151 | Understanding and Managing Bathroom Accidents in Child-Centered Play Therapy

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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Your source for centered and focused play therapy coaching.

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Hi, I'm Dr. Brenna Hicks, The Kid Counselor.

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This is the Play Therapy Podcast where you get a master class in child-centered,

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play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode. I am answering a question from Juliette in Georgia.

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Juliette. Thank you for the email

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and this is actually about children who are struggling with their bathroom habits.

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So,

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enuresis and encopresis

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and when a child is

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either

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having accidents throughout the day or

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specifically having accidents in the playroom

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and how to handle that from a child centered perspective,

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how to help parents navigate that.

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Just kind of the whole gamut of dealing

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with children that are having toilet accidents.

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So let me read parts of the question for you and then I'll share some thoughts.

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I have a question about young clients with potty issues.

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I have quite a few clients ages 4 to 9

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who all struggle with using the bathroom on themselves.

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I've specifically had sessions where a client will poop their pants in the playroom

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and I struggle how to navigate that maintaining child-centered.

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But also trying to transition them out so they can get cleaned up.

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I guess.

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I'm also wondering if you've ever worked with kids

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who have these struggles and how you navigate it both

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in session and with the parents who might be

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feeling pressure to have their kids fully potty trained.

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All right, Juliette, thank you.

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And I guess let me start with. Yes, of course.

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I've worked with kids that are, have struggled with this.

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I actually feel this is probably one of the most common things that we see

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as far as one of the factors of kids control.

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And I'm gonna dive into that in just a minute. So,

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yes, lots and lots of kids that either have accidents

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just universally in lots of environments or specifically in the playroom.

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And we'll kind of look through all of those things. So

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and interestingly, Juliette, that you posed this question,

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we've been talking about this in the CCPT Collective as well.

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So several other therapists

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in the online community also raised a question similar and we discussed it on

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the Zoom call and in the forum and we've been processing that as well.

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So this is obviously a very common concern and question.

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So I appreciate you writing in.

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All right.

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So let's start with what do we know

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about the things over which children have control?

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There are only a handful of them

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and it's eating sleeping pottying and obedience.

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So when we understand that kids feel that much of their lives,

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almost all of their lives.

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Actually,

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they have zero control

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and they have very little power afforded to them.

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So they will often take control wherever they can get it.

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And that often comes in the way of

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bathroom accidents.

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So sometimes it's the opposite as well. Let me throw this out.

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This is kind of a side turn, but it's important

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sometimes kids will refuse to go to the bathroom even when they need to.

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So they will intentionally hold

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their urine or their feces.

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That is also a control issue.

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That is also part of the same underlying route.

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However,

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in

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therapy, because emotions are involved,

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it usually ends up being the other way that they're having accidents.

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So I just want to make it very clear, even kids that will refuse to use the bathroom

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same route and we're kind of dealing with a different manifestation of very similar

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underlying issue.

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All right. So

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when we see enuresis and in caprices,

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and we either have parents report that that is

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an issue or it's happening in the playroom,

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we can link it to control. First and foremost,

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we can link it to high levels of anxiety often

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and

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we know that it's somatic in nature.

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So those are our three

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big level things that we need to be considering

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when we have a child dealing with these issues.

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There's a control factor,

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there's almost always anxiety involved and it's somatic in nature.

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For those of you that might not be familiar with the word somatic,

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that is the body's emotional

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physiological reaction. In other words, emotion is driving what's going on,

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but there is a physiological reaction in the body

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similar to racing, heart, sweaty palms, lump in the throat pit in your stomach.

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All of those are also somatic reactions. So the body

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is showing you and telling you what emotion you are experiencing in

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that moment and it's usually very high elevated levels of that emotion.

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So, somatic symptoms

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are very closely linked to big feelings in kids.

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So how do you deal with it? If it happens in the playroom,

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let's start there.

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There are kind of two camps or two schools of thought on this.

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So I will throw out both and then I'll share with you how I handle things.

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So one is you notice that the child has gone to the bathroom on themselves.

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So their pants are either wet or you can smell or

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you can see that they've had an accident in the playroom.

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There have been times when

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urine has literally dripped down the child's leg onto my floor.

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I mean, then it's very clear that they are having a bathroom accident.

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Sometimes their pants will all of a sudden be soaked.

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And you realize, ok, they've had an accident.

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We've had kids that have pooped themselves in the playroom

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and you can smell it. You can see

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their either diaper or underwear bulging from the feces.

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So, I mean, there's all kinds of ways that this happens.

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My therapist, I was actually not in the office this day,

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but my therapist and office manager reported that there

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was a child that had loose stools so badly

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that he started pooping himself in the playroom.

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They got him out into the hallway and it was

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literally running down his leg dripping all over the floor.

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It was an absolute nightmare and I'm not trying to be gross, but

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I'm trying to let you know if you've not had a

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child that's had a bathroom accident while playing with you.

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You will, I'm just,

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it's not a, it's not a threat. It's not to scare you.

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It's just you need to be prepared because it will inevitably happen

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unequivocally.

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You will end up with a child that has an accident with you in some way, shape or form.

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So

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we need to really have an understanding of what's best practice, what to do,

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et cetera.

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So I'm circling back to the two options.

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The first is you notice that it happened and you bring it up to the child

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almost as in an observational

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commentary.

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So,

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oh, it looks like you might need to use the restroom.

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It looks like your pants might be a little bit wet

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or

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it looks like you might need to go to the bathroom.

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It looks like you might have something that you need to go check on and,

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and take care of in the bathroom

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so you can bring it up but it has to be completely neutral. It has to be judgment free.

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It has to be a comment as just as if you were saying, oh, it looks like you spilled

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chocolate ice cream on your shirt,

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right?

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So your emotions cannot get in the way

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when you bring something like that up and inside you might be going. Oh my word.

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What a nightmare. What am I gonna do? What's the mom gonna think? Ok.

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So you might be spiraling internally,

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but what is presented to the child needs to be completely calm,

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completely neutral and you state it as a

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fact just like you would state anything else.

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That is one option.

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The other option is if the child does not say anything about it or does not bring it up,

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neither do you?

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And there are child center play therapists that would say both are within

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the model

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and you could fall on either side of that fence.

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I personally

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have

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erred on the side of bringing it up to the child

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because I used to have leased office space.

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Now, obviously in, you know, in my own building it's different,

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but I used to have leased office space with carpet

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and the idea of a child sitting on someone else's carpet

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and getting poop or pee or whatever on the carpet,

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then that just becomes a cascade effect of all kinds of issues.

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So I,

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at that point decided I would just gently acknowledge what I thought had happened

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and address it.

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It's almost like, you know, the elephant in the room needs to be talked about. Right.

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So as long as you bring it up neutrally and factually,

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and as if, you know, it's really no big deal at all,

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it doesn't create any kind of shame or embarrassment or guilt.

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I mean, yes, of course, there's probably all of those things for the child,

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but you are doing everything you can to minimize that

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reaction because you're stating it as a very normal fact.

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All right. So it looks like we might need to go to the bathroom.

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It looks like your pants might be a little bit wet.

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It looks like you might need to go and address some things, et cetera. So

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that is the way that I typically bring that up.

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Here's

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a veteran trick

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that you need to be aware of

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that. I learned the hard way and we've just implemented ever since I

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had a scenario unfold in my playroom.

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So I had an older girl, she was actually a twin

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and she was probably 9, 8 or nine. So, I mean, we were way past the

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bathroom accident age range, right?

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And I still to this day

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think that it truly was just somatic because she didn't even

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indicate that there was anything going on.

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I mean, she just peed herself in my session

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and then realized it and said, oh my gosh,

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I just peed myself and she brought it up to me.

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Well, at the time,

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I didn't know what I know now. So

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we go out and of course, mom's like, um, no, I don't have a change of clothes.

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I stopped having a change of clothes when she

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was three and learned how to use the bathroom.

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And therefore there was nothing that she could wear

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and she ended up going home in the police pants

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to my police costume.

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So in my bathroom,

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she changed out of her wet clothes and put on the pants to the police costume

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and went home in those and washed them and brought them back.

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And that happened several more times, kids would go home wearing my costumes

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because they had had an accident and they didn't have anything else to wear.

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And I realized Brenna,

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you can continue doing what you've always done and continue to get

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the results that you've always gotten or you could solve the problem.

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So we bought five packs of boys and girls underwear.

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And at one point, we had

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like three or four packs of like the little small elastic waisted cotton underwear,

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sorry cotton shorts.

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So I'm bringing that up to let you know,

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it is helpful to keep those in storage

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in your bathroom or at your front desk or in your playroom somewhere,

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wherever you can keep it

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because you will inevitably need them.

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And then parents aren't as embarrassed. Parents aren't in as much of a bind.

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You know, if you can give them shorts and underwear to put on,

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not only can they finish their play time,

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but then you can just wrap the wet clothes in a plastic bag.

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Hand it to mom and say we had a little bit of an accident, et cetera and you know,

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no harm, no foul.

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So

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please make sure that you invest in

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some underwear and short packs, go to Walmart and if you're out of the US,

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whatever your cheapest

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place, you can buy kids clothes,

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go and get some like 34 or five packs of underwear

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and shorts for boys and for girls and give them out.

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Don't ask for them back. This isn't like a hey, I'm loaning this to you.

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This is I have these here specifically for situations like this.

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They're yours to keep, we can keep doing our session, you know.

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All is well,

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all right. So what happens to address this with the parents? Now

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if parents come and tell you that it's a consistent problem

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and they are mentioning that it's happening at school and

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at home and in all of these other environments,

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you're going to have the same conversation essentially that

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you would if it happened in the playroom.

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So your goals in that conversation are to reassure

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parents that it happens

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that it was an accident

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that it's no big deal. It didn't ruffle you or bother you whatsoever.

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You were actually prepared for it.

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You had the underwear and the shorts because these, these very things happen

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that will normalize for them and reassure them

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that

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this is just something that happens because especially if the child is older,

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you know, 7, 8, 9 year olds, it's like they're like,

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what in the world? Why?

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And it just like, sends them into a tailspin panic.

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It's your job to help them know that this

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is completely normal and it happens all the time.

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They also need to know that it is emotionally driven.

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And this is especially true if the parent

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tells you this in an initial parent consultation,

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for example,

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help them understand what the somatic nature of this is.

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Help them understand how it's connected to control.

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Help them understand how it's rooted in anxiety,

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connect all these pieces together for them because then they have a why

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it doesn't change the fact that accidents are frustrating.

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It doesn't change the fact that they want the

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child to be able to not have accidents anymore,

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but they at least understand why it's happening. It's somatic.

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This happens very consistently. It's tied to control. It's rooted in anxiety.

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It all makes sense in light of what is going on.

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And

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you want to make sure that your reaction

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and your discussion

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is calm and emotionless

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because they will model how you perceive it.

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So if a kid has diarrhea dripping down their leg and it's pooling on your floor and you

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have a sense of panic on your face or if you are freaking out or if you're going.

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Oh my gosh. Ok. Um,

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if any of those things are happening,

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parents will absorb that energy and they will

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think that it was an absolute catastrophic disaster

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if you go. Oh,

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ok. We're gonna have to get into the bathroom.

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We're gonna have to make sure that you can get on the toilet.

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If you just handle it neutrally, factually, completely in control and calm.

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Look inside you might be wanting to vomit what whatever it is, what it is.

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But

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outside

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you come across as the poster child for calm in control. Confident.

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I've got this no big deal.

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This is just, you know, a day in the life of a child-centered play therapist,

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occupational hazard, right?

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So when that is your vibe, parents absorb it very recently,

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a little boy pooped himself in my playroom

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and he eventually told me I could tell that he had,

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but he hadn't quite brought it up to me yet.

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So I was kind of waiting to see how it was going to unfold before I said something.

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And he tells me

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Miss Brenna, I need to go to the bathroom. I think I have some poop.

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And so we go to the bathroom and he's really little.

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And so of course he tells me that I have to help him up onto the toilet

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and then that becomes a whole ethical thing. But that's for a different episode.

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So

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mom's in the car. I help him onto the toilet. Then I tell him I'm gonna wait outside.

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Then he tells me he's done

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and then says, but you have to wipe me because I don't know how to do that yet.

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And I'm like, oh my gosh, this just keeps getting better.

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So anyway, again for a later discussion, but

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I ended up taking the

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dirty underwear and the dirty shorts

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and we put those in a plastic bag,

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set them up at the front. He changed into new dry clothes.

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And then when the session was over, we met mom outside, she rarely waits in the lobby.

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So we met her outside

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and I, she sees that he's in new clothes and I hand her a plastic bag

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and she has kind of this panicked look on her face.

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And I said

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we had a little bit of an accident in the playroom today,

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but we took care of it. We went into the bathroom, he used the restroom,

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got him in dry clothes.

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These are the wet ones just wanted to let you know what happened,

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but

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it's somatic in nature and it's normal and it happens pretty consistently

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and it will even itself out the longer he's in treatment.

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And she still kind of had a deer in headlights look, but she at least was just like, ok,

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and then she got in the car and drove away and whatever. So

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that is your goal is to reassure and normalize,

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help them understand the why help them understand that it will get better.

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It always does. And I don't say always unless, I mean, it, you know that

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I've never had a child that had somatic issues that didn't

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get better or resolve as a result of play therapy.

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It is the outcome that parents are hoping for. They just have to wait for it to emerge.

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So I hope that that's helpful. Juliette, thank you so much for the question

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and I know many people have been asking that so

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very important that

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we talk about that. So I'm very grateful for you submitting that

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if you would like to know more about the CCPT

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Collective and know what we're talking about in there,

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what our Zoom calls involve and include,

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please go to ccptcollective.com. You can

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give it a free trial, see what it's like.

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And there is an amazing community of people in there live

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Q and A twice weekly with me on Zoom call.

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So obviously, I'm doing Q and A's every Thursday, but you can certainly get quicker,

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easier access to me if you're in the collective.

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So I'd love to have you in there. And a huge thank you to all of you that have joined.

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I'm just so excited for that space and for what is happening in there,

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all of you supporting each other

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and answering each other's questions and

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sharing experiences together.

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That's exactly what I had hoped for when I created that space

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and you all have made it happen so huge. Thank you to my active collective members.

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You have made that a really, really special, engaging, warm,

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welcoming environment and that just makes me smile.

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So I'm really appreciative

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for all of you that have poured into that.

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All right,

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love you all. Hope you have a lovely weekend and we will talk again soon. Bye.

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Thank you for listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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For more episodes and resources.

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Please go to www.playtherapypodcast.com.