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Older Kids with Bathroom Issues: Why Does it Happen? How Can You Help? Part 2

English: Typical Male Restroom in the U.S.

English: Typical Male Restroom in the U.S. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

In last week’s post, we looked at the possible origin for encopresis (soiling after the usual age for toilet training) and enuresis (wetting after the usual toilet training age) in older children with a history of trauma and/or neglect.There is something about an older child wetting or soiling themselves that can send parents into a fury, especially if the incident is perceived to be intentional. This is understandable. We all have buttons, and a big one for many of us involve the transmission of germs whether it’s via spit, mucus, vomit, urine or feces, we don’t want to be around it!

In this week’s post, now that you have a theory from last week about where the issue originates, I want to help you to figure out what to do to help your older child, who will often experience shame as a result of the incident. If you have any questions about implementing any of these strategies, I hope you will ask in the comments section, or discuss it with your child’s therapist.* One of the reasons I am writing this post is because there are very few therapists who specialize in this issue, so if your child’s therapist is not familiar with it, please think about printing out and taking in this article.

As I stated in the first post on older children with bathroom related problems, the first intervention is always to follow the suggestion of your child’s physician as we do not want to fix a broken bone with a band-aid and some medical intervention may be necessary. As sensitive as I know parents are about this issue, children are also very sensitive about it, even if they pretend to be aloof. In fact, I know one of the beliefs parents have that send them into a fury about older children wetting and soiling, is that their child does not even care about the fact that they are doing it when, in reality, often children that have this issue are experts at covering up their feelings so you do not know how humiliated/ angry/ frustrated they are.

Before I give you suggestions, I want to give two important guidelines for all the interventions I use with children. My number one guideline is to follow the PLACE parenting attitude whether your child has attachment disturbance or not. The second is to make sure your child is primed to receive help from you. What I mean by that is, ask your child if they want help. If they say “no,” DO NOT OFFER IT. When you offer children help and they don’t want it, you are only listening to yourself talk and asking to be frustrated. If you offer it, then back off. After you child has refused a couple of times and their refusal has been listened to and honored, their curiosity begins to take over and eventually they ask you what help you have to offer. Then, and only then, are they open to receiving and they will be primed to listen to your advice.

With that said, here is a list of ways I have helped children with enuresis and encopresis:

1. Especially if you recently adopted or started fostering your child, do not panic! You may have a child who is looking for buttons to push to get you upset or make you reject them. If you have an upset reaction, they may see that it gets a rise out of you and will be more likely to continue. Without over-reacting, try to employ natural consequences, i.e. the child has to clean up the mess as appropriate for their developmental age. Remember to use your PLACE attitude, which means that humiliation and embarrassment of your child are not acceptable consequences. In fact, with a child that would purposefully wet or soil themselves, humiliation and embarrassment may actually reinforce the behavior in ways you did not anticipate. To better understand this concept you can read my Caught in the Loop post.

2. My first suggestion for someone with a child with ongoing problems of this nature is therapy. While my sample is quite skewed, I have not seen any children with this issue that did not experience a feeling of fear about the problem, often accompanied by humiliation, even if the behavior is perceived to be intentional by their parents. While moms and dads can be helpful in navigating those feelings, therapists are trained to add an additional and necessary layer of help. Also, as you well know, children are often more motivated to do something someone else suggests over the suggestion of their parents. You know your children do things for their teachers that they would not do for you and bringing the issue to the child’s attention while in therapy often gives a child an extra bit of motivation to work on it. Additionally, if your child has a history of trauma this includes the bathroom in any way, it is important for them to be able to process this history with a trained professional.

3. My most successful intervention in the area of helping older children with encopresis and enuresis is to reintroduce the idea of toilet training. Before you skip this idea because you think your child is too old to re-potty train, let me tell you that I have used this with children in their early teens with success. The reintroduction is delicate and goes like this (and, as I say in many of my posts, the tone is important…think about how Mr. Rogers would say it):

“I wonder if when you were younger and didn’t get what you needed, you might have missed out on some of the signs your body gives you when you need to go to the bathroom.”

It may take a few times of gently suggesting this to your child for them to begin to get curious with you. Suggest you could help them to learn how their body knows it needs to go. Think about this. Your body knows it needs to go when your bladder feels full. I teach kids to playfully ask their bladders out loud in my office, “Bladder, do you have to go to the bathroom?” You would be amazed how many children have quickly realized by asking that question that they do, indeed need to go…right then…and we end up taking a quick restroom break.

You can also point out that sometimes you have been able to tell when your child needs to go and that when kids are young and have parents that take good care of them, the parents often point out when a child is doing the potty dance. For some kids, we come up with a signal that the parent can make, rather than asking out loud in public whether a child needs to go. This works well with a child who has a history of being shamed or traumatized in relation to going to the bathroom,or who was never potty-trained appropriately.

4. An additional technique to use with children who were not properly potty-trained, is to teach each your child about controlling their bowels. One way I do this is to have children picture a balloon full of water. I tell them to picture the balloon turn over so that the opening of the balloon is on the bottom. If you are using your fingers to pinch the balloon, it is like the muscles around your bladder holding the pee or poop in. If you were to let go with your fingers, you would see the water come out of the balloon. For some balloons, you would have to give an extra squeeze from the top to empty it out. Bladders can be like this too. When I work with kids with issues controlling their bowels, I suggest to them that they picture the balloon as their bladder every time they need to go to the bathroom. Muscles hold the urine until you get to the toilet, then they let go and we make sure your bladder is emptied completely. For kids with urinary issues that are feeling brave, I also suggest kegals, where they start urinating, then try to stop the urine one or two times every time they go in order to build up the muscles (consult with a physician to make sure this is a good idea for your child).

Also, and many adults do not know this, there is a right way and a wrong way to empty your bowels. To most easily and completely empty your bladder, teach children to sit, leaning forward with their forearms resting on their thighs. Have a small stool near the toilet so children can put their feet on the stool making it so their knees are higher than their hips. This will help kids that hold onto stool and urine, to most easily and quickly relax and let go when they are going to the bathroom.

5. For kids with bowel issues, especially kids that hold it until it gets painful, I teach a quick exercise to help them control bowel functioning. This is good for relaxation as well. Lie on the floor and counting slowly to five, suck your belly in. Picture your belly button touching your spine. Then, again to a slow count of five, push your belly out until your belly button is actually sticking up. See if you can make the pulling your belly in, equal in time to the pushing of your belly out. Ideally, kids who are learning to control their bowels will do this exercise for 3 minutes a day. The typical response I get from kids when I teach them this exercise and they actually do it in my office is a moment afterward when they start to get excited (like the potty dance) then a request to go to the bathroom. Success!

For children where this does not work, see about helping them find a Pilates class in your area. Many of the Pilates exercises, strengthen the core and pelvic muscles allowing for greater control.

4. I find the toughest kids with bathroom issues are typically the ones who are doing urinating and soiling on purpose, although often the times they do it are few and far between. As I recommended in my previous post on this issue, it is important to figure out the why, but really the intervention for purposeful urinaters and soilers is to make sure they are in therapy with someone who works on teaching them to state their feelings. Often these kids need remedial learning in the expression of feelings, and, while parents can do some of this, a child therapist will have the training to find ways that work for your child to teach them the proper expression of big feelings. Sometimes this means helping them to understand that they will not be harshly punished for the expression of their feelings, and others it will mean having a therapist identify that your child may be experiencing a traumatic reenactment.

I know that this is a sensitive topic for many families and people do not want to be identified by leaving comments, however, if you have questions, or a suggestion that works that I forgot, please let me know. You can feel free to leave a comment or to contact me privately via email: helpforyourfamily@gmail.com

*see disclaimer

January 31, 2013 Posted by | attachment disorder, child development, discipline, mental health | , , , , , , , | 1 Comment

Parent Affirmation Monday- 10/29/2012- Love

English: In the End ...

English: In the End … (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

This week we are focusing on the second of the parenting characteristics detailed in the PLACE attitude, loving. While it may seem simple to say we must always strive to parent with love, as parents we know that can be hard at times. I find the matter to be simplified if I focus on the true intent behind my interactions with my children, without being side-tracked by the other details.

Take chores as an example, yes, I do want my children to help with the dishes but what is behind that desire? Sometimes the desire we are most connected to when we ask is the desire not to do the dishes ourselves, but we also know that there are times we ask our children to do a chore that we could easily do in less time, with less effort for the child, and less effort for us. So why bother to ask children to do chores at all? Of course we do it because we want them to grow up to be contributing members of society and to any relationship with others. Why do we care about that? Because we love them and want our children to be happy and proud of themselves as they grow into adults. Boiled down to its most essential qualities, our direction toward our children comes, for most parents, from a place of love because we care about them and their happiness.

There are ways to phrase requests or instructions that help our children to know that we are coming from a place of love. One of these ways I detailed in my post, End the Hassle! Tell Kids What They Deserve, in which I describe how to tell kids they deserve a clean room, safety, a healthy body, less stress about school (i.e.- do your homework), etc. Some other statements that put love first with your children:

I love you too much to argue with you about this.

I love you more than I care about what you accidentally broke/spilled/ruined.

I don’t want you to feel any worse than you are going to feel about talking to me this way, let’s both cool off in a separate room…

I love you.

You are special to me.

I was thinking about you today.

I think you get the picture. This weeks affirmation is:

I am loving and loveable and I honor my love for my children by showing them with my words and actions.

Remember, the more you say the affirmation, the truer it becomes for you. If you find yourself slipping, remind yourself that is how you used to talk to your kids before you figured out this way of talking. Forgive yourself, because you probably learned how to talk to yourself and your children the other way from your parents, who learned it from their parents, and so on. Congratulate yourself on trying something new. Good luck!

October 29, 2012 Posted by | affirmations, help for parents, parent support/ self improvement, Parenting | , , , , , , , | 3 Comments

Preparing Children for Major Transitions

Summer Camp 2010

Summer Camp 2010 (Photo credit: Olds College)

Written by, Kate Oliver, MSW, LCSW-C

It’s summer.  Anyone with a child in school recently has, or is about to experience a major transition from having the school routine schedule to a summer schedule.  Perhaps your children have camps, vacations, different childcare arrangements, or long stretches of time at home, or, if you are like my family, a combination of all of those depending upon the week.  Even though summer can be a time of excitement and activities that children love, remember, even something exciting can be stressful.  To illustrate this, think about the last time you went on vacation.  Did you experience any stress before you went away?  Did you worry you were going to forget to pack something?  Did you have to work to make sure you stayed in budget or planned accordingly for activities vs. rest?

Even though your child does not necessarily have the same stressors you do, they have others.  Their stressors may include concerns like whether any other kids they meet on the trip or at camp might like them, whether this is going to be a fun place to go or not, whether the rules will be the same or different for them than what they are used to, whether they will have the food they like to eat on the trip, and what to expect next.

The adopted children I see can often have additional concerns such as whether someone from their birth family might spot them (I have heard this even from children adopted at birth), whether people in public will spot their family and ask why they look different or whether their family will be accepted.  They may worry if they are going to see relatives that they feel treat them differently from children born biologically into the family, or that their adoptive family is planning on leaving them in the new location.  Many of the children I see have the additional worry about embarrassing themselves by wetting the bed or their pants during the day if that has been a problem for them.

So, how can we prepare children for all of these transitions?  Here are a few tips to get you started.  The first few are for everyone, then I have a few special tips just for people with children with attachment issues.  Remember, every child is different.  That is why I am giving you several suggestions.  I encourage you to use those that feel right for you and your child.

1.  Prepare your child by telling them in a matter of fact way about what to expect.  For example: “Remember, you are going to camp tomorrow, I don’t know if you will know any of the kids there but I do know Ms. Suzie from last year will be there again.  I’m going to pack you an apple and some cereal in your lunch instead of a peanut butter sandwich because the camp does not allow peanuts in your lunch.”  Or, “We are going to Grandma’s.  Remember, we went there last year and you slept in the same room with your cousin Joey.  Sometimes you got to go to bed later and one night Aunt Cindy is going to watch you while Mom and Dad go out.  If two adults tell you two different things to do, I want you to come ask me if you are confused.  If I’m not there, I will always let you know who is in charge.”  You may need to break this information up into several conversations if you have a child that has difficulty taking in too much information at once.  I also like to ask children what they heard me say so I can hear them say it back and confirm that they heard what I think I said so I know if they got it.

2.  Always let children know who is in charge if you are not with them.  Meet the camp counselor, introduce your child to them and point out that that person is in charge.  “She’s in charge of this camp and I expect you to listen to her.”  Or, “We are going out and you are staying with Nana and Pop, I expect you to listen to both of them.”

A side note about tone here: I am not suggesting any kind of accusatory tone.  I always recommend a matter of fact, friendly tone that takes into account that our children are little humans with feelings.  I could see the above statement being said in an accusatory way and I hope you will refrain from that as much as possible.  If you have a child that has attention or attachment issues making it possible that they were not hearing you, or that they will pretend they did not hear you later, you can have them repeat it back.  Make it a game: You: Who’s in charge?  Child: Ms. Jenny’s in charge.

3.  Talk to your child about any transitions before they happen a few times so you can figure out if your child has questions that are causing anxiety so that you can get answers for them.  It is difficult to predict the ways in which children will formulate stories to fill in the gaps in their understanding.

When I was around 13 and my youngest sister was five, my family moved to a house about five miles away from the home we were living in.  I remember one night at dinner, we were talking about the move and someone asked my sister if she was excited to be moving.  She hesitated and got a little teary, then blurted out, “Yes!  But, I’m going to miss you guys!”  Remember, even if your child has made this transition before, it may only be their second or third time doing it.

A year in the eyes of a child is infinitely longer than a year in the eyes of an adult.  For a 33-year-old, a year is 1/33rd of their lives, for a four-year old, a year is 1/4 of their lives.  That’s a big difference.  A lot happens in the year of a child, and going somewhere, like a camp or vacation, where they have not gone for a year still qualifies as a major transition in their eyes.

4.  While you are making sure that you are talking about the upcoming transition some, I want to caution you to refrain from talking about it too much.

Recently my family and I went for a vacation weekend to a child friendly hotel/amusement park.  While we were there, my husband and I walked through the lobby where there was a show going on.  The show had animatronic characters singing a song.  I can only assume the song was called “There’s Nothing to Be Afraid Of.”  I assume that was the title of the song because the characters sang that line at least twenty times in the short time we were walking through the lobby.  I turned to my husband and remarked that while I was not scared before, I was thinking I might need to be scared now!  After all, why are they so adamant about telling me that there is nothing to be afraid of unless there is, in fact, something that might be kind of scary?

My point is, I have seen many parents who are worried about their child’s response to something new, prepare their child by talking about it endlessly.  A child who might not otherwise have been so worried, can then become fearful and put more energy and focus more anxiety on this thing Mom and Dad seem to be so worried about…it must be big.  Discussions about a transition need not be endless, just check-in, answer questions gently and matter-of-factly, and refrain from shaming or embarrassing children for asking what you think is a silly question.

I have two additional tip for parents with attachment disturbed children:

1.  Attachment disordered children still need safety and predictability, however, be mindful that they can often find ways to mess up vacations for themselves and put extra strain on the family by acting out when they are anxious.  Often a child worries they will mess up a vacation until they torture themselves internally about it so much that they go ahead and get in trouble just to get it over with.  Depending on your child, you may want to keep some things about a vacation private until just before they happen and to keep your plans flexible.  For example, say you have decided to go to a water park for one day during the vacation.  If possible, give yourself a window of days and times to go.  That way if your child is having a rough day you can just go the next day so they do not feel you are taking it away because they ruined things.  Then, on the day you do go, you can tell your child that morning or even on the way there and field questions as they come.  Children with attachment issues can get overly anxious and have temper tantrums as their anxiety builds and giving them a few surprises can actually save them from this anxiety in the long run.  Reserve this for things you are all doing together, do not surprise your child by telling them you are leaving them with someone else, even someone else they like.

2.  Be mindful that as you tell a child your expectations, you are not also handing them “the keys to the kingdom” as one of my colleagues likes to say.  What she means by this is that attachment disordered children are interested in what makes you the most upset so that they may use that against you whenever they are feeling anxious, insecure or fearful.  Be careful that when you are telling them your expectations as detailed in the suggestions mentioned earlier that you are not also highlighting the things that will annoy you the most if they do them.  “We are going to grandma’s and she is making cookies.  You may have two.  I expect you to use your manners.  If there is something you would like to have, please let me know so I can tell you if it is okay,” is very different from, “We are going to Grandma’s house.  No stealing, no lying.”  The first example encourages children to meet expectations, the second informs the children of the ways they can disappoint themselves yet again.

For all children, stating what you do want is always preferable to stating what you don’t want.  If I told you not to look at the title of this post, what is the first thing you think about doing?  Reading the title of course!  However, if I said to you that I hope you keep reading this post to the end, where is your attention?  Children are the same way.  High energy children, and attachment disturbed children are like this more than others and if you say, “Don’t steal,” their little minds say over and over, “Don’t steal.  Don’t steal.  Don’t steal.” until they have thought it so hard they find a chocolate bar in their pocket that they really may not have meant to have there.  If you give a child another thought such as, “Ask me if you want something,” and they say this over and over in their heads, even if it does not always work out, it plants a better seed in a child’s mind.  The more seeds like that you plant, the more likely they are to take root.

What are some transitions your children are going through?  Are there other ways you help your child with major transitions?

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June 21, 2012 Posted by | attachment disorder, child development, help for parents, Parenting | , , , , , , , | Leave a comment

Delighting in Children Who are Not Used to Delight

Cover of "Feelings"

Cover of Feelings

Written by, Kate Oliver, MSW, LCSW-C

When I speak to parents of children with attachment related issues about trying to delight in their children, I hear a couple of common responses.  The first response is that, to be honest, their children are not all that delightful.  The parents I work with have children that lived their first several months or even years with a marked lack of being delighted in, so, because they do not know any better, they do not desire to be delighted in and, rather than feeling good, being delighted in can actually be scary, or intimidating to the child.

Even if you can find a moment of delight during the day, for parents with children with insecure or disorganized attachments I hear that they, the parent, often experience repercussions, sometimes extreme repercussions, (like the kids I have known who have taken what was otherwise a nice day and ruined it by destroying something their parents loved by, say, urinating on furniture on purpose, or cutting up a cherished item) soon thereafter.  I also have parents tell me that allowing themselves to delight in their child leads to the child becoming more demanding because the child either believes that if they do something to make their parent happy they should get some immediate reward, or the child feels good and falsely believes that the good feeling comes from something outside of them (such as the item they were delighting in or an amusement park ride).  In an attempt to continue the good feeling, the child demands more and more of the parent until the parent is sorry they delighted in the first place since they have such an ungrateful little so and so.  While some of that feeling is normal for any parent, for this post, I am focusing on those parents with a child on the far end of the attachment disordered spectrum.  All children test limits sometimes and may engage in some of these behaviors, but attachment disordered children do this as part of an ongoing pattern of behavior, rather than as a part of the normal limit-testing all children do.

What is a parent to do?  If you have a child that engages in the above mentioned behaviors when you try to delight in them, I have a few reminders to help you stay sane and remain in a place of loving kindness toward your child.

1.  Your child may not know how to share a good feeling.  In other words, due to early neglect and/or trauma, your child may not have developed the understanding of how to share good feelings with others.  They may have what I have heard called “scarcity thinking,” meaning that only one person can feel good at a time and, because they may not also have had a chance to develop empathy, they decide the person feeling good is going to be them.  Because they did not have an early environment of shared good feelings, they just do not know how to, well…share good feelings.  Remember too, that having someone notice them may have had a very different meaning for them and the meaning may not have a positive association for them.

2. Your child may not know how to experience delight.  Remember the neuron transmitters from my previous post?  Your child did not get that so, guess what, you get to teach them!  This would be a good time to review my post about chronological age vs. developmental age.  No matter the chronological age of your child, their developmental age is quite a bit younger.  How do you teach a child delight?  Like this: say something along the lines of (with a tone like Mr. Rogers, remember him?) “Look at us!  We are so happy together!  We are feeling the same feelings at the same time!”  Allow the feelings for a few moments but, as you observe your child beginning to take it over the top, in the same tone, “Sometimes I wish we could feel so happy all the time, but feelings come and go don’t they?  It was so nice to have that good feeling.  It looks like we are going back to the regular feelings now and that’s okay.”  In this way, you are teaching your child about the normal ebb and flow of feelings, and building in normalcy about delight to address the first reminder, that all feelings are around for a little while, then leave, then come back again, and that is part of being human.

3. It takes many, many encounters for a child with attachment issues to actually learn how to genuinely delight.  While a baby is primed for good feelings and eagerly absorbs them, they do that because they are also open and actually vulnerable.  When a baby learns to delight, their vulnerability has paid off.  For your child, the vulnerability did not pay off, so they stopped allowing themselves to feel vulnerable.  Remembering this can help to ease the frustration for a parent that says, “But she’s lived with me longer than she lived with them!  When is she going to learn that we are safe!”  The answer is that she will learn to feel safe if we can capture the moments where she allows herself to be vulnerable, and during that quick window, you prove to be a safe and loving person.  You prove this by maintaining a playful, loving, accepting, curious, empathic (PLACE) attitude as much as possible so that each time that window opens a little you enhance the opportunity for growth and change in your child, so that next time the window opens a bit farther for a bit longer until, eventually, it stays wide open.

4.  Think of the alignment of the planets in our solar system.  If one planet were to be knocked off-balance, the others pull it back into place using their gravitational pull.  Similarly, for your child, when they come to you having become accustomed to being the “problem child” then you treat them as if they are not, they seek familiarity (they realign the planets as they know them) by doing something to make you as angry as they are used to parents being.  We call this seeking homeostasis.  I find one way to help if you have a child who does this is to name what is happening.  In a matter of fact, gentle tone, I would suggest saying something along the lines of, “Having fun can make people uncomfortable or worried sometimes.  I think it makes you feel that way.”  Or, “I am so sad when you are too scared to let yourself be happy without making yourself pay for it later.”

I find we can be most compassionate when we can look to the origin of the issue rather than taking the response of our child personally.

If you have a child with a history of attachment issues, what have your experiences been with delight?

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June 15, 2012 Posted by | attachment, attachment disorder, help for parents, Parenting | , , , , , , | 6 Comments

   

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