This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Thursday, August 24, 2017

What's That Smell? Potty Issues

There are many different causes for "potty issues" (aka "enuresis" - wetting and "encopresis" - pooping).  Often there is more than one cause.  

"Potty issues" can be bed wetting, refusal to poop, daytime wetting or pooping, pooping or wetting in inappropriate places or at inappropriate times, "painting" with poop...). 

Dysregulation, trauma triggers, a need for control... can cause issues and regression in this area. These can also cause the "RAD Stink" which has little to do with potty issues, but usually smells worse.

The RAD Stink - You've heard of the "smell of fear"?  This is the smell of dysregulation.  It usually smells like a combination of poo and the worst body odor you can imagine.  Yes, sometimes our kids' hygiene is not the best, but this stench doesn't go away, even with thorough washing and a change of clothes (although we have found that using a combination of antibiotic waterless hand soap under the armpits and a change of clothing can frequently keep the school from sending her home yet again!). 

Developmental - lack of readiness for potty training. 

This can be an emotional development too! Your child could be 8 years old, but operating emotionally at the level of a toddler. Age Appropriate Therapeutic Parenting
My Potty Training Philosophy is that it is better for children to switch straight from diapers to underwear when they have all of the signs of readiness (Showing an interest in the potty.  Able to take own clothes on and off.  Staying dry for over an hour or so - Children who are not physically ready will “dribble” all the time, rather than hold the urine).

Physical causes - Potty issues can be caused by:
  • Chronic constipation (which can also cause urinary tract infections), 
  • Urinary/ bladder/ kidney infections,
  • Problems with the "plumbing" (Kitty and my sister had to have surgery to correct issues with their "plumbing" - the "tubes" leading from the bladder being too small or the valves from the kidneys not working correctly), 
  • Allergies can cause severe gastrointestinal issues, 
  • Medications and med changes can cause gastrointestinal issues and other issues
  • Sleep issues - deep sleep (which can be caused by exhaustion, medications, or be biological/ genetic predisposition...) can mean the body may not "hear" the signals that the bladder or intestines are full
  • Hormones (trauma can trigger early onset of puberty meaning hormones can come into play at a much younger age!),
  • Hernias (my nephew had a hernia at age 8 that caused him to wet his bed at night)...
  • Scarring body may not "hear" or recognize the signals


Emotional causes - This subject will always make me think of Christine Moer's  "Pee Song."

  •  It's part of them. Some children develop an irrational fear of the potty or "losing" part of their body (poop).  I have seen a child "hold it" all day to avoid having to use the restroom at daycare, waiting instead until she was put in a diaper at night - causing serious intestinal issues.
  • Distracted, forgets, or doesn't like transitions  - to stop what they're doing and go potty). They may be dissociating - not aware of the world around them, or the opposite- too focused (hyper-focused) on what they are doing to stop and use the restroom.
  •  Doesn't want to draw attention to themselves.  The child may be afraid or uncomfortable asking or interrupting to ask to go.  
  •  Dissociation from physical self or lowered awareness of body - not knowing they need to go until it is too late - this can include not realizing or not caring that they have wet or messed their clothing.   
  •  Sexual abuse can cause a fear of bathrooms (might reminds them of the place they were abused), unwillingness to be naked (for toileting, baths, or showers), and unwillingness to touch themselves in places they were abused (causing issues with wiping and hygiene as well). A sexually abused child may have tried to make him/herself "unattractive" by being "dirty" or smelly. 
  •  Outdated defense mechanism -  A way to protect themselves emotionally. Sometimes old defense mechanisms outlive their usefulness, but the child can't stop. Defense mechanisms can feel life or death and the child doesn't feel safe without them (this is a "perceived safety" and has nothing to do with their current situation - where of course they are safe). Why Doesn't My Child Feel Safe?
  • Regression or delayed development.  Frequently children with trauma issues will remain stuck in earlier developmental stages or will regress - especially when dysregulated or triggered. The child may not be ready for potty training yet (or any more). It might be a way for your child to tell you they need the support and attention you would give a younger child - like kids who start baby talking, "forget" how to do things they used to be able to do, and wanting to be fed by you.
  • Way of expressing without words that they are unhappy or in emotional distress. Sometimes it really is a way of saying, "I'm pissed," or "Poo on you!" It also could mean "This is a poopy situation!" or "I don't give a poo!"
  • Entertainment and attention. Enjoys watching others jump around and get upset. Draws attention to them (negative attention is still attention!).
  • Feeling in control of their environment - a lot of kids feel that they can't control what's going on in their lives, but they can control what goes in to and out of their bodies and what happens to it.
  • Hoarding. An irrational fear that can be caused by a loss of everything when moved to a new situation (like foster care) or due to a mental health disorder like obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and/or depression.
  • The smell feels "normal," maybe even comforting. A child who experienced neglect at a young age may have consistently sat in wet/ dirty diapers or surrounded by this smell. Just like a child who grew up in chaos might act in ways to trigger that chaos, because that is the "norm" for their neurological system.
  • Comforting. Kids with attachment issues can wet the bed for comfort.... the smell of themselves comforts them subconsciously. {Try finding something ELSE that is comforting (the smell of mom - give her a shirt you've worn to sleep with, the smell of popcorn - put a bowl of popcorn by the bed... etc). 
  •  Proof you love them. Only parents handle pee and poop and still love you. 
  • Pushing you away before you can reject them - Many kids of trauma "know" they are unworthy or unlovable and believe that when you find out you will leave like everyone else - so to get control of that they find ways to push you away. If You Find Out I'm Not Perfect You'll Leave.
  • For reasons we don't always understand!  I worked with a neurotypical fully potty-trained child in a daycare situation who liked to change her clothes... frequently.  When told she couldn't just change her clothes for no reason (the teacher didn't have time to stop everything and let her change multiple times a day) - the little girl "made" a reason!  It took us a while to figure it out, and the first thing I tried (stopped allowing her to change into her pretty princess panties and cute outfits and providing her with gender-neutral clothes from the class stash) caused her to step up her game, until eventually she even started finger-painting with poop. We had to back up and stop making it a control issue.
  •  Some combination of the above - Dysregulation, illness, hormones, med changes, trauma triggers... all can suddenly trigger or worsen issues. 


So What Do You Do About It?

This is why part of our job as a therapeutic parent is to be a detective. Figuring out why it's happening can help us figure out how to stop it.

Handling it - 

  •  Avoid shaming or making it a control issue.
  •  Remain as calm and matter-of-fact as possible
  •  Expect the child to help clean up, but try to keep within their developmental abilities. Remember an emotionally delayed child should only be expected to do what is developmentally appropriate for their emotional age. For example, you wouldn't expect a 2-year-old to mop up all the potty water from an overflowing toilet, disinfect the room, cleaning supplies and themselves.
  •  A child in fight/ flight/ freeze is acting purely instinctually - the thinking part of the brain is not online so it is best to address things when the child is regulated. Dysregulation and Meltdowns
  • Social Skills. Sometimes having outsiders comment on the child's smell/ hygiene will help, but it could also feel shaming. Plus, most adults won't do it. They'll politely suffer through the smell instead (and tell you about it). Other kids will usually just avoid your child. I have warned my children that it can cause social issues, but it rarely worked.
  • Keep a change of clothes (or 3) with the child (backpack, locker, cubby...) or in the nurse's office or somewhere the child can access it. Waterless, antibacterial handsoap can often help with odors and cleaning.
  • Give the child some socially acceptable words/ euphemisms they can use to explain to others what happened. My 16yo daughter called me from school once asking me to bring her a change of clothes, because she'd, "lost an argument with the water fountain."
  • Make a schedule. Does the child need reminders to go potty? Assistance getting up in the middle of the night to go to the bathroom.
  • Use a timer. Some kids can't handle having you tell them what to do, and/or they get preoccupied with what they're doing and forget to go. Having a timer means the reminder is consistent and better yet, it's not coming from you.
  • Make an appointment - have a doctor make sure the cause isn't a medical issue.
  • Keep hygiene lessons brief - but do give them. I let my kids know that not changing underwear/clothes/ sheets with pee or poo in it can burn the skin and lead to infections. I also gave lessons (with clothes on!) in how to wipe and clean. (Also in how to change out a toilet paper roll!). These do have to be repeated as needed. My kids took a long time learning this. 
  • Cleaning - Wear gloves! This was less from worry about germs or the ick factor and more about the fact that the smell of poo really adheres to your skin. When cleaning up yet another overflowing potty I always wear gloves!
    When cleaning bedding and clothes - we generally add 1 cup of vinegar to the load.
    When cleaning carpet -
    -- For poo - I've used Arm&Hammer Cat Box Litter! I sprinkle it on the carpet, wait a while and vacuum it up.
    -- For pee - using something absorbent, I try to dry up as much as possible (assuming it's still wet). Then I use Odormute (which you can get at pet stores, Wal-mart, wherever). You have to use enough to let it soak into wherever the pee touched (including the carpet pad). One box has lasted me a long time.
     
    ·     Check often. My daughter slept in a loft bed. I frequently had to give it a smell test. I also had to watch for wet pull-ups, which for some reason she liked to hide.

    A trick for frequent bed wetters - We had a plastic mattress cover (of course) and made the bed as usual (fitted and flat sheet). Then we covered that with a plastic layer of some sort (I liked shower curtain liners - preferably ones that didn't make crinkly/ crunchy noises). Made the bed again (fitted and flat sheet). Repeat for several layers. Keep some clean pjs (and pull-ups if used) by the bed - we used a little wooden chest.
    When the child woke up in the middle of the night to wet sheets, all they needed to do was strip the top layer of sheets and their pjs, the plastic sheeting generally kept the urine from getting everywhere. Put on new pjs - kept in the box/ drawer/ whatever right next to the bed. Grab a new blanket if needed (we kept folded up comforters/ blankets on a shelf at the bottom of the bed.
    Voila! Back in bed ready to sleep in minutes. Could be done multiple times in one night if needed. In the morning, the child could put the whole mess in the washer (with some hydrogen peroxide and/ or vinegar or whatever you like to use).

    Low Tolerance/ Overwhelm
    It is sometimes necessary to simplify a child’s life a LOT to lessen the feeling of “overwhelm,” which can lead to potty and other issues

    This can be like childproofing – avoiding and removing things and events that can be triggers.  This can also be making their world smaller and lowering expectations. 


    One thing Kitty's therapist recommended was stripping her room. Nothing but a bed, one book, and one stuffed animal. It was NOT a punishment, and not something they could "earn" back (or actually not earn back, because my kids are afraid to be emotionally attached to things as it gives others power over them so they affect indifference to them. ).

    For a time, I even took my daughter's dresser out of her room and had her check out her clothes each day (this cut way down on the wet pull-ups and worse stuffed behind dressers and other places).

    We also cut back on the chore expectations she "should" be able to handle. I would break down tasks into small steps and give them to her one at a time. Instead of saying, "Clean your room," which was overwhelming and just didn't happen. I would say, "Empty your trashcan." and when that was done, then I would say, "Put your dirty clothes in your laundry basket." When that was done, I would say, "Put your laundry basket next to the washing machine." Most of the time, I would have to do these things with her (not for her, but be present in the room, often helping clean near her). Chores, Responsibilities, and Other Things My Kids Can't Handle

    Eventually, she got to where she could do a few tasks at a time, but the chaos in her head will always be reflected in the chaos of her room. I still help her keep it regulated. Therapeutically Parenting the Adult Child

      


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