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At an early age or before potty training, it's expected to some degree that kids might urinate when or where they shouldn't. For example, during a child's toddler years. But what if it appears that your child is intentionally urinating on the floor or they have more pee accidents than other kids who are the same age? Is there a connection between attention deficit hyperactivity disorder (ADHD) and urinating on the floor?
In this article, we'll talk about the connection between accidents and ADHD, how to tell whether a child is peeing on the floor intentionally, and why kids might urinate on the floor despite being potty trained. Then, we'll go over tips to help parents get the problem under control, such as making a bathroom routine for children.
ADHD And Urinating On The Floor
Research confirms it: There’s a link between attention deficit hyperactivity disorder and a higher prevalence of daytime wetting. Various factors might play into why this happens. First, research shows that ADHD may be the most common psychiatric condition associated with lower urinary tract issues such as overactive bladder. Second, ADHD can cause trouble with paying attention and other symptoms that might make accidents more likely for children.
Mental health conditions like oppositional defiant disorder and anxiety also have a connection. Since diagnoses like oppositional defiant disorder (ODD) and anxiety are more common in children with ADHD, this is something to consider.
Is It Intentional?
Pee accidents are not usually intentional. Even if it appears that a child is intentionally urinating on the floor or in other inappropriate places, it may not be intentional at all. That isn't to say it can't be intentional.
Sometimes, a child intentionally urinating on the floor will pair with other symptoms, like temper tantrums or angry outbursts. In the case that a child does throw tantrums and daily life seems to be a power struggle, the combination of behaviors may give a parent a clue about what's going on with their child. If a child frequently exhibits defiant behavior or lives with a diagnosis like oppositional defiant disorder or conduct disorder, it's possible that they're urinating on the floor intentionally. Since a child with these conditions may purposefully defy others, one way to do it is to urinate on the floor when they know they shouldn't.
That said, there are a number of different physical and mental health-related reasons why a child might be peeing on the floor or in other inappropriate spaces. Some are linked to ADHD directly, whereas other causes are separate. While these may be out of a child's control, it's possible for parents to teach children how to control and navigate the issue.
Accidents in the house, at school, or in other spaces are tough for most parents and their kids. You might find yourself having to bring your child a change of clothes on a regular basis, and you might feel frustrated wondering, "why is this happening with my child?" Whether in the house or at school, it goes without saying that accidents can be embarrassing for a child. Consider multiple possibilities before you regard your child's behavior as intentional.
Why Does My Child Urinate On The Floor Despite Being Potty Trained?
It's ideal to find out why accidents happen to your child so that you know how to best address it. If your child urinates on the floor (or even poops their pants) despite being potty trained, there are a number of potential reasons to look into. How do you know which one it is?
Sometimes, saying, "Do you know what made this happen? I'm not mad. You can tell me," is the best way to get to the bottom of why a child is urinating on the floor. Even if it's not a direct statement, it might give you a clue. For example, if they say, "I couldn't wait," they might've been too focused on another task to notice that they had to go.
Of course, take the age of your child into consideration. A toddler you're working to potty train may have less control than older children. For other kids (those too old for pull ups or who have already been potty trained), the issue might be more urgent and troublesome for parents.
Keeping that in mind, here are some common causes that may lead a child to urinate on the floor despite potty training.
The child is overwhelmed or overstimulated
Children with ADHD, anxiety disorders, and other conditions, may be more apt to become overwhelmed or overstimulated. Similarly, stress at school or in a child's home life may lead to overwhelm, causing more accidents.
If a child can't control things in their life or feels worried about something that's going on in their world, they might show a number of physical and behavioral signs - including accidents.
Attention seeking behaviors
Attention-seeking behavior could be the reason for a child intentionally urinating on the floor in some cases.
Let's say that your child has a new sibling. If the pee accidents began only when the baby came along, this is an example of how attention-seeking behavior might be at play. This is just one example of why a child might want more attention.
That said, it's important to reframe the way we view attention-seeking behaviors. Seeking attention isn't bad. Attention-seeking behavior is a way to communicate "look at me," "spend time with me," "give me affection," and so on.
Attention is a human need, and it's not bad to want it. The key is to help children learn to communicate things like, "I feel left out," "I want a hug," or "I'm sad" so that they don't need to communicate through behavior.
Distractibility
As mentioned, some kids may wind up peeing on the floor or having an accident because they're too fixated on another task or activity. For kids with ADHD, this isn't at all unlikely. It's not intentional behavior. It's symptomatic, and it can be addressed by ensuring a child makes regular bathroom visits through a routine or other means, which we'll discuss later.
Hyperactivity
At times, if a child pees on the floor, it might be due to hyperactivity/impulsivity symptoms. Just like distractibility associated with ADHD can play a role, hyperactivity and impulsivity can lead to a range of inappropriate behaviors.
Hypersensitivity
Kids with ADHD are more prone to sensory overload or hypersensitivity. Overstimulation caused by hypersensitivity and lack of body awareness, often connected to sensory issues, might make it hard for a child to notice their need to use the bathroom.
Another underlying medical condition
If a child has more pee accidents at random than they used to, it may be worth looking into other common medical conditions. Urinary tract infections and diabetes, for example, are associated with frequent urination. As discussed, mental disorders like anxiety may also play a role.
Tips To Try
There are ways to reduce accidents in children. If ADHD symptoms, feeling stressed, or another similar cause is the culprit, these tips may help you and your child. it's important to make a doctor's appointment if a new or undiagnosed medical condition could be at play (e.g., if accidents have started over the last few years despite no issues with bladder control in the past, appear to be outside of a child's control, and if the tips below don't work).
Try Joon To Help
Joon is a routine app and game for children with ADHD and their parents. The goal of Joon is to help kids with ADHD follow through on tasks and routines. Parents sign up first and create a task list for their child. When kids complete tasks, they get rewards that let them care for a virtual pet in the game.
You can modify your child's task list at any time and can pick pre-loaded tasks or input your own. Going to the bathroom on schedule, getting dressed, or virtually any other activity are all examples.
Joon is backed by occupational therapists, teachers, and child psychologists. With over 3.6k reviews, Joon has an average rating of 4.7 out of 5 stars in the App Store.
Click here to try Joon for free.
Reward them for urinating in the toilet
Positive reinforcement works well for kids with ADHD.
Many parents use a reward chart for kids during potty training as well as to encourage household chores and other good deeds. If a child is urinating on the floor, a reward chart can be a useful tool to aid behavior change.
Provide stickers or another small reward when a child uses the toilet to help them get and stay in the habit of doing so.
Create positive bathroom habits with a routine
It may seem strange to create a routine for using the bathroom. However, in the case that a child peeing on the floor is due to distractibility or a lack of physical cues, routine bathroom visits can be a game-changer.
Create a routine for your toddler or child that includes specific times of day where they must go to the bathroom. Even if children or toddlers say they don't have to go, ask them to try at scheduled times.
Make sure they're getting enough sleep
Not getting enough sleep can disrupt behavior, school performance, mental health, and the physical body. Research suggests that lack of sleep can worsen ADHD symptoms, and of course, it can influence the way kids and toddlers act or behave. Peeing on the floor, experiencing temper tantrums, and other inappropriate acts may be more prevalent when a child doesn’t get enough sleep.
Ensure your child is getting enough sleep for their age. Make sleep hygiene tips like removing electronics from the bedroom, following a soothing and consistent nighttime routine, and avoiding caffeine the standard in your house. If your child has a sleep disorder, work with a medical provider to treat it appropriately.
Make sure that other needs are met
If you know or suspect a cause, make sure that your child's other physical, emotional, or mental health needs are met. If a child has a mental illness that might be a factor, for example, or if they throw temper tantrums, behavioral health support through therapy or other means can be advantageous. Getting children support at a young age can help kids by giving them the right tools early on.
If it's a case where an older child is jealous of a new sibling (or of anything else they see a parent spending time on, like a new pet or job), it might be beneficial to set aside time to do something special with the child. Have a conversation with kids (e.g., "this is why your baby brother needs extra attention") so that they understand.
Practice mindfulness
If the child's urinating on the floor due to a lack of attention to physical needs and cues, one way a parent can help is to practice mindfulness. Teach children to get in touch with their body's cues by discussing what signs they may experience when it's time to use the bathroom.
Mindfulness can also help a child manage big emotions. Children who have accidents due to stress, anxiety, overwhelm, or another similar cause might find that mindfulness practices are a valuable coping skill. Breathing exercises (like box breathing) can help kids self-soothe, too.
Practice boundaries and communicating their needs
If you identify a specific scenario that's leading a child to urinate on the floor or anywhere other than the bathroom, set boundaries and help children communicate their needs effectively.
For example, if a child doesn't want to miss out on fun times (they don't want to leave an activity to use the bathroom), let them know that they can be excused briefly and will not miss out but that they do need to use the toilet.
Teach children the skills to use to communicate the need to use the toilet confidently. Some children need a script to turn to in certain situations. For example, "I need to use the bathroom and will be right back."
Takeaway
A child intentionally urinating on the floor may not be doing so intentionally at all. Many different factors can lead to a child peeing in inappropriate places or times, whether that's in their own house or in other spaces, like school.
Issues like an overactive bladder are more common in kids with ADHD, and executive function or related concerns associated with ADHD could play a role. It's also possible that there's another underlying issue to address, such as another underlying medical condition.
If a child does have a tendency to act out, they may be urinating on the floor in the house or in other spaces as a form of defiance.
Regardless of the cause, parents can help children reduce accidents in most cases. Try the tips in this article, and if the problem is still not under control, reach out to a healthcare professional who can help.
About
Sarah Schulze MSN, APRN, CPNP
