Your child was finally potty trained, and now a new baby is on the way, or just arrived, and the accidents are back. First, take a breath. This is one of the most common things I see as a pediatric pelvic floor therapist, and it is usually temporary.
Why it happens
A new sibling is a big change. Your child sees the baby getting attention for diapers and may wonder if they want that too. Routines change, sleep changes, and stress often shows up in the body first: in the bladder and the bowel.
Mostly: prevent and watch for constipation
The most common hidden cause of new accidents is constipation. Hard, large or painful poops make children hold, and holding leads to leaks, both pee and poop. The bladder sits right next to the rectum, so a full bowel presses on the bladder. In a classic study published in Pediatrics, when children's chronic constipation was treated, daytime wetting stopped for most of them (Loening-Baucke, 1997). Today this is called bladder and bowel dysfunction, and the International Children's Continence Society recommends checking bowel habits in every child with wetting.
Truly watch out for these signs:
Pooping less than every other day
Hard pebbles, or very big poops that may block the toilet
Standing up, crossing legs, rocking on tiptoes or hiding in a corner to poop. In this phase, standing up to poop is a sign of constipation: your child is trying to hold it in.
Crying, pain or fear around pooping
Smears or skid marks in the underwear
Tummy aches or a smaller appetite
What helps:
Water through the day, and fruits and vegetables at every meal
Pitted prunes. For toddlers, cut them very small or blend them, because whole dried fruit can be a choking risk. A little prune or pear juice mixed with water also helps.
Movement and play every day
A footstool under the feet on the toilet: knees above hips, leaning forward, belly relaxed
If your child still has not pooped in a few days, or pooping hurts, talk to your pediatrician.
Reteach them to listen to their body
Instead of sitting your child on the potty by the clock, help them notice their body signals again:
Name what you see: "I see your pee dance. That is your bladder talking to you."
Give a choice, not an order: "Do you want the big toilet or your potty?" A choice gives them back a feeling of control.
Praise the listening, not only the success: "You noticed your body. That is amazing."
No shame, no punishment. Clean up calmly and say: "Your body is learning again. We will try next time."
Make room for the big sibling
Give them a big kid job with the baby, like choosing the diaper or singing during changes.
Plan special one-on-one time every day, even 10 minutes, so they do not need accidents to get your attention.
Read a story together about using the potty. The Day I Learned books with Alex & Lea were made for exactly this.
When to get help
If accidents last more than 4 to 6 weeks, or your child holds their poop, cries when pooping, or has not pooped in several days, book a consultation. These signs need a personal plan.
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References
Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997;100(2):228-232.
Tabbers MM, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274.
Austin PF, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-481.
