4 Year Old Having accidents--Help!

Hi M.! I wanted to let you know you are not alone. I see a lot of posts from moms about this issue and we have a 7.5 year old son that has had constant wetting issues his whole life. In fact I have posted on this topic several times over the past few years- below I have copied and pasted the "what happened" from one of my posts from 2008 and hopefully it helps you.

"it has been a while since I posted and boy, how things have changed. I think this is a good time for me to add on to the "what happened" section.
I finally took my boy to a pediatric urolgist. We has to drive down to Primary Childrens Hospital in SLC. With insurance, we didnt even have to pay anything for the apptmt!
The doctor put him on a voiding schedule, every 2 hours. We had to remind him every 2 hours to go to the bathroom, no matter what. We had a chart by the toilet so he could mark off each time he went. If he went at each appointed time that day, he got a treat. the doctor recommended a daily reward and suggested that at age 5-7, they are too young to be motivated by a long-term reward. She also recommended no punishment. If he had an accident, just remind him to change clothes is all.
This is a medical issue, in a nutshell the child has "held it" for so long and so many times that the bladder muscles bulk up. over time, the bladder wall may reach 2-3 times normal thickness because of the enlarged muscle fibers. it now becomes difficult for the child to hold back such a powerful bladder. the voiding schedule not only helps avoid accidents and reminds them to take time out of their busy play schedule, but also helps relieve those bladder muscles so they can start getting back to a regular size.
We bought a 10.00 watch for my boy and taught him how to set the alarm for every 2 hours, also talked to his teacher so she knew he needed to be allowed bathroom breaks whenever needed, and i requested a classroom schedule and told him over and over at what times he needed to go to the bathroom each day. As a result, he rarely has accidents anymore. This changed from 3-4 accidents daily over the last few years to maybe 1 accident every 2-3 weeks. He still wets at night but I have been told this is a seperate issue and also that about 75% of the time once the daytime issue is resolved, the nightime accidents will go away in their own.

I should also add that the medications (oxybutinin) my pediatrician had him on apparantly do more harm than good in this particular situation. Oxybutinin is good for children who are experiencing "urgency" as it makes the bladder less sensitive, however this is NO GOOD if the problem is your child cannot actually feel when he or she needs to use the bathroom!"

Added on: the wetting during the day WENT AWAY the day we moved. We had been trying to sell our house for 2 years and my husband worked out of town and was rarely home. Seriously, as soon as we moved, we stopped having problems! I don't know why, maybe my son was stressed. He will have accidents though if he gets very involved with something, such as video games, so we had to take away video gaming because that is the only time he wets (besides at night, which is a seperate issue and we are just waiting for him to outgrow it).

Please feel free to private message me if you need to, you can also look back through my questions and there is a lot of good feedback on there.

I'd definitely stop making her go every half hour. She needs to understand for herself when she needs to go if this is ever going to resolve. She also needs the chance to develop better bladder control.

Try leaving her to decide for herself for a few weeks, accept there will be some accidents, then see what happens.

how frustrating! have you tried letting nature take it's course, so to speak - she has an accident, if you're out and about, she has wet pants until you can get somewhere she can change. she cleans up the mess, she changes clothes. even make her do the laundry. you probably have, but just my thoughts. i would be so frustrated at this point. what about taking away something the values? does she have a sweet tooth - maybe she doesn't get dessert or a treat on days she has accidents? maybe taking away toys, permanently, each time she has an accident? of course you'd have to really stick by that one and not cave in a week when she seems to be doing better. those toys would have to stay gone. i hope you find something that works, hang in there!

Have you had the "you are a big girl and responsible for your pee and poop" discussion? If not, I'd have that discussion and then stop monitoring her. Let her have accidents and take over the responsibility.

Sounds to me like a power struggle mixed in with you doing too much monitoring. If you give her the chance to be responsible, and give her some time to work it out, I am sure she will step up to the plate. No rewards, nothing more than "Pee and poop go in the potty, you are a big girl now, mommy is responsible for her own pee and poop, and you are big enough to be responsible for your pee and poop." End of story.

Mind you, not all kids respond to the "big girl" thing, so this might not work for you. But I did this with my daughter before her second bday, and while she still has the occasional accident on the bathroom floor while getting on the toilet (she will be 3 in March), just asking her "are you a big girl or do you need mommy to take over responsibility for your body" usually kicks her in the butt enough that she takes herself away from her toys a bit sooner.

All I know is that if my mommy bought me nice toys for going to the bathroom, I'd hold out for that situation too! It sounds to me like it might be time to let her take over the responsibility. Let it go. Seriously, let it go. Tell her "I am done. This is now your responsibility." Then, just follow through with it, and let her clean-up her messes. This will break the power struggle. Let the problem be hers, she is old enough.

Sigh... we are having this problem too. My daughter is 4 too. She goes through phases where she is fine and then she starts peeing in her pants again. The thing is that it is not uncomfortable to her - I usually notice it before she seems to - so there's no benefit to telling her she needs to start taking care of herself. She just plays like it hasn't happened. We have agreed that if it happens at the park, that's the end of play, time to go home. If it happens at home, no shows after school (usually she'll watch one or two until my work day is done) and that seems to be a good "punishment". Thing is, it will probably go away. Has the 6 months been nonstop or will it happen for a few weeks and then go away and then come back? Either way, I had a co-worker who said that she probably just gets too busy with what she is doing to remember to pee - pretty sure mine just pees enough to relieve a little pressure because if she really peed, she certainly wouldn't be able to sit around in her pants the rest of the night! Anyway, I'm sorry I didn't really have anything helpful to say other than, I'm there with you and we are also working on it. Good luck!

I think you should stop making her go to the bathroom every half hour. She needs to learn the signs on her own. It is possible that making her go so often she is too lazy to go when she has to really go. When she does have an accident then let her change herself and clean her mess. You didn't mention medical, have you had her checked out to make sure it is nothing physical?? Take the weekend and let her be, see if she goes on her own, and let her clean herself. Try to not make an issue, no lectures, just tell her to go change and move on. She needs to learn to rely on herself and the signals on her own. Good luck I know how frustrated you must be, but try not to show it.

My 4 yr old is doing the same thing. She trained herself to poop at 18 months but she still has 0-3 pee accidents a day. She has initiated going by herself before but most of the time, if I don't remind her, she'll wet herself. And sometimes, like yours, she would wet herself 15 mins later, so it's hard to keep on top of things even if we're taking them to the bathroom every hr or so. I also believe my daughter's issue is not a developmental, emotional or medical one.
I stopped giving rewards or punishing because she started bargaining and she has helped me clean up but not as a punishment because when I did that, she expressed frustration, shame and embarrassment. So we clean up together, but as a normal thing. I also treat the accidents like a normal thing. We just need more practice, I would tell her. Just like any other skill she's trying to accomplish.
It is a pain to change in public in the winter time. Best wishes!