Steve J. Hodges - It’s No Accident: Breakthrough Solutions To Your Child’s Wetting, Constipation, Utis, And Other Potty Problems

Copyright 2012 by Dr. Steve J. Hodges and Suzanne Schlosberg

ALL RIGHTS RESERVED. No part of this book may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, except as may be expressly permitted in writing from the publisher. Requests for permission should be addressed to Globe Pequot Press, Attn: Rights and Permissions Department, P.O. Box 480, Guilford, CT 06437.

Lyons Press is an imprint of Globe Pequot Press.

Illustrations on by Annemarie B. Johnson, CMI Medical Illustrator.

Illustrations on by Batrice Favereau.

Thank you to Project CLEAN for the artwork on .

Text design: Sheryl Kober

Project editor: Kristen Mellitt

Layout: Mary Ballachino

Library of Congress Cataloging-in-Publication Data is available on file.

ISBN 978-0-7627-7360-2

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

To my children and patients, who have taught me more about toileting than any textbook or classroom ever did.

To my wife for her love and support.

To my parents for devoting their lives to making mine better.

And to Dr. Sean ORegan, the smartest guy I know.

Disclaimer

The information contained in this book is intended to supplement, not substitute for, the expertise and judgment of your physician or other health-care professional. Consult your health-care provider before using the treatments recommended here.

Shortly after Thanksgiving in 2010, Zoe Rosso and her mom, Betsy, were escorted off the premises of Zoes school in Arlington, Virginia. They were told by the principal not to come back for a month, or until Zoe stopped having potty accidents. Zoe had wet her pants more often than the school allowedthe limit was eight times in a monthand therefore was considered not potty trained. Zoe was three and a half years old.

The incident made the front page of the Washington Post, attracted national media attention, and incited some of the most hostile and foolish comments that, as a physician and parent, I have ever read. Betsy was called a lazy person who wants to dump the kid off so she can shop and drink Starbucks and told to quit blaming others for her failures. One Washington Post commenter ranted, Its narcissistic for parents to insist that their untrained child has to be indulged. A parents job is to raise a well-socialized, functional member of society.

I have since had the pleasure of meeting Betsy and her husband, Randy, and of treating Zoe, who is now four and a half. I can tell you that Zoe is quite a well-socialized, functional member of society. Shes a delightful, inquisitive kid and a model patient. I also can tell you its not Betsy Rosso who failed; the system failed her. I dont mean just the Arlington Public School system, which operates the preschool Zoe attended. Yes, policies like those enforced by her school are misguided, and Ive treated countless children who have been harmed by them. But the Rossos also were let down by the medical system, which failed to detect that something actually was amiss with Zoe. It turns out her accidents were not accidents at all.

Though the Rossos have been accused of laziness and neglect, in fact they did everything youd expect from devoted, responsible parents. They worked diligently to potty train Zoe, using techniques Betsy Rosso learned in a workshop run by a developmental psychologist. Zoe achieved dryness in a month, shortly after turning three. When she began having accidents at preschool, a few months later, her parents took her to the pediatrician, who concluded that Zoes wetting episodes were not unusual and likely related to the stress of starting school.

Later, after Zoe left the school, the Rossos took her to a pediatric urology clinic, where Zoes urine was tested for infection and her belly was examined. According to the urology report, Zoes abdomen was soft, with no masses palpable. The report indicated that Zoe may have some underlying constipation contributing to her urinary symptoms but stated that aggressive evaluation and treatment is not recommended.The report did offer the Rossos the option of having Zoes abdomen X-rayed, though in conversation the certified nurse practitioner who examined Zoe never mentioned an X-ray, reassuring the Rossos that accidents in potty-trained kids under age five are developmentally normal. According to Betsy, she was told that Zoe may have a small bladder that has not yet grown to catch up with the rest of her body and that the cause of Zoes wetting problems was likely genetic.

All of this was wrong.

In fact, Zoe was severely constipated. Her entire colon was stuffed with poop, including a mass in her rectum the size of a Nerf basketball. Constipation wasnt contributing to her accidents; it was the main cause of them. I requested a simple X-ray of Zoes belly and saw the giant poop mass for myself. Shortly after that, Zoe began aggressive therapy for constipation, including laxatives and physical therapy to retrain her pelvic-floor muscles. Over the course of treatment she and her family have experienced accident-free periods bookended by setbacks and frustration. Though her bladder continues to spasm, her accidents have become far less frequent. Zoes case has proven to be among the most difficult I have encountered and illustrates the serious and persistent medical consequences that can develop when accidents are dismissed as normal. Despite the challenges Zoe faces, she is finally receiving appropriate treatment, and the cause of her accidents is no longer a mystery. The problem that had plagued the Rossos for more than a year, that prompted Zoes suspension from school and got her mom pegged as a lazy, selfish narcissist, turned out to be easily diagnosed.

I didnt need to X-ray Zoe to figure out the cause of her accidents. I already knew. I had a strong suspicion when I read the Washington Post story, before I ever contacted the Rossos to interview them about school potty policies for this book. And I was certain six months later, when Zoes parents e-mailed me details about her accidents. Its not that Im some kind of genius, as my wife frequently reminds me. Its just that I see cases like Zoes every day at our clinic at Wake Forest Baptist Health, one of a handful in the country specializing in childhood toileting troubles. Actually, I see these problems virtually every day, about a thousand times a year.

I see kids who potty trained early and easily, practically by themselves, according to their moms, only to start having accidents at age three or four. I see five-year-old girls with recurrent urinary tract infections (UTIs), even though Mom and Dad are vigilant about keeping their daughter clean and dry. I see seven-year-old boys who wet the bed and are told, Just be patientyoull grow out of it. I see kids who experience pain when they pee and kids who need to pee so often that they get in trouble at school and make family car trips impossible. All these problems have the same root cause: These kids are holders. They chronically hang on to poop or pee or both, and this holding habit has, for reasons I explain in this book, caused their bladders to go bonkers.

These kids have something else in common: Theyre stressed out, and so are their families. Some folks, like the Rossos, have been told to find a new school or have been the subject of ridicule. Hows this for callousness: At Zoes first preschool, her teacher would broadcast, in front of the other parents and children, Zoes accident tally for the day. At the school that ultimately suspended Zoe, the principal told Betsy Rosso that her daughter had had enough chances. Says Betsy: They acted like she was some kind of criminal.