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Why pediatric pelvic health is so important

And what parents can do if issues occur

Little child sitting on the toilet reading a book.
The correct posture for children on the toilet involves having their feet supported with their knees above the hips. During the potty learning phase, some children may need activities like books to keep them on the toilet until the process is done.
iStock / Special to On the Minds of Moms
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Parenting is a journey with many surprises along the way. One of the most important, yet unexpected, lessons new parents learn quickly is how much time is spent analyzing and inspecting their child’s poop.

Don’t laugh – you know it’s true.

Quiara Smith is the owner and director of Aloha Integrative Therapy , a boutique pediatric pelvic health practice in West Fargo.

She’s an occupational therapist with more than 12 years of experience who works extensively with children who have bowel and bladder issues as well as toileting challenges.

She knows firsthand just how important proper pooping is, especially for young children.

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Quiara Smith’s pediatric pelvic health practice works with children who are experiencing bowel, bladder or toileting challenges. She also provides animal-assisted interventions when that benefits the patient.
Photo courtesy of Aloha Integrative Therapy

“Kids have challenges just like adults when it comes to digestive issues, and I have a real compassion for families dealing with those issues,” Smith explained. “These issues can affect relationships, a child’s self-esteem…it can consume their whole life. I want to figure out how to put the pieces of the puzzle of what’s going on together so kids can start feeling better and enjoy their childhood.”

Smith’s experience with pediatric pelvic floor issues comes from her time at Stanford Children’s Hospital in California , where she recently moved from when her husband took a job at NDSU. She’s owned her own practice since 2017 when she decided she wanted flexibility in her schedule once she welcomed her daughter in 2018.

As a pediatric occupational therapist, Smith also works with neurodivergent children with autism, Down syndrome, and other medical conditions that require complex care, and she also provides animal-assisted interventions when that benefits the patient.

Bedwetting is not behavioral

The most common issues Smith sees in her practice include bedwetting and daytime incontinence where urine or feces are leaking. When she begins working with a patient, she first completes an in-take assessment to dive into any triggers that may be happening or observable behaviors that are disrupting the toileting process.

“Toileting is a sensory process, and not just the sensation of going but also the sensation of when people are in the bathroom and what’s happening in the environment,” Smith explained. “It’s important to assess different environments children encounter as well as the demands of the skill of toileting and see if we need to bridge those situations.”

Dr. Steve Hodges is an associate professor of pediatric urology and the founder of bedwettingandaccidents.com where he offers parents and medical providers resources to help children overcome bedwetting. He said in a 2021 podcast interview around 25% of children may wet the bed until around age 5, but that isn’t necessarily a typical situation for healthy children; if the issue persists, treatment may be necessary. Bedwetting is often caused by constipation because a full rectum presses on the bladder and causes accidents.

Both Smith and Hodges argue that toilet issues rarely stem from behavioral issues and they can’t automatically be outgrown as a child ages. “If parents or kids are asking for help with bedwetting or other issues, we as providers don’t want to dismiss them by just saying the kids will outgrow them,” Smith said. “I educate parents and kids about what is happening in the child’s body based on science and medicine.”

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It’s important for parents to recognize that children cannot control the bedwetting issues because they likely stem from medical conditions that require diagnosis and treatment; children should not be shamed or punished when accidents happen. “I want to help parents learn how to show up for their kids,” Smith said. “Parents are the experts on their child, and I just want to help the children.”

What can parents do?

One of the most important steps parents can take regarding their child’s pelvic health is talking with the child daily about their toileting habits; it may be awkward if those conversations haven’t happened before, but parents can start the process by introducing it as a wellbeing issue.

“It depends on the age of the kids, so help them learn about the body and body parts,” she explained. “Books and videos are great. With older kids you can have the conversation about being a friend to your body and help your child understand why peeing and pooping is important and what it tells us about what’s happening in our bodies.”

Smith pointed to the Bristol Stool Chart as a good resource for parents who want to understand their child’s poop using an actual clinical assessment tool; the type 3 through 5 stool range is preferred so anything other than those, could possibly indicate a medical issue. Tracking concerning issues or general toileting habits can also help a provider better understand what a child is dealing with.

Habits that promote good bladder and pelvic health include drinking a lot of water so urine is diluted and won’t cause a urinary tract infection as well as eating good fiber to keep stool soft; Smith said to think of the P fruits: prunes, peaches, pears, pineapple and opt for oatmeal or whole wheat while limiting processed foods.

It’s also important for kids to have correct posture on the toilet: knees above the hips, feet supported, and leaning forward slightly with very little straining or pushing; products like a toilet stool can help achieve this position. “Good defecation practices are key; squeezing and straining doesn’t mean the stool is hard and can actually cause constipation,” Smith said. “You can check how relaxed your child is on the toilet by palpating on their glutes – is it tight or relaxed? It should be relaxed while voiding pee and poop.”

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Occupational therapist Quiara Smith created a course about potty training for Tinyhood. The online course is available for purchase at tinyhood.com.
Danielle Teigen / On the Minds of Moms

Let’s talk potty training

No discussion on proper toileting habits would be complete without talking about potty training, because that’s where these practices are established and the skills are taught. Smith created a self-paced potty training course with a step-by-step process to help parents and caregivers feel empowered.

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“Research supports that when children are potty trained closer to age 3, they are less likely to have bowel or bladder disorders later in life,” Smith said. Additionally, sphincter control for bowel and bladder management is better achieved between the 24- to -30-month age range, and abilities between each child are vastly different from age 2 to age 3, she shared.

During the beta testing stage, Smith’s online parent education course on Potty training was ranked at the top for its effectiveness and approach. “Potty training is about building those skills over time, and there are many misconceptions about the time it can take and when a child is ready,” she said. “In reality, linking body urge signals and having consistent and accurate sphincter control for going pee and poop is a process that takes 6 to 12 months for mastering the skill of bowel and bladder control independently.”

The potty training course and other resources is available at https://www.tinyhood.com/courses/potty-training .

Related Topics: ON THE MINDS OF MOMS
Danielle Teigen has a bachelor's degree in journalism and management communication as well as a master's degree in mass communication from North Dakota State University. She has worked for Forum Communications since May 2015, first as a digital content manager before becoming the Life section editor and then deputy editor. She recently moved back to her hometown in South Dakota, where she works remotely for Forum Communications as managing editor of On the Minds of Moms.
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