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ThinkstockPhotos 637226866Dear Dr. Debbie,

You addressed my son’s issue with using the bathroom at school  a few weeks ago, but things haven’t gotten better. I admit I haven’t invested much time in helping him get attached to his teacher, partly because I’m afraid the problem is bigger than that. Wherever I take him that’s not home, he refuses to use the bathroom. We may be out all day and he just holds it. At the end of a school day, he heads straight to the bathroom for a significant stream of urine. I know this could lead to a urinary infection, but of course that’s not a good enough reason for a five-year-old to change his ways. Other suggestions?

Me Again

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Dear M.A.,

Usually a child’s avoidance of unfamiliar toilets is due to fear. You and I know that no harm will come to him, but there is some reason he can’t bring himself to use the bathroom away from home, likely an irrational one, that doesn’t make sense to us. It could be that the toilet sounds different than the one at home (a bigger bathroom means a louder echo). Of course, the sound can’t hurt him. Or maybe he was once frightened by the experience of a parent or sibling disappearing (even if only for a few minutes) into a public bathroom and he panicked because he didn’t know if they would return.

The problem with an “irrational” fear is that once it takes hold, the body reacts to the stimulus of the “fearsome” object or event just as if some real peril is imminent. Adults have irrational fears, too. You may have never been bitten by a snake, never known anyone who has been bitten by a snake, nor ever heard of a local news story of a tragedy caused by a snakebite. Alas, somewhere in the real world, and more often in fiction, a snakebite is a true calamity. So the thought or sight of a snake, even a tiny garter snake, is enough to set off your internal alarms to protect yourself.

Desensitization for a Fear
A slow and systematic approach can alleviate an irrational fear. First, acknowledge that your son does not feel comfortable going into the school bathroom, and if forced, is likely to balk. It is very important for your son to trust that you, his teacher, and other adults in his life, will keep him from harm, even a harm that only he perceives. A school guidance counselor may be able to work up a step by step desensitization plan for him. This may include picture books about children using a school bathroom, actual photos of the bathroom stall, a recording – that he can turn on and off – of the flushing sound.

Noise Sensitivity
Does your son show other symptoms of being overly sensitive to sound? If so, discuss this with the teacher to see if the hollow sound of the bathroom could be muted with “white noise,” carpeting, thick drapes, or soft music. Since you mentioned your son has special needs, the school should be willing and able to try to meet your request for accommodations.

Modeling
If he has an older sibling whom he tries to imitate, make several after school visits at which your younger son gets to witness his sibling comfortably using the bathroom. Daddy could be another role model for nonchalantly using the bathroom at school. Modeling can also be done by a friend in your son’s class, but he’d have to first make a friend. Eventually he should want to do what his friend does. That’s what friends are for.

General Anxiety
The muscles involved in toileting require a relaxed state of mind. Have there been tensions in your son’s life that could have left him with heightened anxiety? Some children are more affected than others by a move, a change in a parent’s work schedules, a new sibling, the death of a close family member or a pet, or other abrupt or disruptive upturnings of a tranquil and predictable existence. The family doctor may offer a referral for family counseling to get to the root of past or ongoing turbulence. In a severe case of anxiety, medication can be prescribed.

Please continue to investigate this issue and advocate for your son at school. You have an admirable goal that can be met with determination and cooperation.

Dr. Debbie

Deborah Wood is a child development specialist in Annapolis. She has a doctorate in Human Development from the University of Maryland at College Park and is founding director of the Chesapeake Children's Museum. Long-time fans and new readers can find many of her "Understanding Children" columns archived on the Chesapeake Family Magazine website. You can find her online at drdebbiewood.com.

Click here for more parenting advice by Debbie Wood.

What do you think? Email your comments or questions to Dr. Debbie at editor[at]chesapeakefamily.com.

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