Pee Accidents

Archived Q&A and Reviews

Questions, by Age Related Pages

4-year-old: But I don't HAVE to to go potty!!

Sept 2008

My 4-year old son is potty trained but adamantly refuses to go to the bathroom whenever we ask him to try. Sometimes he will hold his pee for 7 hours or more, hopping up and down, running in circles, etc. but still says he doesn't have to go. If we ask him just to try before getting in the car for a long trip, he won't do it -- even if that means he doesn't get to go to the party, zoo, etc. We have tried all kinds of games to make it more lighthearted and appealing, or more ''his choice.'' He will go on his own if the timing is right, but not when we ask, and the result is occasional accidents. I know this is fairly common and probably just another way to test his power . . . but what do I do? I end up sitting around the house all day, trying to reinforce my ultimatums, while he calls my bluff. Never ever ever never!

I suggest you start making sitting on the potty part of his daily routine. Don't tell him he has to go, just that he needs to sit on the potty and try to go. Let him read a book, read to him, give him a game to play with, so that he'll sit there and relax.

By daily routine I mean at routine intervals in the day: when he wakes up, after eating breakfast, before lunch, before rest time, after dinner, before going to bed. But especially anytime he does what we used to call ''the pee-pee dance'' LOL!

Also, don't show him how exasperated you are, or upset, angry, etc. Just tell him matter of factly it's time to try and go potty and he has to sit there for 2-3-4-5 minutes before going anywhere. When you see him ''dancing'' just say, ''Oh I see you are feeling like you have to go potty, so now is the time to try'' and let him know he has to sit/stand there for 2-3-4-5 minutes regardless of whether anything comes out.

What does his preschool teacher suggest? Good luck! Stephanie

Believe it or not, this one is easy.

Stop asking him if he wants to go! For that matter, you should stop ASKING your child if he wants to do much anything. Especially since your child seems to want to resist, it's time to teach him that there are rules and ... you just do them. Trust me on this. When my child was 4, I totally changed my parenting style. I had to.

So you say: ''It's time to pee.'' He says ''I don't have to.'' You say (consulting watch) ''It's 11:20. It's time to pee. Give it a try and perhaps your body will surprise you.''

It's important to STOP saying ''Jonny, I'd like it if you would.'' or ''Jonny, would you like to'' or ''Jonny, could you...'' because even though this may sound odd, each of those statements gives the child permission to NOT listen to them! Stop giving your child an ''out.'' Be extremely direct. ''You need to X.'' ''It's time for you to X.'' If there's a problem, give them a choice: ''X or Y.'' And then stop there.

While it's nice to teach babies and small children to say please, when a child gets older, and especially if it's a child that is a resistant child, it actually does the child a favor to REMOVE ambiguity. If you want them to do something, you say ''You need to do X.''

Being very clear helped my son a lot. Rules are good to learn

It sounds like you are already doing something similar so I'm not sure if this will help but here's what I do with my very independant/often stubborn 5 year old. When I tell her to go and she says ''but I don't have to'' I say ''that's fine if you don't need to use it just sit on the toilet. If you don't pee that's fine, just try.'' She usually sucks her teeth or does some other completly rude response but then goes to sit on the toilet and nine times out of ten she goes pee. If she doesn't that's fine. I, like you, stand my ground about using the bathroom, but my thing is about her trying/sitting. If she doesn't use it that's fine, she just has to try. Hope this helps. Good luck. M

We have the same issue with our daughter. I think the thing to do is just let them control when they want to go to the bathroom. It sounds like with your son it's turned into a major control issue and probably the best thing to do is back off and let him go when he wants to go. Accidents are annoying (especially on carpet!), but not the end of the world. And an occasional accident sounds better than what you're describing. Also, you could buy a portable potty so if he refuses to go before leaving the house, only to have to go half an hour later when you're not near a bathroom, you can just whip out the portable potty. At some point, I'd like to have the policy we go to the bathroom before we leave the house, but in the meantime the portable potty keeps it from mattering too much. (BTW, the Fisher Price brand one is great.) Sarah

My 3 1/2 year old has been almost potty trained for like 8 months now, slowing moving toward 100% (not counting nightime of course). But I havn't had him refuse to sit very often.

What one friend suggested to us was not to ask if he ''needs'' to potty. But simply say it is ''time to potty'' and take him into the bathroom and sit. Then you can say ''hey, look, there is potty in there!'', or ''oh well, nothing there. Maybe next time''. Eventually, it will become routine and they will relax. Good luck. Bryan

It sounds really challenging! And it sounds like it's become a big power-play between the child and his parents.

My suggestion would be to neutralize the emotion of it. We found success using a timer that went off every hour. When the bell rang, it was potty time. That helped separate potty time from my authority. The other idea I had was to combine it with a sticker chart -- positive reinforcement. So every time that he sits on the toilet and produces, he gets a sticker. Once he gets x-number of stickers, he gets a special outing with a parent or a toy or something special. Good luck. Rachel

Why not just let him go on his own without reminding him? Sounds like a power struggle is going on here. He's old enough that if he does have accidents, he can change his clothes and ''clean up'' after himself. Of course, you'll have to follow up his cleaning. But, put it all back on him and see what happens. Not going out on a fun adventure is not really a natural consequence to not going to the bathroom when you need to, so he's not making the connection in his mind (or he is and he's just testing to see if you're for real.) In either case, no one's winning.

When my 4 year-old says that he doesn't need to go potty, I usually sympathize and make a big deal about how I really understand that he doesn't need to go, but that he must do it anyway (before bed, bath, or before we leave the house), whether he needs to or not. If he says he just went, then I also say I understand and that's great, but I need you to do it again, because I know that ''I just went'' can mean he did it 2 hours ago. Susan

I posted a reply to a similar question last week. when my now 4 1/2 year old used to say he didn't have to go and then later had an accident, i would tell him that if he didn't at least try or if he had another accident, it meant he still needed to wear a diaper. also, if we say he can't do something or go somewhere until he actually tries to go to the potty, we mean it. even if it means not going to the zoo, etc. we try to do this early enough so that we are not rushing to go to some event and this way it gives him some time to ''change his mind'' about really not caring about the event or trying to go to the potty. he rarely has an accident now. no pee in pants!

There are three things you will drive yourself insane trying to get your kids to do: eat, sleep and use the toilet. My advice (on all three) is to back off -- WAY off. I did EC with my youngest, and giving this strong-willed firecracker of a toddler autonomy over her toileting was one of the happiest (accidentally smart) decisions I ever made. I tell my older child (5 y.o.) at the table, ''You are in charge of your own tummy. If you want a sticker, you need to try one bite of each thing on your plate. After that, you decide how much you want or need to feel full. If you don't eat enough, you will have to wait until the next snack/meal'' If she eats three bites, that is her choice. You can try something similar with your potty- striker: ''You are in charge of your own body. If you feel peepee or poopoo, you can take yourself to the bathroom and let me know if you need help. You can earn one sticker for your sticker chart by keeping your undies dry all day.'' There is no punishment for accidents, just lack of reward. Doing a sticker for the day instead of each trip to the potty allows you to step back since you will only need to keep track of accidents, which are easy to spot. In short, he's trying to drive you nuts, and it's working. Simlply remove yourself from the equation (don't worry, he will find something else to drive you crazy when you guys get over this!). When we were doing EC, we had all kinds of waterproof pads. You may want them for the carseat, rugs or sofa if that helps you relax and give him space to assume the independence he is craving. Hope I don't sound harsh -- I almost stuck a fork in my daughter's eye before I learned to leave her alone at the table! Live and learn. :) Happier Hands Off

If I were you, I would completely let it go and let him go when he feels like it. With my son he it was a control thing and also fear of the toilet. The problem was more with poop than with pee. He ended up with a constipation problem and a leaking problem. He is 6 now and does go on his own but he still leaks stool without knowing it sometimes. Its from so much practice of holding it in. Your son will have accidents and maybe he still needs pull-ups. He will figure out on his own that it is more comfortable to not be wet. This is better then the physiological problems that can develop down the line. been there

My advice is let him have the occasional accidents. Just pack a change of clothing with the assumption that it will happen, so you will be prepared. (And try to get emotionally prepared too!) If you are nonchalant about it and just tell him, ok well you can always go when we get 'there' if you need to, then the power struggle will be diffused and the accidents will eventually annoy him enough to be an incentive to go more often. logical consequences are your best weapon

Oh my gosh...this used to drive me absolutely insane!!!! You can't make them go pee. It's the one of the few things they feel they have control over. These are things I tried: a chart....after three times of going pee when I asked he got a reward. It worked once. I let him pee in the yard. (This worked great for us.) I changed the wording from 'going' pee to 'do you want to try?' But, it passes, it really does. He'll have accidents and get tired of changing his clothing. mom of boys

First you have to un-do the power struggle this has become. It's worth continuing to work on getting him to go pee because there can be long-term effects on the urinary system from holding it in too much. I would start having regularly scheduled potty time every 3-4 hours without fuss. Simply at these times (either by the clock or by event -- pre or post breakfast, lunch, etc) he sits on the toilet for 10 minutes. He can either get up after he pees or after it's been 10 minutes. No struggles, no rewards/punishment, no attention, no nothing but 10 minutes on the pot. Hopefully after some time of this he'll decide there's no point to holding on. My daughter has held it in up to 12 hours rather than use a scary public potty, and frequently insists she doesn't need to go. But she has to go to the pot when we say, and when she does she usually pees.

Many people had good takes on this and suggestions. One thing I can add, that would work with many different approaches, is to eliminate the word ''try,'' which implies one needs to make a special effort, and will either succeed or fail. Instead, say ''check,'' which is about finding out what your body needs at the moment. R.K.

I agree with all the advice so far, both about backing off and not letting it be a power struggle, and also about not making it always up to them. Sometimes they have to sit on the potty, whether they ''go'' or not. One thing my daughter enjoyed was when I would say, ''You have to sit on the potty now, but I don't think you have to go. I bet ''no pee pee''. What do you bet? Who do you think will be right?'' (Of course I only did this when I was pretty sure that she did have to go.) Then when she went pee, I'd say ''You were right! You win!'' Sometimes she would even take my hand and lead me to the bathroom saying, ''I want to be right. Do the betting thing.'' Good luck!

4-year-old's pee accidents are making me crazy

April 2004

My almost 4 year old has started peeing her pants everyday, just when she's with me. I started by ignoring it because it's happened before over the past year, i.e: when her brother was born, later when he was in the hospital, when I've had work trips, etc. But then it happened a few days and then would stop.

This time it's been fairly consistent for the past month. Everyday when I pick her up from preschool, she's wet. Then sometimes even after we are home she pees her pants. Once, during her brother's nap, while I was playing Candyland with her, I looked over and there she was peeing her pants. I've taken her to the doctor to rule out a UTI. I assume it's a cry for attention given that her brother is going through advancements and she gets quite jealous of the attention he gets. But I do try to spend time with her that's just her time.

But I'm getting tired of this. So I decided to start removing favorite toys each time she wets. So this week she's lost Barbie, Groovy Girls, Candyland, art projects and scissors, favorite stuffed toys, and I've stopped putting her to bed with bedtime stories and songs. So this morning she peed all over her room. So obviously this isn't working.

She has known how to go potty for almost 2 years now but periodically gets into these wetting phases. This is the longest one of these regressions has lasted.

So now I've put her in her brothers diaper which she seems quite excited about actually and I'm at an absolute loss. I don't know whether to go back to ignoring it and just keep telling her to change herself. She doesn't seem to care about losing any of the favorite toys.

I'm really tired of the extra laundry and not knowing where I can take her and if she'll pee her pants or not. I've tried the ''time to go potty'' and pretty much she'll go if there's a bribe as in...can't go to the park unless you go potty but then we'll get to the park and she'll pee her pants (20 minutes after going potty at home).

She knows it upsets me and it does upset me, it's making me crazy and she seems to enjoy that power.

Any suggestions? I thought things would get easier the closer we got to four, which all of my friends and relatives keep telling me is the magic age.

tired and frustrated

One of my four year old twins has started wetting again also-- not as frequently as yours apparently is, and I think it's more that she just is so busy playing that she puts it off until it's too late. Have you considered putting her back in pull ups for now? It sounds like you're going crazy trying to deal with this. I'll bet if you just use pull ups, praise her when she uses the potty and ignore it when she doesn't, this behavior will stop. I don't think taking toys away/punishing your daughter will have positive effects. I would stress how glad I am to have a ''big girl'' as well as a baby, because there are so many things a big girl can do that a baby cannot. So-- my advice is get a box of pull ups, and just relax. This too will pass. another mom

My heart goes out to you; it really does. My son's been trained since 2.5 years and has had quite a few accidents lately (though not on the scale of your daughter's accidents). I think the key is to keep it from being charged. Try to hide your disappointment and frustration (and I know too well how very hard this is), and consider putting her back in pull-ups for a week or two. I suggested this to my son (as off-handedly as I could), and he seemed a bit shook up and has had no accidents lately.

I suspect your daughter wants to feel like the baby in the family, hence ''she seems quite excited about actually.'' Let her. I suspect taking the 'power' away and letting her be a baby for a bit will get old for her quickly enough. Plus, if she's in pull-ups, you won't have as much laundry nor need to change her wet clothes. Nearly a win-win, with the downside being the cost of pull-ups.

Good luck. As I said, I know how darned frustrating this can be. My son was just this morning lamenting a book I threw away that he had peed on in the bathroom. (sigh) Jennie

Thank you all for your advice so far. I'm the person that put the original post up and what seems to be working for the moment is I did continue to take a toy away each time she had an accident but I also spent more alone time with her. I've also had her help a bit more with her brother.

In any case, we've only had one accident in 5 days and she was devastated when I took her favorite Spot book away. So I'm still spending time reading but her favorite book disappeared and she was not happy.

She's also asked where some of her toys went and I told her, remember, you peed your pants and they disappeared.

So she's making the connection.
until it happens again......

I didn't catch your original posting, but read about how you've chosen to deal with your near 4 year old potty accidents, and I think you should take care when punishing potty issues. Taking toys away for an accident is punitive, and it will likely give your child a negative feeling about the potty, which I know you don't want, as it will ultimately create more issues (mental and physical). Possitive reinforcements are always a better, and healthier, choice for children.

For instance, a pat on the back when your child rememebers to use the potty goes a long way. I know from experience (I have a 4 and 2 year old) that it can be very frustrating to go through steps over. Regression is tough on a mother, and you've already potty trained your 4 year old. But, try to be patient again, and give possitive rewards for getting to the potty. ''You remembered to use the potty every time today! Great Job'' would feel so good to hear, that your child will want to hear it again the next day. If you use a reward system, give a sticker everytime she remembers.

A child this age who is having accidents is generally having them for 1 of 2 reasons. (1) attention / regression (in this case, my advice is...give attention -- possitive attention. Reread some potty books with your kid, like 'Once Upon a Potty', and tell them how happy you are to have a 4 year old who is using the potty so much -- don't mention the mistakes, just the successes)

Another reason for mistakes (2) attention span. Some kids at this age have a real hard time separating themselves from their play. for these kids a playful reminder is very helpful. Talk to them about listening to their bodies, give them a ''potty''watch (everytime any hand gets to, say the 4, check in with the potty). This option actually works great for both cases, as it also gives special (possitive) attention to the child.

Please don't give your child negative feedback regarding their body functions. We want to raise our children to feel happy with and love their bodies and everything they do. If adults don't use kid's body functions against them, they will not learn to use them against others (like peeing just to tell you she is angry).

4-year-old has started wetting her pants at school

I would welcome replies from anyone who has had experience with this problem...

When my daughter turned 4, 6 months ago, she started wetting her pants several times a day, and she has not stopped. I've tried not nagging her for several days and I've tried reminding her several times a day -- neither works for very long. I've had her tested twice for urinary tract infections (both negative). Until very recently, she hasn't seemed to even mind being damp or wet, but recently one girl in her preschool class mentioned that she should wear training pants and she related that to me. My pediatrician mentioned medication, but I am very much against that except as a last resort -- especially since I suspect that it is a control thing. My daughter refuses to stop playing, watching a movie, etc. until she can barely walk. It's quite obvious. Also, she is very headstrong in a quiet way and I think it is her manner of taking control. But, we are debating whether to send her to kindergarten in the fall and I'm not sure whether peer pressure would make her stop or be devastating.

Has anyone had this experience? I would welcome input either on the Digest or personally. Thanks. Stefanie

My 4 year old son recently went through a phase of this a few weeks ago, though it didn't not last as long as your daughter's. It didn't seem to upset him very much, in fact he rarely noticed, or he noticed but didn't mind the wet clothes. It mostly happened on weekends, and I honestly think that he would forget (actually ignore it) because he was so wrapped up in whatever he was doing. After a couple of weekends, we figured out (with his help) that he would try to hold his pee because he didn't want to miss out on anything. We gave him the option of training pants, which he considered and then rejected. We also tried to downplay it alot and explain how he could stop or pause playing and then come back to it. We were able to illustrate this most effectively with his videos, by teaching him how to pause a tape all by himself, go potty, and then come back and start playing it again without missing anything. (I'll never forget the look of astonishment and understanding when he finally understood that possibility!) After another couple of weeks (and of course, with continued reminders of now would be a good time to go potty) he seems back on track. [We're still working with him on the idea of going potty before we go out (especially in the car), but he's stubborn and sometimes tells us I can hold it, but that's a whole other issue.] I think you're right, it is partly a control thing, but I also think that 4 is still pretty new to the whole potty thing. We also suspected with my son that it was also partly a regression which we've noticed before (the regressing part) before some big developmental stage. Good luck and hang in there! Hopefully, your pediatrician will rule out health issues. Natasha

I also have a 4 yr old and find the best strategy for bathroom use is a firm announcement several times a day (It's time to use the bathroom) rather than posing a question (the always ridiculous: Do you need to use the bathroom? - my son has never said yes to this one) or suggestion (You should use the bathroom - and the power struggle begins). Sometimes just the above announcement works but is usually followed by: I don't need to from him and Just try from me. If a battle ensues, I drop it - it is definitely a losing one. Unless a good bribe is handy Well, we can't go to the park until you do. Ellen

Since it seems obvious to you when your daughter needs to use the bathroom, enforce a bathroom break where possible: turn the movie off or interrupt play with a guarantee that she can continue when she returns.

I also make a point of having rules about bathroom habits: We use the bathroom before we go to bed, get dressed, eat lunch, etc. This way it isn't so much a power struggle between us, just following the rules (which alot of 4 year olds are very attached to). He doesn't seem to hold me and his dad or his 9 yr old brother to these same rules so I have the sense that he gets it somehow and understands the rules let him save face about being told what to do all the time. Note, my son is generally an easy going guy so this strategy might not work for some.

I would ask the teacher's at your daughter's school for some help too; i.e. asking them to have her use the bathroom several times a day in a low key way. This certainly isn't an unusual situation and a good teacher will have some strategies that work without shaming the child in front of her peers: gently reminding her to use the bathroom frequently; having the child change her own clothes privately (sometimes taking the time out from play is an incentive for cooperation); positive reinforcement, etc.

Wetting pants: My daughter was out of diapers for about six months at age 3+, and then regressed and needed diapers again for more than eight months. I think it was a combination of things, but that control issue was a big part. One of her preschool teachers said that maybe when she was first toilet-trained, she responded positively by performing well, which is different from doing it from a deeper self-motivation. One is internal, the performing is behavior for others' approval. Nancy

One of ours did something very like this, even to the refusal to stop what they were doing and take care of things, and didn't fully resolve it till age 7, despite scoldings, understanding talks, rewards, nothing, you name it. I think it is partly a power-struggle thing, maybe even within the child him/herself, and partly just overall immaturity (though it does indicate admirable powers of concentration and a long attention span!). We finally quit racking our brains over it and said, You're wearing pull-ups to school until you get this under control, and by the way this is your problem, not ours, and eventually s/he did.

Peer pressure was not a big thing in kindergarten. I think few kindergartners have toilet training so well under control that they can afford to tease their peers! This may be a sign, though, that she's not ready for kindergarten--she'd be not-quite-five when she started, and that can be hard for a kid--not-quite-six is far easier.

Teacher pressure is another thing. If you decide to send her to kindergarten with this unresolved, you should certainly get the teacher's input. Kindergarten teachers have enough to do without daily mop-ups. John

re four-year old girl wetting pants -- I recently went through what seems the very same situation with my four year old girl. Also went to the doctor, no infection. It seems that it may be a similar situation -- they're just too busy with what they're doing to take the time to pee. We made it a policy that she at least had to try peeing before we left the house, every two hours, etc. We also went the big girls don't pee in their pants, and your friends are going to start thinking it's yucky if you're peeing in your pants routine. The results were not immediatate, but she's gone back to using the toilet -- I'd say it took a couple of months or so before she cleaned herself up. Good luck. Andrea

4-year-old wets her pants when she laughs hard

June 2002

Hi, my 4.5 year old daughter has periods of time when she pees in her pants when she laughs hard. There are a lot of times when she wets the pants like 10 min after she's been to the bathroom. She is not a bed wetter and this does not happen at preschool as far as we know. We tried rewards, punishments etc but she says that when she feels she needs to go she had already wetted the pants. She knows this is bad. Any ideas ? Thank you. A puzzled Mom

Please, you must not punish your child for this! It is not her fault, she cannot control it and it happens to many children and adults. I had this problem as a child, and so did my mother. Thankfully, she was sympathetic to my embarassment. We both had immature kidney and bladder issues and I have an extra ureter between my bladder and one kidney that gave me a variety of problems as a child which resolved as it grew and matured. Talk to your pediatrician and see a good urologist such as Joel Piser at Berkeley Urological. I'm sure there are a variey of causes for this and most she will outgrow. In the meantime, shame and punishment will not help.

I would not! punish a child for inadvertently peeing! No kid wants to wet himself deliberately. If you have ruled out organic causes by consulting a board-certified pediatric urologist, try teaching your kid to do kegels. Seriously, it can help tremendously with incontinence. Finally, the muscles responsible for voiding or not voiding will strengthen as your child matures. Punishment for accidentally peeing can scar your kid--maybe she will start ''holding'' her pee, which can give rise to a host of medical problems. Go easy. G

If your daugther had been an adult, I would suspect weakened pubic floor muscles and suggest Kegel exercises. That could still be your daugther's problem. I would have a doctor check it out. By the way, Rudolf Dreikurs, in ''Children the Challenge'', says that punishment never works for elimination problems; it only makes the situation worse. Fran

Not only did I pee my pants when I laughed too hard as a kid, I still do it as an adult! I also wet my pants when I vomit, jump up and down too hard and sometimes when I run. I really can't help it, and my husband is a very, very funny guy so it can be a real problem in public.

Its my bladder; it is weak and overactive, and I've tried medication (my grandmother actually had surgery on hers to solve the problem) but now I just tie a long-sleeve shirt or jacket around my waist and keep an extra pair of pants at the office. Medication just made my mouth dry and made me sleepy. I also have learned to squeeze my legs shut tight and even press on my crotch with my hand to keep the urine in if need be.

If this doesn't work and I pee my pants, everyone is usually laughing pretty hard anyway, and in a great mood, and we just keep laughing, even about the pee.

I remember peeing in my pants once as child at a slumber party (we were crank-calling late at night) and the host refused to let me borrow some pjs and I was a bit traumatized by that but I don't remember any lasting effects from it.

See a urologist for 4.5 year old's Enupresis diagnosis?

Feb 2003

I am trying one more behavioral approach to dealing with my 4.5 year old son's wetting problems, but if this doesn't work, I am advised to look into a possible medical problem. The nurse in my pediatrician's office has informed me that to look into this, first a urine analysis is done in the pediatrician's office to rule out urinary tract infections (which I know it's not, since this problem has existed for a year and half and my son would be pretty sick by now if he had a uti!), and if that's clean, then we'd go on to a urologist. She said she thought the tests they would do would involve catheterization, the thing I am most looking to avoid (hence not exploring a medical condition sooner). My question is twofold: 1) Does anyone have any experience with bringing their young child to a urologist, how did you prepare them/help them cope, and are there alternative ways to looking into this problem other than through a catheter (say, ultrasound, MRI etc.)? and 2) If, god forbid, we have to go through with the catheter, do you think I can convince/hold out for my son to be at least sedated if not put under completely? The nurse told me this is not usually done, but my son has sensory integration dysfunction and impulse disorder, and at his age, this is not an experience he'd forget, I fear, and I don't want to put him (or me) through it, if it's medically feasible to avoid it or at least make him unaware of it. Thanks for any help Susan

Dear Susan, My son is 9 months old and has urinary tract anomalies which have required many tests. Already he has had 7 catheterizations. I understand your hesitation and fear. I cannot give any advice on preparing your older son for it but I must say that I have been amazed at how quickly and easily the tube is inserted and have been suprised at the flexible capacity of the opening of his penis.

The best advice I can offer is to see a pediatric urologist instead of a general urologist. Not only are they more adept at working with small bodies but they also have access to the appropriate sized tools. Their offices are decorated in such a way so as to make the children more comfortable and their personalities are more suited to working with small children.

An ultrasound is one of the tests used to find problems (we have had a number of them) and may indeed be a good first step. Then, if an irregularity is uncovered at least you know that having some of the other tests which do require a catheter are really necessary. Best of luck to you.

I think the advice you got about consulting with a urologist sounds very extreme for a four and a half year old who is wetting his pants or wetting the bed. It is not that uncommon even in children twice his age - see the advice on the BPN website. If I were you, I would get a 2nd opinion - I think it's been quite a while since bedwetting has been considered a behavioral problem. Everything I've read in the last 5 years says it is an inherited hormonal deficiency that they eventually outgrow. a mom

Challenging 4.6 year old still having pee accidents

August 2006

My 4.6 year old boy has been semi-potty trained for about a year and is still having accidents (pee pee only) almost daily. They usually happen because he is busy at play and doesn't want to get up to use the potty. Sometimes it is one accident and sometimes up to 3 or 4. He doesn't want to wear a diaper and often times gets very upset when I ask him to change his wet pants. He is also a very picky eater (almost no fruits and veggies) and can be rigid, stubborn, and has occasional tantrums. Most of the time he is sweet and loving and plays well on his own for long periods of time. Is the potty behavior and picky eating a 4 year old thing? He was a very sweet and easy going baby, then became more challenging around 18 months, peaking around 3, now getting somewhat easier going. Any advice would be great
frustrated mamma

I learned this one for our sons care giver: when ''do you need to go potty'' is met with a no she says, ''Let's try, you might be surprised.'' and when they do go she asks ''Were you surprised?'' It has had a good success rate. Helping him develope physical ques may be of some help too, i.e.,setting a timer for every 2 -3 hours or so as a reminder to check-in for himself when he is absorbed in self-play. Our son has night time accidents from time to time, I try and remember to have him empty his bladder right before bed & acknowledge his fustration when he has an accident and not put any energy on it pam

I just did a bunch of research related to this regarding my almost 6yr old daughter - definitely check out the pee accident relationship to constipation. I recently picked up some edible fiber tablets (they are relatively natural, not chemical, and are orange flavor - one of the flavors my daughter will tolerate) and some chewable acidopholis (doesn't need to be refridgerated like most). Next I'm adding in magnesium to her diet (found a fizzy drink that's pink lemonade flavor) that will soften her stool. It's kinda working - her constipation is less and we're also working on a 'potty' schedule - 5 minutes after every meal or snack. In order to get that going, I put a library of fun books in her bathroom for her, right next to the potty on a stool at arms reach.

If this going on longer, take a look online at a diagnosis called ''enuresis'' for more info on what might be a bit further down the line...

I also got on a yahoo group parent board that discusses these issues with children - it's been *very* reassuring!

Best of luck. Anon

5-y-o with frequent pee accidents

Aug 2012

One week from starting kindergarten, our 5-year-old is having multiple pee accidents daily. In preschool he went days staying dry, but now that he's on vacation, he won't go to the bathroom when we remind him. I'm worried about how he'll do in kindergarten. He's on the daily laxative recommended by the pediatric nurse practitioner we saw, which has helped put an end to the poop accidents she thought were caused by constipation, but the pee accidents have returned. We'd appreciate any recommendations about therapists that might help him be more willing to use the toilet when it's suggested and when he feels he needs to go, or other approaches.

i understand how upsetting all this can be. my daughter had pee accidents until she was, wait for it, yes, about 11 or 12. she is about to turn 14 now and it all seems behind us finally. i tried many things, but in the end just decided to live w/ it until her body (and mind) grew out of it. that meant waking her up at 2-3 am every night to take her to pee to at least prevent that horrible wet-bed scenario. but frequent wet, smelly undies, irritation on her bottom due to sitting in pee for many hours (at pre-school, school, camp, etc.) were just part of our lives until (i think) HER BLADDER JUST GREW INTO BEING STRONG ENOUGH TO HOLD IT AS LONG AS NECESSARY.

of course this flies in the face of conventional wisdom (oh, every kid has perfect bladder control at age 2, 4, 5, whatever, but certainly not much longer than that). but my take is that every kid is different (no matter the national averages or whatever) and all you can do is the best you can do w/ each situation. oh, and, again against conventional wisdom, the first thing I would do (and of course you are not me) is to get rid of that laxative and any other ''drug''-type solutions. those things have nasty side-effects with which i wouldn't want to have to deal at any cost. your boy already has a pee issue--i wouldn't want to give him a bowel issue as well.

good luck. i know it's hard to be patient w/ things like this, but...nature has its own ways. ''relieved'' dad

Many ''pee and poop accidents'' (otherwise known as Enuresis and Encopresis, respectively) are caused by feelings of anxiety in young children, especially when beginning something new (e.g., new school year) or experiencing a significant change in routine (e.g., new sibling, parental separation). I encourage you to continue working with a medical professional to address any medical issues related to these problems. From a psychological perspective, though, I would begin to address the anxiety. Specifically, I would recommend that you talk with your son's kindergarten teacher about the class policy for when children can use the bathroom and how they indicate that they need to go. For example, some teachers have all of the students go to the bathroom at the same time and ask those who have to go in between to wait. Other teachers have a nonverbal signal (e.g., waving one finger in the air) to allow students to tell the teacher they have to go at anytime of the day. However the classroom is structured, try to keep an open communication system with the teacher so that you know what's happening at school. Also, I suggest setting up a reward system where your son can earn a ''prize'' after a certain period of time without an accident. As with any reward system, be sure to choose a prize that is of value to your son. The prize does not have to cost money (e.g., trip to the park, have a friend over). Also, don't make the prize too big because you may need to offer bigger prizes for awhile until the problem is resolved. Also, in the beginning he may earn a prize after just one dry day. But, soon you'll increase the challenge and explain that he will earn a prize after 3 dry days, or something like that.

I encourage you to talk people (e.g., teachers, other parents) to get more ideas about how to help your son not have accidents and, more importantly, feel good about himself and happy and safe at school.

Best of luck to you! Megan Flom, Ph.D. meganflom [at]

Oh, I really feel you! In fact, I was going to write the EXACT same question today. Our son potty trained himself just before he turned 3, was good for six months, and since then it's been constant accidents. He's turning five next month and just started kindergarten. He can write his name, read the comics, do some math...and he can't stay dry. It's so frustrating.

A few months ago I read this Slate article about constipation and pee accidents:

I bought the book. We'd already done a bunch of medical tests to rule out problems, but no one had x-rayed our son to see if he was constipated. Although he was asymptomatic, his x-ray showed he was full of poop and gas. We gave him Miralax for a few months. They say that a full colon presses on the bladder nerve to the brain and triggers spasms. It can take a few months for the nerve to stop triggering spasms after the constipation is relieved.

We have had mixed results. Our son was able recently to stay dry on a drive to Los AngelesC,bwith similar issues. I'm telling myself that this will be over one day. I hope someone else can help. tired of a mound of wet clothes

I am a pediatric nurse practitioner with lots of experience in this area and I would encourage you to check in again with your PNP about your son's accidents. If he has had a history of constipation he may still be holding in his BMs, even if he is no longer having accidents. The number one cause of pee accidents after a child has been fully toilet trained is bowel movement backup! That's because if a little kid's colon is filled with poop, there is less room for the bladder to expand to hold urine and the pressure in the area can interrupt the nerve signals that tell a child he has to go (that's why some children will say they don't feel anything when they have pee and poop accidents).

The ''gold standard'' for seeing if there is a back up is an Xray. I usually suggest that parents start with a simple ''24 hour transit test''. It should take about 24 hours from eating to the time undigested food comes out in a BM. If your child eats about 1/2 cup of corn or raisins, you can watch for them the next day. If they don't show up, keep looking--at the time they arrive you'll know how much back up there is in his colon.

It's really important to figure this out before you assume that it's all behavioral. Your son may need some extra help in school no matter what since kindergarten rules about where or when children can go to the bathroom vary. You can let the teacher know that your child may need extra reminders or quicker access to the bathroom.

I've written about these issues and you can find more information about what to do on my website, Best, Meg Zweiback RN/CPNP

Ditropan for wet kindergardener?

April 2010

My kindergartener has a history of wetting his pants frequently. He goes through short phases of keeping his bladder under control, but they never last. We were hoping that the peer pressure of kindergarten would give him some incentive to pay more attention to his bodily needs. Unfortunately, that hasn't happened and we've come to the conclusion that this is not something he can will his way into controlling.

After ruling out UTI, diabetes and an abnormal bladder, his urologist has recommended we try a few months on ditropan to see if his bladder will calm down. I'm eager to help him get to the other side of this problem -- it's not fun to be the kid with the wet pants -- however I'm leery of giving him a drug that seems to have many potential side effects for what is not a dangerous condition.

Has anyone else gone this route? Did your child experience side effects? Did ditropan help? Hoping to stay dry

Our 6-year old daughter, now in first grade, still wets her pants. She has also gone through short periods of time in which she stayed dry, but then reverts back to the wetting. I pulled my hair out for a couple of years, trying to figure out what would help. After a lot of reading (including BPN archives) and exams and discussions with various healing practitioners (both conventional and holistic), I realized this is not something we can ''fix'' for her. She, like your son, will undoubtedly grow out of it (who still wets their pants in high school?). They just need more time for the brain and bladder to talk to each other more fluidly; for whatever reason, those neural pathways between the bladder and brain are not fully functional/reliable yet. Before taking a pharmaceutical drug (which will always have side-effects, whether noticeable immediately or not), please consider a gentler approach, like homeopathy. Many children have overcome this issue with the right homeopathic remedy, and another good route is acupressure (acupuncture without the needles). Also, I have heard Body Talk (a treatment program) is often helpful. I have not fully pursued these paths myself, but will in another year or so if the problem hasn't resolved by then. You've got a few years... kids don't start being mean and teasing one another about this kind of thing until second or third grade. Until then, I would relax--your son will pick up the nervous energy about the issue from you, which won't help. A homeopath you might like to consult is Christine Ciavarella, in El Cerrito. Best wishes, Tracy

++ Ditropan for wet kindergardener?

I think there are other things you can try before you take what to me is a drastic measure. If you read T. Berry Brazelton (see Touchpoints), he goes into ways to increase awareness of the NEED to pee, and offers other helpful advice. Awareness of the need to pee is probably the main problem because if he had to go to the bathroom a lot to pee, that would be a different problem, right? Actually, my son had the latter problem when he was 4 and it went away. I learned that that sometimes happens at times of stress, and, in this case, he was starting a new school. But his bladder did eventually ''calm down.'' Remember, that kindergarten is a big step--and therefore adjustment--for most kids, and that in itself might aggravate the problem, and the peer pressure you thought would help eliminate the problem might be aggravating it as well. It is probably humiliating for him when he wets his pants in school, but you can help by not freaking out about it and having confidence that it is a temporary situation. Likewise, I hope the teacher isn't making a big deal about it. The most obvious temporary solution of all: is to keep him in a diaper under his pants as you're working with him on bodily awareness and getting to the bathroom asap. If he becomes aware of his need to pee, he can always go to the bathroom and undo the diaper partially in order to pee into the toilet or urinal. Finally, if he does sometimes know that he has to go, you have to talk to the teachers and make sure that it is quick and easy for him to get out of the classroom. Let's hope the bathroom isn't too far away either when the urge to pee arises. And he has to know that it's perfectly fine. You can work out with the teachers that he doesn't have to raise his hand and wait, but he can go right away. These little details can make a big difference with some kids with these kind of problems. Good luck! Mark K.

My son who is 6yo and in kindergarten has had at least three waves of wetting his pants - first at school and then just everywhere. I found it mortifying. After one of the waves lasted two weeks, I took him to the dr to rule out UTI, etc. The doc talked to him about just trying to go every 20 minutes, because of the brain body disconnect. It helped for like a week. I finally bribed him with computer time, if he stayed dry, he could go on the computer. It has worked for over a month now.

I agree with all the posts. I was so embarrassed when I would pick my son up from school and his pants were all wet in the front, I thought I would do anything to stop this - but - put him on medication? Personally, I think my son is a sensitive child, and was having fears of using the bathroom at school alone, etc. That said, I would go to a child counselor before I would go the drug route. anon

I'm a pediatric nurse practitioner with a lot of experience in toileting issues. You've probably investigated some other causes of the wetting, but just in case, I'd like to mention a few that are sometimes overlooked:

Partial emptying: lots of little kids are in such a hurry to ''go'' that they only let out some urine. That means that their bladders are often slightly distended which can make it hard to notice the feeling to go when it's really urgent, and they wind up not having as much storage capacity. It can help if they learn to sit, ''go'', count to 5 and then ''go'' again.

Liquid type: I'm sure you've been asked this already, but does your child drink very sweet or caffeinated beverages? Have you ever noticed different patterns based on what he has eaten?

Constipation: Many children have hard or infrequent bowel movements. The pressure in their colon can get in the way of the signals from the bladder to ''go'' and the full colon reduces the space in the bladder to hold urine. If your child doesn't have a good size soft BM every day I would talk to your pediatrician about this.

Ditropan is used with some children with frequent bladder emptying. Like all medication it has side effects which you should weigh against how severe this problem this is for your child right now. Meg Zweiback R.N., CPNP

5 year-old boy still having pee accidents

May 2009

I have a 5 year-old boy who still has pee accidents, sometimes several in one day. He had a urine test at his pediatrician's office and he does not have a UTI. I think that he gets engrossed in what he's doing/playing and doesn't always hear the signals that his bladder is sending to his brain. We have a star chart and rewards for dry days that he gets to choose himself. This definitely helps. I also think that he will probably grow out of this as he gets older. I am looking for other suggestions for things that we might be able to do to help him to hear what his body is telling him now. He will be starting kindergarten in the Fall and I am a little bit worried about him getting teased by other kids for having accidents at school. Thank you. Molly

Start worrying when he's 15, but for now, don't even give it even the smallest bit of thought or worry. Don't even expend the energy required to read the rest of my post. sean

This is highly unlikely, it possible your son is having seizures? Loss of bladder control often follows a seizure.

We didn't realize that our son was having absence seizures until his kindergarten teacher noticed them. Absence seizures often last only a few seconds, where the child just spaces out. They are ''absent'' for a few seconds. So they are quite subtle, esp. if you don't know what they look like already.

Now that our son's seizures are under control, he no longer has accidents. I feel horrible about all the times I nagged or scolded for wetting his pants, when all the time it was the seizures! Now accident-free

My son also went through a long phase of peeing in his underwear - not a big accident, but enough to have to change his underwear and sometimes his pants. I found that he was just holding it far too long and wasn't responding to his body signals. He said he did not even know he was peeing ... we would just see it in his underpants, etc. Since he wasn't noticing it, rewards for dry days, etc. would not work and would simply be the wrong approach since it did not seem to really be within his control.

The best solution just seemed to be to teach him to pee at routine times throughout the day. He went upon waking, again before school, as soon as he gets home from school, once in the afternoon, and again before bed. I did not make it an option, he just goes whether he feels he needs to or not. Turns out that he realized that his body did need to go, even though he wasn't feeling the signal, and I think this made him more sensitive to his body signals. I wonder if he didn't think he needed to pee unless he felt that ''emergency'' signal, and now he feels the less urgent fullness and now recognizes that this is the time to go. I remember him often being surprised at how much urine he would produce and we would remark that it looked like his body really needed to go even though he didn't feel like he did. Over time, this method caused him to be more sensitive to his body signals, and I think it is good to teach routines about the bathroom - i.e. using the toilet before you leave the house. Seems counterintuitive, but overriding having him listen to his signals for awhile caused him to end up being more sensitive to his signals in the end. Now we are always dry. By the way, we had a short episode of the same thing with poop in the pants during his sixth year, and the same method worked. We developed a few times a day where he would just sit on the potty and relax to see if he needed to poop. A few weeks later, the issue was over. I throw out poopy underpants

My now-8-year-old also had pee accidents in kindergarten and I just wanted to reassure you that it is not uncommon. Several kids in his class had an extra pair of pants and underwear in their backpacks just for this purpose. My son was potty trained by three, including making it through the night without ever wetting the bed. There were few accidents in preschool. But when he got to kindergarten he just could not get the rhythm of the day down. He would wait until the very, very last minute to go, even though the kindergarten had its own bathroom. Sometimes the very last minute was when they were outside, or in the auditorium, or some other inconvenient place. So he did not make it in time to the toilet. For us, it really was just kindergarten - he didn't wet his pants in 1st grade, and now in 2nd grade this problem is just a distant memory. One thing that seemed to help is his big brother telling him ''When your bladder says pee, don't wait. Go now.'' I remember my son telling me ''I have to go to the bathroom now. My bladder says pee, and like Joe says: don't wait, go now!'' So it might be the same with your son - he just needs a little trick to remember to go. G

5-year-old with frequent pee accidents

April 2009

My 5 yr-old daughter started potty-training at 2 1/2 years of age. It has not been easy right from the start.

At 4, she was still having as many as 4 accidents on bad days. Her doctor suggested that constipation which she often has, causes the intestine to pressure the bladder causing drip accidents - a kind of incontinence. The remedy for this was drinking water and eating vegetables and fruit. She doesn't drink much water, but eats good variety of vegetables and fruit. This helped a bit with the constipation but the accidents continue.

Now at 5 1/2, I can explain the facts to her about digestion and how a bladder works. We have talked to Dr. Lee, urologist referred to us by her pediatrician. He seems to think that the leaky bladder accidents were caused by delay in using the bathroom, i.e. her bladder was stretched out by repeated forgetfulness to use the toilet. His suggestion to fix this was to have her use the toilet every 2 1/2 hours. She has been on this 2 1/2 hour regimen for 3 months. This helped to decrease the number of accidents, but has not helped her in knowing when she needs to use toilet. If her teachers forget to get her to the bathroom, she has an accident but these have not been the drippy frequent accidents.

My concerns are that 1) she is going to kindergarten next fall where the teachers will be more involved with teaching and may forget to remind her to use the bathroom. Will an alarm wristwatch be helpful in getting to the bathroom at the required time? Or will this delay her independence in learning to use the toilet?

2) her peers will make fun of her for needing reminders or wetting her pants.

3) MOST IMPORTANT, by age 5, she should be feeling her full bladder and be able to get to the toilet before wetting. Why hasn't she learned to do this and why hasn't she learned from the many accidents she's had?

4) LEAST IMPORTANT, but on my worry list is night-time training. If she is not independently able to stay dry during the day, should I bother her and me to wake up to use the toilet once in the middle of the nite?

Has anyone had similar experience with toilet-training? Thanks for reading.

Hi. I am sorry to hear about your daughter's pee accidents. I am sure this is a struggle for you and her. Have you looked into her diet? I have read and heard from friends many times how some children are sensitive to certain foods and this sensitivity can show up via incontinence. In fact, my 2.5 year old son, whom I have ec'd since he was born and is nighttime potty trained, only pees in his sleep if he's eaten too much bread or grains over the course of a couple of days.

I remember reading about a teenager who overcame nighttime incontinence by doing the Feingold diet, which removed some specific foods, particularly foods w/ additives. A friend of mine is doing the Specific Carbohydrate Diet w/ her son and is seeing results re rashes and daytime incontinence. Please look for Breaking the Vicious Cycle by Elaine Gottschall and /or Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride. Both books discuss the effects of diet on gut health and give diet recommendations for healing. Google SCD or scdiet to get started now. Your daughter's constipation could be an additional indicator that she is having bowel issues. The body will talk to us in mysterious ways! Please don't try to just control the accidents w/ a timed wristwatch! Something is interfering w/ the signaling in your daughter.

I would also recommend seeing a different doctor.

good luck, Nita

My son had the same problem. We realized he was drinking gallons of water in the shower before bed. The accidents haven't stopped completely but are way down now. JodyT

5-year-old's accidents after birth of sibling

April 2009

Hello, My 5 year old son has recently started having pee accidents. I've noticed that this has coincided with the recent birth of his sister and realize that kids often regress at the birth of a sibling. These accidents tend to happen at school, parties or during playdates -- not so much at home or when he is doing something low key. When asked, he tells me that he is not aware that he has to pee. My son has always had a problem disengaging from activities to use the toilet -- he has a really hard time stopping things that he is deeply involved in. Is it possible that he really may not feel the urge to go?

I understand that this may be his way of reminding us that he is still little and needs us. I'm just not sure how to handle this in a way that meets my son's needs while also getting him to the toilet in time. Will this just correct itself if we continue to make special time for him and assure him that we know he still needs us? Right now, we are reminding him with non-verbal cues like a tap on the shoulder, as he is embarassed for us to verbally remind him in front of his peers. But obviously we are not there during the school day or other times to do this. What makes matters worse is that sometimes I get really annoyed at him for having accidents (and then I feel awful for showing him my irritation) -- which doesn't help anyone! Any advice would be most appreciated! Thanks. anon

You are right that it is perfectly normal for a sibling to regress after the birth of a baby. It will figure it self out. In the mean time you should continue to remind him to go. Have him go right before the playdate or party and depending on how long it is, remind him to go during also. Non-verbal communication is probably good as to not embarass him. He probably hates is as much as you do! He just forgets, that is why they call it an accident. Talk to his school and see if they can make sure to remind him to go at school too. I am sure they would understand that this is just a phase and be willing to help him overcome it. Just be patient with him and you will have to put some effort in just like when he was originally potty trained and this too shall pass. I am sure it does get frustrating, but showing your frustration to him may make matters worse, so try your hardest to keep them to yourself. Understanding mama

Five-year-old regularly pees in his pants

March 2007

My son is in kindergarten and regularly pees in his pants at home, at school, pretty much anywhere, every day. After he stopped using diapers (at over 4) he had occasional accidents. A few months later the accidents became more and more frequent. We have ruled out physical problems. We have tried a sticker chart which he didn't seem to care about. If I remind him to use the toilet he usually says he doesn't have to or gets angry at me for asking. Right now, I'm trying not to say anything at all, to just let him decide to stay dry. So far, no progress. Any suggestions? Tired of all the laundry

Is he doing this because he's lazy? You said you've ruled out physical issues. Is it anxiety? Emotional issues? One way, possibly, to stop is to make him do his own laundry. Don't change him (I know, it's wet and stinky)...let him be wet and stinky and if he can't stand it he can go change him self. My now teen at one time would poop in his pants at an age when he knew better, because he didn't want to bother going to the bathroom. I made him change and clean himself and wash his soiled underpants in the sink. That stopped REAL fast. Good luck. anon

Our now 12 year old peed in his pants til he was six and a half. We worried about it a lot. Then he stopped on his own at six and a half and there has been absolutely no problem since. Our son is a little slow to learn some self regulation issues, but he is very bright and does get it a little later than some kids. Other things he gets earlier than other kids. Good luck.

Once I heard a friend of mine telling her then 4-year-old that it was time for a ''surpise pee.'' We've been using that term ever since: ''It's time for a surprise pee.'' ''I don't have to go.'' ''Well, see what happens --- that's why it's called a surpise!'' AB

My now 9 year old son wasn't really and truly completely dry until he was 7. Even though you have 'ruled out' physical problems one thing his ped. suggested which did help was giving him a Metamucil cookie every day (or maybe 2x day, I don't remember). He believed that my son was having trouble sensing when he needed to go. An xray confirmed lots of back up. It did indeed help but took a few weeks. The other thing which kept him peeing (after having been mostly dry) was stress at school. There was a lot more stress than we realized. For a variety of reasons we eventually pulled him out and put him in an independent school. He was almost completely dry after that. Anyway two things to consider. anon

My kid potty-trained himself early, and still had some accidents in Kindergarten. The solution suggested to me was to take away his ''backup'' clothing in Kindergarten, and to tell him this: If he peed in his pants, he didn't have clean ones to change into. (I did sneak a set to his K teacher when he wasn't looking.) That was it; he stopped. It turned out he didn't like stopping what he was doing and he knew he had a backup. When he realized he didn't, getting to the toilet was a higher priority. (The teacher also helped by noticing the ''potty dance'' and reminding him to go.) Jennie

6yr old still peeing in his pants

August 2005

My 6 year old son is still wearing a pull up at night and has pee accidents about twice a day. When I'm around I take him to the bathroom and 15 minutes later he has an accident. Does anyone have advice or is this something I should seek professional guidance about...Thanks

From a professional perspective, your concern warrants intervention. There are a myriad of possible causes for your son's situation. Most therapists will consider many factors before determining the best way to resolve it. Whether or not you choose to stay in dialogue with me on this issue, I would ask you to document (for yourself) your son's history around it. Ask yourself these questions:
What does your son's pediatrician have to say about the situation?
When did you first notice your son wasn't progressing on this behavior?
Did he ever have a time of particular regression on this issue?
When and how have you tried to direct his bathroom behavior?
Were there any particularly challenging moments or incidents?
Does your son have siblings? (If so, what are their histories and how might they have made any contributions [positive or negative] to the situation?)

The answer to these and other questions will serve to guide the course of intervention a professional will recommend. I hope you find this helpful.