Many fostered and adopted children have difficulties with wetting (aka enuresis) and soiling (aka encopresis). Indeed there are many children with happy, healthy enough lives who have such problems. There are, however, enormous variations in severity, meaning and cause and therefore the best ways in which to deal with them.
Wetting and Soiling are issues over which foster carers and adopters may receive particularly confusing advice. This is usually because the most effective way to deal with it will vary according to the cause of the problem.
An important distinction is whether the wetting and/or soiling is primary or secondary i.e. whether the child has never been “dry” (primary) as opposed to having been successfully toilet trained and then the problems with wetting and/or soiling re-emerging (secondary).
Why do fostered and adopted children wet and soil?
Some children just take a bit longer than others. The National Institute for Clinical Excellence (NICE) recommend that no treatment is necessary for children under five years old. 8% of children aged nine and a half years old wet at night (less than twice a week) and 1.5% of children the same age wet more frequently. Soiling and smearing are less common problems than wetting and anecdotal evidence would suggest these issues are more common in children who have experienced early trauma than in the general population. For general guidance on nocturnal enuresis have a look at the NICE clinical guidance for professionals.
Children who have experienced neglect at the time of toilet training may have missed the opportunity to jump this developmental hurdle with support and encouragement.
Children learn about what their internal feelings mean and how to manage them through sensitive, attuned care. This is explored on the Emotional Regulation page and the same mechanisms that are at work in how children understand and manage their own emotions are also implicated in children learning to perceive and interpret the physical signs of needing to go to the toilet.
Many fostered and adopted children have a negative experience of urination and defecation. Many children are left in soiled nappies, underwear and/or bedding. They may have been punished by being ignored, ridiculed, degraded, shouted at or hurt physically for their normal bodily functions. Therefore, they may be avoidant of any interactions with adults about wet or soiled underwear or bedding. This often leads to children hiding the soiled items, so ashamed and frightened are they of what their bodies have done and what their parents/carers may do and say.
Wetting and soiling can also be associated with anxiety. In situations of extreme fear and worry, to which fostered and adopted children have been overexposed, bladder and bowel function are much harder to control. This may be a general feeling of worry or it may be specific e.g. a child may be fearful of coming out of their bedroom at night time, perhaps due to fear of a chaotic, violent and/or intoxicated adult. Another possibility is a specific fear of the bathroom, which may have previously been an environment of fear, either because of active abuse or because it represents separation from their carer (we typically enforce or encourage separation via closed doors when someone is in the bathroom).
These problems may also be an unconscious cry for the type of intimate care routinely afforded to babies and toddlers. This can be a positive sign that your child is willing to try letting you parent them completely and an unconscious question to you about whether you can provide all the emotional and physical support that they need.
Some children who have experienced sexual abuse may, on a conscious or unconscious level, strive to make themselves and themselves and/or their bed inhospitable to their abuser(s) via wetting and/or soiling.