1 Is your child under 2 years old?

2 Are you worried about your child's lack of bowel control?

3 Has your child ever been able to control his or her bowel movements?

4 Does your child pass very liquid faeces, often soiling his or her underclothes?

5 Have you been trying to train your child for more than a year?

6 Are you worried about your child's lack of bladder control?

7 Has your child been dry in the past and started wetting again?

8 Is your child under 3 years old?

9 Does your child wet him- or herself during the day?

10 Does your child still wet the bed at night, even though he or she is dry in the daytime?

11 Is your child over 5 years old?

12

Possible cause At this age, a child's nervous system is not mature enough for complete bladder or bowel control to have developed.

Action There is little that you can do to toilet train your child until he or she is ready. Wait until your child is older and shows signs of being able to exercise some control over his or her bladder and bowel functions. You may then find the toilet-training tips useful.

13

Possible cause Your child may be constipated, resulting in a partial blockage of the rectum. This causes soiling due to an overflow of liquid faeces past the blockage. Consult your doctor.

Action Your doctor may initially prescribe a laxative to clear the blockage. He or she will probably also recommend adding extra fruit and vegetables to your child's diet (see Avoiding constipation in children). If your doctor suspects that your child's constipation is caused by an underlying physical or behavioural problem, he or she may refer your child to a specialist.

14

Possible cause A loss of previously normal bowel control usually has an emotional cause. Your child may be anxious or upset and seeking attention. Such behaviour may be due to a recent change at home, such as the arrival of a new baby or parental separation.

Action Make sure that your child has every opportunity to use the toilet or potty. Talk to your child about his or her worries, and provide plenty of love and reassurance. If the problem persists for more than a few weeks, consult your doctor, who may refer you to a specialist.

15

Possible causes It does not usually take this long for a child to gain bladder or bowel control. Your child is probably rebelling against your efforts to enforce toilet training. Rarely, there may be a physical cause for his or her lack of control. Consult your doctor.

Action If there is no physical cause, your doctor may suggest that you have a break from toilet training. Ideally, wait until your child is keen to cooperate before trying again.

16 See your doctor within 24 hours

Possible causes Your child may have a urinary tract infection (see Urinary tract infections in childhood). Alternatively, an emotional problem may be the cause.

Action Your doctor will test a sample of your child's urine. If the result indicates that an infection is likely, a urine sample will be sent to a laboratory for analysis to confirm the diagnosis. Meanwhile, your child will be started on antibiotics. Further tests, such as ultrasound scanning (see Investigating the urinary tract in children), may be needed to look for any associated problems. If no infection is found, your doctor will discuss the possibility of an emotional upset with you and your child.

17

Possible cause Reliable bladder control is seldom fully achieved before the age of 3, and many children will still be in nappies. There is unlikely to be any cause for concern.

Action Follow advice on toilet training (see Toilet-training tips), and make sure your child has plenty of opportunities to see other people, especially children, use the toilet. Most children learn quickest by imitation.

18

Possible causes Lack of bladder control during the day is unlikely to have a medical cause in a child under 5, but in an older child, it may indicate a physical or emotional problem. Consult your doctor, whatever your child's age.

Action Your doctor will examine your child and may arrange for tests, including urine tests, to find an underlying cause. If no physical cause is found, follow advice on toilet training (see Toilet-training tips). Children over 5 years may need to be referred to a specialist.

19

Possible cause Around 1 in 6 children wet their beds at age 5, and 1 in 20 still wet their beds at age 10. Regular bedwetting rarely has a physical cause, even in an older child, and is particularly common if one or both parents were late to acquire night-time bladder control.

Action Follow measures for overcoming bedwetting. If these do not help, consult your doctor, who may prescribe a course of drug treatment or drugs that can be used for events such as an overnight school trip.

20

Possible cause Lack of bladder control at night is common in children under 5 and is rarely due to an underlying disorder.

Action If you are still putting your child in nappies, continue to do so until he or she is often dry in the morning. When accidents do occur, try not to get cross. Change the bedclothes with as little fuss as possible, and reassure your child. A mattress protector and bedclothes that are easy to wash and dry will make coping easier. Your child will eventually achieve night-time control.

21

Consult your doctor if you are unable to find a cause for your child's problem from this chart.

22

Consult your doctor if you are unable to find a cause for your child's problem from this chart.