Toileting Accidents

Is your child having accidents?

Is your child:

  • Doing the Pee-Pee dance?
  • Withholding urine or feces?
  • Always running to the restroom at the last second?
  • Having toileting accidents?
  • Refusing to go potty unless you remind him?
  • Wetting his pants on purpose?
  • Having an accident whenever she is doing something fun?
  • Seeming defiant; deliberately peeing on the carpet?
  • Holding it so long you must see the doctor about constipation?


Does your child have frequent toileting accidents? Was he or she easy enough to toilet train initially but continues even on into kindergarten or first grade to have accidents during the day at school or at home during the night? You may find that your child wakes up with a wet bed or can’t have sleepovers for fear of accidents.

You may notice that your child stands and pees on the floor without realizing it. She may get up from playing and notice that she wet herself.

Alternately, your child may wet himself during times of emotional distress. It also could be that your child simply refuses to use the potty because he or she is enjoying playing and does not want to be bothered to go to the restroom.


Here, the underlying problem could be sensory, perseveration, or need for control. These challenges, when pervasive, are called enuresis (challenges with urination) and encopresis (challenges with defecation). There are three questions to ask yourself if you are concerned about your child’s persistent toileting accidents.

  1. Is he or she “wired differently” from a sensory perspective? That is, is your child less sensitive to bodily sensations, the feeling of being dirty and needing to bathe? Does he or she seem to have less awareness of his or her body and need to go to the restroom? Some children’s sensory systems are developed differently, and they don’t feel the cues that one would typically feel to indicate a need to go to the restroom. These children might not know what it feels like to “have to go pee.” If you suspect it is more of a sensory need, an Occupational Therapist may be able to provide therapy for toileting and other Activities of Daily Living (ADL’s).
  1. Does your child have trouble with perseverating or hyper-focus? This term means trouble shifting off of a fun activity like the computer to do something else like take a bathroom break. In this case, you may find that your child has adequate control over his body but simply refuses to go because he is having so much fun. Some children may become distracted by something motivating and misjudge the time it will take to make it to the restroom, thus resulting in an accident. 
  1. Does he or she seem to want to be in control? Is not going to the bathroom related to anger, defiance, or rigidity? Perhaps your child never does anything you suggest. In this case, children may restrict and withhold themselves from going to the bathroom in an effort to have control. Children cannot control very much in life, but they do ultimately control using the bathroom.


The strategy to use depends on the reason for your child’s accidents. See guide below based on the type of toileting issue.

  1. What to do about sensory toileting accidents: Work with your child to understand what going potty is all about. For example, you could review a book about understanding our bodies. Describe how digestion works, and even draw a picture together of what happens when you drink water all the way to having to go pee. Then talk about the feeling of needing to go potty.

Many sensory impaired children have neurological issues that are interfering with their ability to know when they have to go. Children with ASD and some with ADHD also have toileting accidents. Disorders like Cerebral Palsy and Down syndrome may induce toileting issues. In that case, a variety of on-line resources [2] is provided below. Occupational therapy intervention may also be helpful.

  1. What to do about perseverating or hyper-focus toileting accidents: If your child is having so much fun that he forgets to stop to use the bathroom, try these strategies. Devise a reminder system, such as a watch that vibrates on the hour to signal the need for a bathroom break. Then reward your child for trying to go to the bathroom each hour. Make this activity pleasant and positive, not punishing.

When there are accidents, have wipes and tools needed to get cleaned up in the bathroom, and allow your child to do most of the clean-up (depending on appropriateness for child’s age and ability). Cleaning up, washing hands, taking a shower, or depositing clothes in the washer can be good jobs for your child to get into the routine of doing. Again, these activities should be a part of an overall hygiene regimen, not punishment.

  1. What to do about control related toileting accidents: If your child is also having eating challenges, control is the likely culprit. Offering control to children in other areas can help to decrease accidents. Although this is a frustrating situation for a parent, it is very important that you do not lose your cool. Show your child that you are calm and flexible. Deliberately offer choices and be willing to negotiate on minor issues. Decide to let other rules and instructions go while you are working on this problem.

Some children with emotional issues will want control within their environment. Elimination is within the child’s control.

In situations where a child has experienced trauma or a recent loss, a child may struggle with toileting. They may even smear feces or urinate on things. Children with emotional control issues require consistent support and nurturing. When you have concerns, seek help early and often.

Should these strategies not go smoothly, first meet with the pediatrician, to be sure no medical cause for accidents is present. Then seek out a professional, such as a behavioral therapist or psychotherapist, depending on the underlying causes for your child’s struggles. Get into a proactive routine to avoid frustration, shame, constipation, and bad habits.


If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • Sensory problem (Moving & Sensing):difficulty reading sensory input; attending to cues that indicate a need to use the restroom; less sensitivity to being smelly or dirty
  • Emotional challenges (Feeling): being irritable; feelings of sadness and depression; looking to have some control in life; can be an outlet for anger; because of traumatic events or recent loss experienced by the child
  • Perseverating (hyper-focus); getting stuck or over-focused on something with challenges shifting attention to something important like a need to use the bathroom
  • Toilet training or Adaptive problem (Daily Living): some children struggle developmentally to learn to control their bowels and to use the toilet at the appropriate times
  • Rigid Behavior or Non-compliance: the child may use withholding feces or urine as a means of control and resistance to authority


Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • Anxiety: some children who are very anxious will have frequent accidents; they may wet pants due to excessive fear and worries
  • Obsessive Compulsive Disorder: some children who are very rigid and controlling may refuse to use the bathroom; they may avoid public restrooms for fear of germs or refuse to use the bathroom at school
  • Autism Spectrum Disorder: some children who have autism perseverate or hyper-focus and have challenges attending to other types of cues, like bodily awareness; children may have problems because sensory system can be inherently different
  • Attention Deficit Hyperactivity Disorder AD/HD Combined or Hyperactive Impulsive Type: some children who have challenges with sustaining attention, distractibility, hyperactivity, and impulsivity; children may act without thinking; may get distracted and miss bodily cues
  • Trauma and Attachment Disorders: children with trauma experiences can have toileting issues; could be a cry for help; smearing feces is a serious sign of a significant emotional issue; children may seek to control because life has been scary and unpredictable
  • Depression: depressed mood or, in children, irritability that is pervasive; children may seek control in an area of life because of anger/frustration
  • Bipolar Disorder: children may seek control and refuse to use the bathroom because of feelings of worthlessness and sadness; alternating with periods of elevated mood, pressured speech and goal directed activity


If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • Clear Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
  • Psychotherapist or Play Therapist: to treat emotional symptoms that may be related to the toileting accidents and help a child develop healthy coping and adaptive skills
  • ABA Therapist: to treat behavior; can help develop a behavior plan to address toileting behavior and more appropriate behaviors
  • Psychologist or Neuropsychologist: to conduct a full assessment and to look at symptoms in mental health and/or behavioral context
  • Psychiatrist and Pediatrician: to manage and prescribe psychotropic medication for inattention, impulsivity; stimulant medication for ADHD is effective in a high percentage of children with focus challenges. Parents should consult with a doctor to check for a medical reason for these challenges. See a pediatrician and a Gastrointestinal (GI) doc before assuming this behavior is emotional, behavioral, or sensory

These professionals may recommend or administer the following tests for this symptom:


[1] Books for parents and clinicians:

Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

Frank, Kim (2003). The handbook for helping kids with anxiety & stress.


Foxman, Paul (2004). The worried child: Recognizing anxiety in children and helping them heal.


Papolos, Demitri & Papolos, Janice (2002). The Bipolar Child: The definitive and reassuring guide to childhood’s most understood disorder.


[2] Books for kids with anxiety:

Huebner, Dawn (2005). What to do when you worry too much: A kid’s guide to overcoming anxiety (What to do guides for kids). 


Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me.


Cook, Julia (2012). Wilma jean and the worry machine.


Peters, Daniel B. (2013). From worrier to warrior: A guide to conquering your fears.


[3] On-Line resources for toileting problems:

Image Credit:
Description: Urinary problems
Stock Photo ID: #519307746 (iStock)
By: ridvan_celik
Previously Licensed on: May 14, 2017
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

Back to: Home → Behaving