Daughter won't get off toilet

Question

Answer

You're in a bad cycle with your daughter. You're exhausted at night and naturally want to go to sleep, but your six year old has started insisting that she has to stay in the bathroom for half an hour or even an hour, with the urge to pee. You're sure it's not a physical issue, because you took her to the doctor, who said she doesn't have a urinary tract infection. This is happening every night now, and it's wearing you out. So you refuse to stay with her, but she starts screaming. You don't say it, but this must be eroding the closeness of your relationship with your daughter, with you resenting her and her feeling like she can't depend on you. It must also be hard to settle down for a peaceful night's sleep after a screaming fit every night. I'm glad you wrote for help.

I know you wrote to me as a psychologist assuming this must be an emotional issue, because your physician ruled out a urinary tract infection. And maybe this is an emotional issue, and I will address that in a moment. But I'm betting this is NOT an emotional issue, but a physical issue.

Why? Because any child who would create this kind of power struggle and insist on sitting in a cold bathroom for an hour night after night, rather than climb into the cozy family bed, would be provoking power struggles in other areas of her life with you. Since this is the only place you're having a problem with her, it's most likely that your daughter is actually experiencing a physical need to pee that is keeping her on the toilet. I know the doctor told you she doesn't have a UTI, but that doesn't mean there isn't a physical issue.

What kind of physical issue could it be?

• Does she take bubble baths at night? They often cause symptoms just like UTI. This would explain why it only happens at night. Even shampoo and soaps can irritate the urethra in some kids; you may want to switch to showers for awhile and see if the symptoms go away.


• Is it possible that she is constipated, so that her bowels are pressing on her bladder?


• Is it possible that the doctor didn't culture the urine? They almost certainly only did a dipstick test, which means they could easily have missed an infection. (I'm not a urologist, but I understand that the dipstick can give false negative results for several reasons.) I would suggest calling your doctor back and telling her that the symptoms have persisted and asking if they can do a culture of your daughter's urine regardless of the dipstick indicators. Sometimes the culture, or a blood test, will also be positive for infection even when the dipstick isn't. Finally, ask your doctor about interstitial cystitis, or an irritated bladder, which can cause the urge to pee without an infection. I don't think it is common in kids, but it has been known to happen, particularly to kids who have allergies.

So it's entirely possible – I would say very likely – that your daughter actually has a physical issue that is bothering her. It feels worse at night because other stimulation is gone then and her body's signals are louder; any mother who has lived through teething knows that pain often feels worse to kids at night. Your daughter is uncomfortable in her body, and the only thing that relieves it is sitting on the toilet. When you say you're going to bed, naturally she feels abandoned and gets a bit hysterical.

Pursuing a physical cause is almost certainly the best way to resolve this issue. It might be as simple as forgoing baths for now, and getting an attachment for your tub so your daughter can “shower.” Until this is solved, I would step up the cranberry juice and any herbal teas with which you're comfortable, to treat the symptoms until you get a diagnosis.

Now, what if there really is no issue physically? Then we need to figure out why a six year old would feel compelled to sit on the toilet for half an hour or an hour at night, even at the risk of a rift with her mother. The most obvious reason is anxiety, the other reason would be some issue in her relationship with you.

If your daughter has had bed-wetting problems, she might have become anxious about making sure that her bladder is fully empty before bed. But you didn't mention an issue there.

If she has OCD (obsessive compulsive disorder, a disorder that is almost certainly inherited, although it can be worsened by environment), then symptoms might well be emerging now, and this could be one. However, that is almost certainly not what is happening here, because she would have other, more obvious symptoms (compulsive ritualistic behavior) as well.

If she is prone to anxiety in general, and is made anxious by your sense of urgency about getting to bed, she might actually have a harder time relaxing to pee. This is more common that we might think. Ironically, when we get anxious and try to push hard to get the pee out, it pinches the urethra closed! Try reading to her when she's on the toilet, or do relaxation exercises with her. Another trick used by urologists is to have her blow on a pinwheel; the distraction and blowing relax the muscles.

What about her relationship with you? Your daughter is at a stage when kids face major developmental hurdles. They learn to read, ride a bike, tie their shoes. Their brains change so that they are more capable of analytical thought and managing their emotions. It has been my observation that many six year olds react to all this with some regression. It's almost as if all these forays into the world as a big person are scary to them, and they need to be sure mom is really there to comfort their “baby self” if they need her.

You don't mention any of this, and you clearly have a close relationship with your daughter – you cosleep and she is with you rather than at school during the day. But even close parent-child relationships naturally change as the child steps into her own identity, life and passions. It may be that what is going on between you and your daughter is a struggle about independence. Children worry that becoming an independent individual means separating from us, and to some degree, it does. They may become very independent at this age, but regress in some ways, particularly at night.

If this is the case with your daughter, she may be testing you to see if you will really be there when she needs you. In that case, the best thing you can do is reflect her feelings and let her express them fully, letting her know that you're listening. “You really want me with you. You don't want me to go. You are afraid you will feel alone and unhappy in here without me.”

How can you be so calm, patient and empathic when you're exhausted?

1. Tend to your own needs. For the next few weeks, you may be required to do a little extra parenting at night. So do whatever you need to do so that you get a bit of a second wind before bedtime. And make the whole process a bit less onerous for you. Make sure you have a chair in the bathroom. Make yourself a nice cup of herb tea. Make sure you're dressed in something cozy and comfortable. Maybe you can even read your own novel while your daughter reads her own books.

2. Start the bedtime routine at least half an hour earlier. Explain non-judgmentally to your daughter that until you two are able to help her body feel more comfortable that it is done peeing and can go to bed, you need the extra time.

3. Remind yourself that something is indeed going on with your daughter. She isn't just trying to be ornery and keep you from going to bed. You may not know what's bothering her, but something is. She needs your parenting now.

4. Finally, give yourself a break. It sounds like your daughter is with you 24/7, unschooling, cosleeping. It can seem, when all we want is to sleep and our child is expressing seemingly arbitrary needs, like we're second class citizens who can never get our needs met. Your needs do count. It may not be possible to meet them at this moment when your daughter is struggling, but all moms know what that feels like. When we find ourselves balking at extending ourselves yet again for our child, it's a signal that we need to pay more attention to our own needs. Notice, as you're going through your days, any ways in which you could better balance your own needs with those of your child.

Wondering if this approach makes sense if this is actually just a power struggle? Power struggles happen between parents and kids when we don't see the need or feeling underlying our child's behavior, and instead respond by attempting to control them (which, of course, is impossible.)

(That doesn't mean we can't set a limit, as long as we allow our child's emotional response to that limit: “It really is bedtime. I see that makes you upset. I am right here listening and you can show me how upset you are.”)

But more importantly, defusing power struggles starts when we attend to the deeper need or feeling that's causing our child's behavior. There's no power struggle if we can respond to that need or feeling instead of fighting with our child: “You need to know that I will always be here when you need me. I will. You can count on that.” Your daughter needs to know this will always be true, even though as she grows up, she will need you less and less.

Hopefully, you'll be able to resolve this issue quickly and make your daughter more comfortable physically. But whatever happens, you can use this opportunity to deepen your relationship with your daughter. A silver lining, indeed.