Q: My 9-year-old daughter doesn’t seem to notice she has to urinate until the need is urgent. I often see her fidgeting and hopping from one foot to the other, and when I tell her to go, I see the dawning look of realization on her face.

She was toilet-trained by age 3 but wasn’t reliably dry at night until she was 6. She has been dry since then.

For the first time in years she has had a few accidents (probably because I wasn’t around to remind her to go, or she was too shy or she waited too long), and she is very distressed.

Is there anything we can do to train her to notice the early sensations of a full bladder? Is she putting herself at risk for problems by waiting until she has to go so badly that she must run to the toilet? — Via e-mail

A: Your daughter’s distress about the accidents is a good sign that she will do as much as she can to solve this problem.

You will want to encourage her impulse to find solutions — and her confidence that she is up to the challenge.

If you express too much concern, or pressure her, you may find that she resists.

Rather than “telling her to go,” as you say, perhaps you and she could agree on a private code or signal — for example, touching your forefinger to your wrist as if you were pointing to your watch: “Looks like it’s time to watch what your body is telling you right now.”

Such an alert is a small change that shifts some of the work from you to her. You can’t always be there to remind her. You and she both need to learn to feel that she can handle this responsibility independently.

Perhaps she could learn to scout the location of the restroom when she is in a new setting. If she finds out in advance, she may feel less shy. She might need you to help her figure out how to ask. Language that’s appropriate and within a 9-year-old’s reach: “Excuse me, could you please tell me where the nearest restroom is?”

She might also develop the habit of using the bathroom at regular times, even when she doesn’t think she needs to go — like before leaving the house or when arriving at school or a new location.

You might also ask if she has her own ideas about why the accidents happen so she can try to come up with solutions of her own. You are understandably sensitive to her embarrassment. But it will be important for her to know that what matters is how she feels about the accidents — and that you are ready to help, without judgments of your own.

You ask whether waiting too long puts her at risk for health problems: In theory, the healthy bladder is set up to trigger its own emptying before problems arise. But we urge you to have your pediatrician discuss this problem with your daughter, especially if she had gone for years without accidents. Urinary tract infections are a common cause for renewed wetting.

 

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndicate, 620 Eighth Ave., 5th Floor, New York, N.Y. 10018. Questions may also be sent by e-mail to:

[email protected]

 

— The New York Times