Paediatric Development and Bladder Control
As any parent will tell you, potty training can be a handful. The good news is, there are lots of ways to help your kids go through the developmental stages leading up to and during potty training! That's where Danielle Bararuk, our Physiotherapist and Pelvic Health Therapist, comes in. With a special interest in paediatric physiotherapy, she can tell you all about the many factors that can impact your child's ability to potty train and the many stages that get them there.
Bladder Control Starts With the Core
Before we can cover bladder control and toilet habits, we need to understand your child’s development. Your child’s motor development is impacted by their postural alignment and their core muscles. The inner core muscles—pelvic floor, transverse abdominus, multifidus, and diaphragm—provide core stability for children to learn to sit, crawl, stand, and move. For this team of muscles to develop and work together, there needs to be optimal postural alignment.
Postural alignment is how all of your bone structures stack on top of each other: the head, neck, rib cage, spine, hips, knees, and ankles. The best postural alignment for children’s development is when the head, rib cage (where the diaphragm is housed), and pelvic girdle (where the pelvic floor muscles are housed) are positioned one over another. When this alignment is achieved, the diaphragm and pelvic floor muscles “talk to each other,” working together as a unit.
Postural alignment and the inner core team go hand-in-hand. When a child has good postural alignment (head over rib cage over pelvic girdle), their inner core muscles will strengthen naturally and progressively, which is required to develop new motor skills. Infants can’t sit up properly until their core team is developed, and they need these same muscles for bladder control.
Encouraging Proper Postural Alignment
If children cannot reach the ideal postural alignment, the inner core team won’t be able to strengthen very well, resulting in poor postural control and stability. Postural control delay means that the child could struggle to stay upright and instead adopt a more slouched posture, making it harder for them to develop more advanced motor skills like walking, running, and jumping.
Sometimes to make up for this weaker group of core muscles, a child will use other strategies to control their movement, like holding their breath. By holding their breath, a child is trying to mechanically stabilize their spine without using their inner core team. However, this is not a healthy alternative to developing those inner core muscles.
If you’re noticing some of these signs in your child, there’s no need to panic! There are many ways a paediatric physiotherapist can work with your child to correct this lack of postural control.
When Do You Start Potty Training?
Even if a child is developmentally ready to potty train, meaning they’ve achieved optimal postural alignment and developed their inner core team, they still may not be ready to learn a new motor skill! There is no “right” time for children to begin potty training. As parents, there are signs you can look out for in your child that demonstrate they’re ready to start potty training. These signs include:
The ability to follow simple instructions
The ability to pull their pants up and down by themselves
An interest in sitting on the potty
Telling you when they’re wet or dry
Letting you know when they have have just pooped
Parents: rather than following "hard deadlines" for how your children should be developing, look for behavioural and physical signs instead to see how their development process is going and when to encourage them to take the next step. The key is to look for motor milestones rather than thinking, "At age four, they should already be doing this—what’s wrong?!"
If your child is delayed in any of their motor development, this could be a sign that something is impacting their continence. So, if your child isn’t coordinated in kicking a ball, this could be a sign that they don’t have the core control or proper muscle recruitment, which in turn, affects their bladder control.
Getting Started With Potty Training
Good positioning on the toilet is important. It’s valuable to teach children right from the beginning not to strain when having a bowel movement, and the best way to avoid the need to do so is to have the child’s knees elevated slightly above their hips. This creates the correct angle for stool to pass easily, and therefore, helps them avoid straining. If their legs are dangling off the toilet, they may engage their pelvic floor muscles to help support themselves up, but pelvic floor muscles need to stay relaxed to most easily pass stool.
Best tips: Use a small, child-sized potty to get that correct angle, or, if you’re using a regular-sized toilet, use a small stool for the child’s feet to rest on to get their knees up.
Make sure your child is breathing regularly when pooping. If they’re holding their breath to strain, it can put unwanted pressure on the pelvic floor, and as we’ve already learned, the pelvic floor should be relaxed while having a bowel movement.
Best tips: If your child is holding their breath while passing stool, try having them sing a song or blow on a pinwheel to regulate their breathing.
Make sure your child is drinking enough water. Children should stay hydrated to make healthy stools and avoid concentrated urine that can be hard on their bladder. If your child is having issues with constipation, it could be affecting their ability to control their bladder. Because the bowels and bladder sit right next to each other, if there’s a large stool mass (constipation), it can press down on the bladder and affect its ability to function properly.
Best tips: Keep an eye on how much water your child is drinking, and if constipation does become an issue, speak to their doctor, naturopath, or a pelvic floor physiotherapist about treating it.
There are so many ways for parents to benefit from understanding the developmental stages their children are going through. Potty training can be an especially lengthy process, so knowing how to best help your children, and when to reach out for help from professionals can be so valuable!
When you visit a paediatric physiotherapist like Danielle, she will help your child’s inner core team work together. We’ll focus on setting your little one up with proper alignment, work on strengthening their muscles, and teach functioning movement patterns to adopt healthy habits in using their pelvic floor. When we start with the basics and developing their core, we can start with the fun that is potty training and bladder control!
Pelvic health and paediatric development are two of Danielle’s passions in physiotherapy, so if you have any questions or concerns regarding your child’s development or bladder control, we would love to help them reach their maximum potential. Let’s get in touch!
