Friday, 22 April 2016

Bladder Control - Teaching a Child to "See" Himself Holding the Pee

I assessed a six year-old boy with day and night wetting. He holds his pee to the last minute when playing and Mom reminds him to pee when she sees the typical postures. He often denies he needs to pee when Mom reminds him. Sometimes an argument develops. 

Mom advised that he recently started to cooperate when she asked him to pee. The way Mom reported this made me think she had intervened to gain the cooperation and I asked her to explain how this came about. She went on to relate, “I explained what he looked like when he was holding his pee.” With words and some acting skills the Mom demonstrated the typical holding postures culminating in the inevitable race to the bathroom. 
Once a pre-school child starts to hold their pee during compelling play activities, they also start to lose touch with the early signals of bladder fullness. The signals fade away in a  manner similar to how "background noise" disappears. 
One psychological reason for this common phenomenon is that these children are in the Early Childhood phase of development, a time of egocentricity when the children only see the world through their own eyes and limited knowledge. They are not yet able to "see themselves" through the eyes of their peers or parents.
Once a child matures into Middle Childhood, the next psychological phase of development, they learn that they are part of a group (family, church, class, team) and that what other people think (parents, teachers, peers) has a value. 
This Mom helped her boy to "see himself" and this worked because he was far enough along towards Middle Childhood that he could learn this important concept. In my experience this is possible in about 20% of grade one children and about 50% of grade two children. By the end of grade three about 90% of children will have matured into Middle Childhood and are able to "see themselves" through the eyes of others. 

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