I’ve been doing parenting activism for years now and the question comes up over and over: what to do when your child has potty accidents?

I’ve experienced this issue firsthand. I’ve read a lot on it. I’ve had some success in overcoming it. My motto anymore is “When people know better, they do better.” I aim to give people tools to effectively deal with their children.

So, first, let’s get the hard part out of the way. The following seems to be a lot for people to swallow but: potty accidents are not a behavioral issue. They are a medical issue. Behavioral issues may lead to medical issues but the issue is medical. Here’s the brief overview: kids hold. Super young children especially hold. They don’t go to the potty until they absolutely have to go, rather than when they first have to go. The book by Dr. Steve Hodges, It’s No Accident describes this. When I learned this, I asked my 6 and 8 year old once if they had to go to the potty. Their answer was “well, kind of.” My eyes were opened. Kids do this, even into older ages.

Using my child development work, I took a hard look at how children develop in this respect. An ability to take in data and use it to make “reasonable” decisions doesn’t happen until until 3 years, 4 months. At this age, which is Three Year Old Milestone 7, Categorizes and Uses Data, they take in data, categorize it, and use it to navigate. It was at this one that my children came up to me and said, as if it were novel, “Mommy! I noticed I had to go potty so I did!” Or, alternatively, “Mommy, I’m holding my poop.” Until then, the signals are mainly going to their spine and they are more responding to overwhelming stimuli rather than making reasoned decisions.

I describe in my work that the early 3 year old milestones all relate to navigation. Children in their early threes are like a rat in a maze trying to figure out how to get the cheese. They make one guess as to how to go forward, then they can pivot, and eventually they can strategize, which is Milestone 5B: Strategies around 3.3. They are somewhat blindly doing it until this time. Yeah, they are making guesses, etc., but they are a bit like a pinball in a pinball machine, using a lot of trial and error. Then after this, I describe it as if they develop a “periscope” as they start to take in large amounts of data and use them to make decisions. Which is around when you can start to hand off some potty decisions to children.

And at this age, 3.4, reason-based decisions but starts. Dealing with complex variables–say not having toilet paper, being at someone’s house, going out, etc.–doesn’t happen until the late threes or early fours. My general recommendation is that children don’t be potty trained until age 3, get a lot of supervision until 3-1/2 (watch for the pee pee dance, etc.), and get ample potty reminders even until older ages.

If a young child is asked to take over this process without ample support, they will likely hold. When children hold, over time, it causes problems. It stretches out and stresses their bladder. The signals to their brain get all messed up. Or poop builds up in the rectum. These are the main reasons for potty accidents. It’s more complicated than this. But, basically, things are awry. Potty accidents are a sign of digestive distress.

This can be hard to hear. When I heard it all and realized the damage it caused to my first son, I was incredibly sad. But armed with this information, we can move to fix it.

I do not think children are developmentally ready to take over the whole potty process until much older ages. And by much older, I mean like age 12. While I think you can obviously potty train before age 12, I think we need to have a supportive environment for them. We cannot ask them to take it over entirely by themselves. No amount of reward charts will fix this. We need to expect to have a responsible role for a long time, likely as long as they are dependent on us to eat and drink. We humans are kind of responsible for making sure each other has good health. This is how I see it anymore.

I was utterly floored by how much helping my children with this helped them. I had to apologize to my husband. He intuitively wanted to give them more reminders to get to the potty. I said no–because I thought it was a purely medical issue. I wanted to change their diet, try some solutions out, talk to them, etc. I thought potty reminders, frankly, were a bit mean. But when I read that they hold, I realized, yes they do need reminders. A lot of them. So, I had to apologize to my husband. Because I stopped this from happening, and he was right.

So, there is almost nothing worse than trying to talk to an older child about potty accidents. It’s terribly embarrassing and frustrating for them. They’ve already heard your spiel a million times. What they need are effective solutions. Period.

We had a family meeting about it. Our family meetings are “Brainstorming” sessions. I approach it as “We have one problem to solve. What are your creative ideas?” I recommend this. It was a huge success for us. No one is being lectured. You, nor them, are frustrated. You gather around to tackle the problem. ANY solution is ok at the brainstorming stage, “Even if you say you want to take a rocket and pee on the moon.” I tell them, “We have one problem to solve: how to stop potty accidents. What are your ideas?” Plays are effective at describing the issue. My husband had my children in absolute stitches when he re-enacted someone having to urgently get to the potty because they waited too long.

At this Brainstorming session, I had written down “More Potty Reminders.” This was in addition to “more fruit,” “more walks,” and some other ideas. I thought for sure they would hate having potty reminders. Well, the next stage at a brainstorming meeting is ticking off what solutions you like. I was ready with a purple marker to tick off what ideas each family member liked. I was floored that my children actually WANTED potty reminders. I suggested every 2 hours. They wanted them every hour. They wanted help with everything. They wanted more fruit with breakfast, more nuts, help remembering to take their probiotic everyday, etc.

So the 3rd step in a Brainstorming, Problem Solving sessions is to make a plan. It has technical details. I laid out what foods to have for breakfast, how often to give potty reminders, that they wanted help taking certain supplements, etc.

And that’s what we did. And that’s what I do. Every day, I do this. I give potty reminders and help them. It’s made a huge difference. I was sincerely floored. I COULDN’T BELIEVE how MUCH they went on the first day. I would give a reminder, and sure enough–pee or poop came out of them. All day, it kept coming out of them. Whereas before the only seemed to go a handful of times a day, now it was closer to a dozen. And each time–well, stuff happened. They all around seemed springier and boingier. And, yes, they smell better, too.

Here are some other things you can try:

• Belly massages
• “Chug” with them. Encourage everyone to drink together for at least 5 seconds
• Healthy feasts to encourage new foods
• Reduce dairy
• Increase liquid
• Many potty reminders. After breakfast especially. Whenever you think of it. Before you start anything.
• I leave further medical intervention to doctors. I refer people directly to Dr. Hodges website and the page where he discusses accidents bluntly, typically the one for 3-10 year olds: Bedwetting Age 3-10

In general, I am opposed to giving children “natural consequences.” People think the “natural consequence” of wetting themselves will get children to the potty. It doesn’t. I discuss in Misbehavior is Growth: 3 Year Olds why I do not use “natural consequences” on children. I think they need mentors and support, not consequences. They are not developmentally ready to take over all of these decisions entirely on their own yet. I want to see a culture where we happily lend support to children. I write about it here: Generous, not Gentle Parenting.

I know this is a sensitive topic. But our children’s digestive health is important. Ancient wisdom says all health is in the gut. I want to see a culture supportive of this. While all of this is counter to current cultural wisdom and is hard to hear sometimes, with good information, we can get better solutions. I hope you feel more empowered to tackle this otherwise difficult problem.

If you know someone struggling, would you please send this post to them?