Almost 4.5 and multiple daily accidents but dry at night - physical or psychological?

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Please help before the urge to kill her overwhelms me entirely.

DD is 4, been out of nappies in day since 2y3months (too early but nothing I can do about that now other than regret it every day!). Has had the odd day, or even a week, here and there without accidents but more often than not has 1-5 wet accidents a day. She has never had a poo accident since coming out of nappies. She has also been dry at night for the last fortnight bar one night. For context, she has a 3 month old sister and we anticipated a regression as she often regresses (if going from 1 accident every couple of days to multiple accidents a day can be called much of a regression...) when there is a change to routine. But...

It is driving me completely demented. We have done stickers, we have done ignoring it completely, we have done screaming banshee. Nothing works. I think the fact that primary school is looming is upsetting me even more as I don't want her to be the kid that smells of wee!

Given she can stay dry at night (she usually wakes up to wee) makes me think it can't be physical as otherwise she'd be wetting at night. So if it's mental, what can I do? It's a massive trigger for me, and while I can stay calm for the first couple of times in a day, by the time it gets to 3 or 4 or 5, especially when I've just reminded her, it's like all hell breaks loose in my head. I've just had to shut myself away from her in the spare room to stop me doing something I regretted when she peed on the floor while I was putting her sister to bed and made no attempts to clean it up :(

It could be a UTI. It's worth taking her to the doctor and getting it checked.

But if it's an on again/off again problem and she seems well in herself (i.e. no other symptoms of a UTI) then I think it's more likely to be psychological.

You say you've tried lots of different things, how long do you stick with each one? If something isn't working then you need to try something else, but constantly changing is no good. Inconsistency is the worst thing. Do you and everyone else who look after her (Dh, nursery teacher, childminder etc.) all follow the same system?

Does she wee on command? If you ask her to go to the toilet every hour, will that avoid accidents?

Is there any pattern to her accidents apart from an increase when there is a change of routine? Are they more common when she's tired? Is it in temper? When she's too involved in doing something? When she wants attention?

I'm seeing HV on Tuesday for the little one so am going to ask her advice and get an appointment to rule out constipation. I don think it's UTI as she doesn't complain about pain or anything but will certainly ask them to investigate!

We did the "ignoring" for a lengthy period and got nursery fully on board (not reacting to accidents, being matter of fact, getting her involved in clean up) but then it gradually crept back to high numbers of accidents with no apparent trigger. So thought it was a good time to try and different tack and tried stickers/rewards - cue one week of no accidents at all at the end of February but has since deteriorated again!

Nursery very supportive and will do whatever we ask.

She will sit on the loo when asked, so before we go out or before bed, and usually wee. I was unsure about getting her on every hour as wasn't sure if it would teach her to ignore her body's own signs of impending wee? But it would probably take the stress out of the situation for a while and we work on extending it?

To be honest it's probably all of those things - she had one accident at the park (10ft from the loo and 10 minutes after I'd asked her if she needed to go!) while playing in the sand so presumably didn't want to stop playing/was engrossed - and another while I was putting her sister down for a nap, so presumably attention-seeking. But I struggle to see how to prevent those. I know I need to spend more quality time with her, maybe that would make the difference. I need to shake off my frustration with her in order to do that though - catch 22!

I'd go back to basics and sit her on the loo regularly, it's not ideal, but it's better than constant accidents.

I'd also talk to her about making a fresh start on the whole thing in a fairly grown up way. I'd maybe say at bedtime 'Look DD, we both know that this weeing in your pants is no good! You're a big girl and you know how to use the loo. So, all these accidents are going to stop now. Tomorrow you and me will have a big girls day out and we'll go and get you some new pants and some special stickers. We'll both make extra sure there are no more accidents so that you keep your new pants dry and clean and you can get one of your special stickers'.

I'd make a big fuss of her new pants, let her show Daddy and/or ring Granny and tell her about your exciting shopping trip etc. I'd also try a 'we're in this together' approach, so when she succeeds make it a 'yay..we did it' type thing and when she fails 'oh no, we didn't get to the loo in time'. Tell her you're going to help her by reminding her to go (every hour/two hours at first). You could even ask her to remind you to remind her....'now will you remind me that it's wee wee time after lunch/Peppa Pig/when we get in from the park' and then if she does, 'thank goodness you reminded me! You've got such a good memory, I'd totally forgotten!' or something along those lines. Maybe set a timer/alarm to remind you and make a game of going to the loo when the buzzer sounds.

I'd just take it right back to day one of potty training; on the loo regularly at your request (don't wait for her to ask) and lots and lots of fun and praise.

New pants/new start is a good idea. I could do with some myself Thanks for listening to my whinging. Will report back!

This was my DD1. I think it was at least in part psychological (but kick started by a long term undiagnosed lactose intolerance which caused diarrhea and wee accidents) it kept going right until she started school, few accidents at school/home since - more often when very stressed.

Stuff that helped - let her clean up herself, towel up wet floor, everything wet in the bath redress self. Tell you so you cam check all cleared up.
Bedtime Bath every day.

Insist they go to the bathroom 20mins after each drink if doing so won't cause additional stress.

To be honest, I made a big big deal about how she could not keep doing this once she was at school and she didn't, and I don't know if that was a factor for her and her personality,

Masses of for you. It was a really horrible, stressful experience for me - please don't feel like it was your fault.

Hi my child goes through phases but recently had more accidents but is also having a few UTIs. In fact, daughter had bloody urine but is symptomless. No arm in having her checked but screaming is pointless. We make sure kids have a pee before bed. Know it can be related to stress also. Hope it improves.

Oh trust me. I know the screaming is pointless, she just stares at me! And it's just about the only thing I lose my temper over, something about it makes it a massive trigger for me which I'm sure she realises and plays up to. I just can't fathom why she'd rather sit in wet clothes than use the toilet! I'm reassured to hear it got better for you TeWi. Will rule out physical and aim for a more positive tack and see how we go!

TMI but she's just had an enormous poo after several days of rabbit droppings. That may well have been a major contributing factor!

Ah! I was about to come on to suggest that.
Dd2 was dry at night before 18 months. She was fine during the day when she trained at 2yo as long as she wasn't too busy to stop what she was doing.
But we had a phase around 4-5yo where she seemed to frequently do some in her pants, sometimes just a dribble and sometimes a lot. She would often say she didn't feel it coming.
Now I know that a particualrly precious pair of pants in the spare pants collection at school did have a slight influence -apparently all the girls wanted this pair-in fact dd2 (among others) was perfectly capeable of saying they were wet when they weren't if they thought this pair was available.

However turned out she was very constipated. in fact she was on medication for around 3-4 years dealing with that. Apparently when they are very constipated they can't feel their bladder's full.

Does she ever complain of tummy paid? That's what I took dd2 to the doctor for, and finding it was the cause of wee accidents was only a side effect.

Only in the past fortnight after some time away with grandparents so not eating her usual diet. She's had sultana bran for breakfast the last few days and is back on brown/seeded bread that we always have at home and the difference is noticeable! She's continued to be dry at night and is down to 1, sometimes none, accidents a day. I might speak to HV later and make her an appt with GP just to be sure she's all cleared out! I have read before that constipation is the primary source of wet accidents but as she goes several times a day (!) I hadn't thought it applied here until now. That story about the pants is great; kids are so funny!