By Steve Hodges, M.D.
Have you ever been at your wit’s end with a child’s potty accidents or bedwetting?
At times, feelings of frustration and desperation can prompt parents to take extreme measures.
That’s apparently what happened when two Florida cops “jailed” their 3 1/2-year-old after months of poop accidents.
In a previous post about this incident, I explained why punishments are never appropriate for toileting accidents: accidents, flat out, are medical issue. Just as you cannot threaten (or incentivize) a child into overcoming eczema or diabetes, you cannot use punishment (or praise) to resolve encopresis (chronic poop accidents) or enuresis (bedwetting or daytime accidents).
But now that the boy’s parents have given an additional interview about the incident, to the Daytona Beach News-Journal, I have more to say.
This incident — including the actions of the parents and the boy’s daycare, as well as the media’s coverage — demonstrates our society’s complete misunderstanding of toileting problems.
Because of this misunderstanding, both kids and parents suffer. Kids shoulder blame and shame and, critically, miss out on the medical treatment that will actually resolve their accidents. Meanwhile, parents experience frustration and lash out in ways they otherwise never would.
In a follow-up interview with the Daytona Beach News-Journal, the boy’s parents, Sgt. Jessica Long and Lt. Michael Schoenbrod, explained what led up to “jailing” their son and what has transpired since.
Below, I comment on key passages in the article, debunking common misunderstandings about encopresis and/or enuresis. In my clinic, I find that when parents learn what actually causes and resolves these conditions, they’re less prone to frustration and can shift their focus to treatment.
•The article states that the boy “had seemingly” been potty-trained and later “regressed.”
My take: I have no doubt the boy was potty-trained, as toileting accidents have nothing to do with a lack of “training.” The boy was having poop accidents because a pile-up of stool had stretched his rectum, compromising its sensation and tone. This child could not feel the urge to poop, and his floppy rectum lacked the oomph to fully evacuate.
So, poop would just fall out his bottom. I guarantee you this kid did not feel or notice his accidents.
When a child remains accident-free for months or years and then, seemingly out of the blue, starts peeing or pooping in his pants, parents assume the child has “regressed” in potty training. In reality, the child’s chronic constipation has progressed to the point where he cannot control his bowel movements.
A vicious cycle develops: The rectum’s loss of sensation allows even more poop to pile up, which stretches the rectum further, making it even harder for the child to poop.
In some kids, the result is encopresis — chronic poop accidents. In other kids, the enlarged rectum aggravates the nearby bladder nerves, triggering pee accidents and bedwetting. Many kids develop both encopresis and enuresis.
Meanwhile, parents become increasingly frustrated, observing that their child “refuses” to poop on the potty. Of course, the issue has nothing to do with “refusal.”
•The article states that if the boy didn’t stop pooping in his pants, “he might be expelled from his daycare.”
My take: This is a sad and common scenario. I’ve had numerous patients suspended, expelled, or threatened with expulsion from preschool or elementary school due to encopresis or enuresis.
I wrote about one of these kids, a 3 ½-year-named Zoe, in my first book, It’s No Accident. After Zoe had exceeded her preschool’s limit of eight accidents per month, she and her mom were escorted off the school premises and told not to return until Zoe stopped having potty accidents.
The incident attracted national media attention and cruel, misguided posts from commenters in the Washington Post. Zoe’s mom was called a “lazy person who wants to dump the kid off so she can shop and drink Starbucks” and told to “quit blaming others for her failures.”
Zoe’s first doctor erroneously attributed the girl's accidents to an underdeveloped bladder. In fact, the culprit was severe constipation. An x-ray showed her rectum harbored a mass of stool the size of a Nerf basketball. Treatment for chronic constipation, involving enemas and laxatives, resolved Zoe’s accidents.
My website offers several free resources to educate school personnel about the causes of and treatments for accidents, including the K-12 Teacher’s Guide to Student Toileting Troubles and 8 Potty Tips for Preschool Teachers.
FURTHER READING: The Problem with Preschool Potty Training Deadlines
•According to the article, the boy’s parents tried everything, including “praise and celebrations” when he pooped on the potty, dinosaur decorations in the bathroom, a smartwatch to remind him to poop, and “punishments such as timeouts, spankings, and toys being taken away.” None of it worked.
My take: Of course none of it worked. Encopresis is not a behavioral or psychological issue. It’s a physiological issue. A clogged, stretched rectum simply will not respond to praise, threats or punishments!
Praising or punishing children for incidents not within their control only leads to frustration for parent and child alike.
What does work? Resolving the chronic constipation.
First, the hardened stool pile-up must be dislodged and cleaned out, a more challenging task than most folks realize. Then, the rectum must be be fully evacuated on a daily basis for months so it can shrink back to size and regain lost sensation and tone.
That’s when accidents stop for good.
Among physicians these days, the go-to treatment for encopresis and enuresis is a high-dose Miralax clean-out, followed by a daily dose of Miralax (PEG 3350). I used to recommend that regimen myself, but 15 years of research and experience have taught me that Miralax doesn't suffice in most cases.
A more aggressive treatment, involving liquid glycerin suppositories or enemas, sometimes in combination with oral laxatives, resolves accidents more quickly, effectively, and permanently. The regimen I’ve found most effective is the Modified O’Regan Protocol, aka M.O.P., described in The M.O.P. Anthology 5th Edition: The Proven Way to STOP Bedwetting, Daytime Enuresis, Encopresis, and Chronic Constipation in Toddlers Through Teens.
No matter what treatment a family chooses, cleaning out the rectum will prove more effective than timeouts or dinosaur decorations.
•According to the article, the boy’s accidents “had been going on for months.”
My take: It’s entirely unsurprising the accidents had persisted for months, because once encopresis develops, a clogged, stretched rectum will rarely resolve itself. Leaving encopresis or enuresis untreated is a huge mistake.
My private Facebook support groups are filled with parents of children encopresis who were advised by doctors, “Don’t worry, you’ll outgrow it,” so they were never treated. I have an entire support group for parents of teens and tweens with enuresis and/or encopresis.
Virtually all these children demonstrated signs of constipation by age 3, but their symptoms went overlooked or undertreated. That’s how you end up with 5th-graders who need to wear diapers to school and 17-year-olds panicked about the prospect of heading off to college with pull-ups.
Any case of encopresis that has persisted for months needs immediate attention and ongoing treatment. Even once accidents resolve, kids with encopresis are highly prone to relapse. If treatment is suspended too soon or not gradually enough, the rectum fills right back up. Treating encopresis takes time and attention.
•According to the article, Sgt. Long picked her son up at his daycare center and upon learning that he’d had another poop accident, decided to take action “because the boy is ‘super smart.’ She felt that if she didn’t follow through on her threats, “He’s just going to keep doing it.”
My take: The ability to stay accident-free has nothing to do with intelligence. Parents frustrated that their bright, accomplished children have accidents jump to the conclusion that the child is doing it on purpose and must be taught a lesson.
Not only does this approach fail, but kids internalize the blame.
I recently received an email from a 15-year-old with enuresis, who wrote: “My GPA is 3.97, and I’m an athlete good enough to get into a small Division 1 college. But even with all that, I can’t seem to grasp the concept of being dry at night.”
Of course, being dry at night isn’t a “concept.” It’s a matter of having a stable bladder and unclogged rectum. Yet this poor kid is convinced his bedwetting is somehow his fault. He wrote, “It just makes me so mad at myself that I can’t outgrow it."
Where did he get the idea that the accidents are his fault? From his dad, apparently. The boy wrote: “My dad wants me to sleep in a wet mattress to learn what ‘discomfort is’ and how disgusting I am that I pee myself still. He has tried punishments like taking away my electronics and my breakfast."
That’s the same mentality that led the Florida couple to inflict timeouts on their child, take away his toys, and, ultimately, put him behind bars.
It's absolutely critical for children to understand that accidents have nothing to do with their intelligence or value as a human being. I feel so strongly that I have co-written multiple children's books that emphasize this point, including Bedwetting and Accidents Aren't Your Fault and Emma and the E Club.
•According to the article, when the jail strategy failed, the parents “moved on to other methods, including having the boy meet with a licensed mental health counselor.” The boy’s mom said she later took a week off from work to focus on the problem and the child has pooped on the potty ever since.
My take: Encopresis isn’t a mental health issue, so treating it as such will ultimately fail and can actually make matters worse. (Also, a week of instruction a child on pooping won't resolve chronic constipation, and no amount of instruction will dislodge a pile-up of stool.)
Most mental health counselors don’t receive training on the causes of encopresis and enuresis, and many interpret accidents as a sign a child has “unmet needs” or is “acting out.”
Unfortunately, the characterization of encopresis as at least partly a behavioral issue is prevalent in psychology and psychiatry literature. Encopresis and enuresis even rate their own entries in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by American Psychiatric Association (APA).
Though these conditions are demonstrably not “mental disorders,” encopresis accounts for 3% to 6% of psychiatric referrals among school-aged children. Many of the counselors these children are referred to misunderstand the condition.
One therapist who does understand encopresis and enuresis is Amanda Arthur-Stanley, Ph.D. a Colorado psychologist who collaborated with me on a free guide, The Mental Health Professional’s Guide to Enuresis and Encopresis. I urge therapists and parents alike to read it!
Though mental health counseling won’t shrink a stretched rectum, therapists can play a helpful role in these situations, helping families cope with the emotional fallout from months or years of untreated encopresis or enuresis.
The Daytona investigator who looked into the jailing incident concluded in his report that the jailed 3 ½-year-old "did not receive emotional damage as a result of this incident."
But the investigator cannot possibly know whether that’s true. Of course, I have no first-hand knowledge of this incident, but I do know that the repercussions can be significant and long-term when accidents go untreated and worse, when, kids feel blamed, whether by their parents or society at large.
“Many kids with these conditions experience a devastating loss of self-esteem,” says Dr. Arthur-Stanley, whose private practice focuses on encopresis and enuresis. “Accidents can lead to feelings of embarrassment, hopelessness, anxiety, and depression. As therapists, we can help kids build feelings of self-confidence.”
Sgt. Long says she had no criminal intent when putting her son in jail, and I’m sure that’s true. But the real crime here is that our society does not understand what actually causes encopresis and enuresis. And so, kids miss out on the treatment that will make all this go away.
Even if the Daytona boy’s poop accidents have ceased for now, experience tells me his toileting issues will not end here.
Among my teenage bedwetting patients, you can draw a direct line from their poop accidents at age 3 to their enuresis in high school.
I had one patient, a 14-year-old boy, who had been assured for years that he would “outgrow” his bedwetting. Doctors attributed the boy’s bedwetting to anxiety and sleep disorders, overlooking the fact that the boy had a history of chronic constipation and, in fact, had delayed kindergarten because of his poop accidents.
When the boy landed in my clinic, his mom was stunned to learn her son was still constipated. “I was like, ‘WHAT???’ We thought the constipation was under control because he wasn’t having poop accidents anymore.”
Eventually, the kid’s accidents resolved, with the combination of enemas and medication. The ordeal that began with postponing school at age 5 concluded with him taking a gap year at age 18 — all because his constipation went unrecognized and untreated for years.
It would be a shame if something like that happened with the Daytona boy.