liked by 1 person

    1. The issues just change with time don’t they?!
      Thanks for the comment. You are always so lovely with your sharing etc. Things sound very challenging at your end sometimes, it’s so generous of you to take such an interest in everyone else xx

      Liked by 1 person

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