Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / Bonus: Ask a Pediatric Urologist

Transcript

Bonus: Ask a Pediatric Urologist · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:01
  Speaker 1: Hello. This week, I have another special treat for you.
• 0:04
  Speaker 1: You're going to hear an interview that I did on
• 0:06
  Speaker 1: Instagram Live with doctor Liza Aguiar. Liza is a pediatric urologist,
• 0:12
  Speaker 1: and when we asked you to submit questions for her,
• 0:13
  Speaker 1: you've sent us one hundreds. In this conversation, we were
• 0:16
  Speaker 1: able to dive deep into some of your questions about circumcisions,
• 0:20
  Speaker 1: daytime potty training, nighttime potty training, and bed wedding, and
• 0:23
  Speaker 1: her real thoughts about MiraLax.
• 0:25
  Speaker 2: Hope you enjoy. Ah, you got it?
• 0:32
  Speaker 1: Hey, Hey, Hello, Okay, So I was saying, we're going
• 0:36
  Speaker 1: to talk about pediatric eurology. We're going to record this.
• 0:39
  Speaker 1: I want to start. I think people who are watching
• 0:41
  Speaker 1: this probably know who I am, or at least some
• 0:43
  Speaker 1: of them, but I would love you to introduce you yourself
• 0:47
  Speaker 1: and tell us who you are.
• 0:49
  Speaker 3: Sure.
• 0:50
  Speaker 2: I'm Liza Agiar.
• 0:51
  Speaker 3: I am a pediatric urologist, so I specialize in kidneys, bladders,
• 0:57
  Speaker 3: like the urinary system and also genitals as well.
• 1:02
  Speaker 2: And I'm a mom.
• 1:05
  Speaker 1: I like the way you said that. It's like and
• 1:06
  Speaker 1: I have a side project. I have a side project
• 1:08
  Speaker 1: in generals.
• 1:10
  Speaker 2: Yeah, penises.
• 1:13
  Speaker 3: So I am a mom of a three year old boy,
• 1:18
  Speaker 3: and that's me awesome.
• 1:20
  Speaker 1: And you're my neighbor. I mean, that's not how we
• 1:22
  Speaker 1: know I'm your neighbor. Yes, but it turns out you're
• 1:24
  Speaker 1: my neighbor.
• 1:24
  Speaker 2: So that's it's a good street. It's a good street.
• 1:28
  Speaker 1: Okay, So let's start. We're gonna start by talking. We
• 1:31
  Speaker 1: have sort of like three buckets of questions. The first
• 1:35
  Speaker 1: bucket is penises, the second bucket is it's sort of
• 1:38
  Speaker 1: daytime potty training, holding pe and the third is nighttime.
• 1:42
  Speaker 1: So we're gonna start with with penises, and.
• 1:45
  Speaker 2: I would say them there's a set of.
• 1:47
  Speaker 1: Questions about circumcision that people ask all the time, and
• 1:50
  Speaker 1: people sent in a bunch of them, and I think
• 1:53
  Speaker 1: the first one I want to start with is just
• 1:55
  Speaker 1: like can you talk about this procedure? And like is
• 1:58
  Speaker 1: it painful? Which I think is sort of almost where
• 2:00
  Speaker 1: everybody starts, like what happens?
• 2:02
  Speaker 2: And how should I think about it? Sure?
• 2:04
  Speaker 3: So, by far, the majority of circumcisions happen a few
• 2:08
  Speaker 3: days after life, within the within the first few days.
• 2:11
  Speaker 3: And what we know about pain and circumcision is that,
• 2:15
  Speaker 3: you know, boys do feel pain, even as newborns, the
• 2:21
  Speaker 3: nervous system is you know, relatively developed, and we know
• 2:25
  Speaker 3: based on like more objective data, like their heart rates.
• 2:29
  Speaker 2: Go up, they cry.
• 2:30
  Speaker 3: So yes, there's some pain associated with it, but most
• 2:33
  Speaker 3: kids tolerate it very well and you know, by the
• 2:39
  Speaker 3: day after they're you know, pretty much behaving somewhat normally.
• 2:44
  Speaker 2: And most OBEs.
• 2:46
  Speaker 3: And pediatricians who do newborn circumcisions offer some local anesthesia,
• 2:52
  Speaker 3: so some like light acaine or numbing cream to make
• 2:56
  Speaker 3: it less painful. So it's in general a pretty low
• 3:02
  Speaker 3: risk procedure. We talk about risks of like bleeding and infection,
• 3:07
  Speaker 3: but serious injury to the penis is very rare. And
• 3:13
  Speaker 3: what happens is that most newburn circumcisions, uh, there's like
• 3:17
  Speaker 3: a little bit of a like a clamp that goes
• 3:20
  Speaker 3: over the tip of the penis and the foreskin gets
• 3:23
  Speaker 3: clamped off and then the skin just heals.
• 3:26
  Speaker 2: So there's no stitches in the newborn circumcision and typically
• 3:31
  Speaker 2: like no bandage.
• 3:32
  Speaker 3: Is necessary, just a lot of vascline or anti ointment
• 3:35
  Speaker 3: and routine like diaper care.
• 3:38
  Speaker 1: So so when you people ask I guess one question
• 3:43
  Speaker 1: people often come was like what is the reason to
• 3:45
  Speaker 1: do this, like like okay, so you know, there's a
• 3:48
  Speaker 1: sort of like what are the risks? And then what
• 3:51
  Speaker 1: are what why would what are the reasons to do
• 3:53
  Speaker 1: this other than you know, there's sort of cultural like
• 3:56
  Speaker 1: for which this is sort of an important part of
• 3:58
  Speaker 1: your cultural traditions.
• 4:00
  Speaker 2: But other than that, what are the reasons?
• 4:04
  Speaker 3: So I get asked that question a lot, like are
• 4:07
  Speaker 3: there any medical benefits to a circumcision? And I'll add
• 4:10
  Speaker 3: a little bit of context to that, So because I
• 4:14
  Speaker 3: get asked specifically about this a lot. So in twenty twelve,
• 4:19
  Speaker 3: the American Academy of Pediatrics came out with this policy
• 4:22
  Speaker 3: statement about circumcision, and it said that the benefits of
• 4:27
  Speaker 3: circumcision outweigh the risks, and the specific benefits that they
• 4:32
  Speaker 3: mentioned were reducing the risk of three things.
• 4:37
  Speaker 2: You're intertract infection, P.
• 4:39
  Speaker 3: And L, cancer, and transmission of some sexually transmitted.
• 4:44
  Speaker 2: Diseases including HIV. So like WHOA, that's big.
• 4:51
  Speaker 3: And of course, as you can anticipate a lot of
• 4:54
  Speaker 3: phone calls to pediatric urologists saying should I circumcise my son?
• 4:59
  Speaker 2: Because of this, there were a lot of you know,
• 5:01
  Speaker 2: there's a lot of.
• 5:01
  Speaker 3: Anxiety and worry, and I don't think that was their intention,
• 5:05
  Speaker 3: but the headlines, obviously, you know, promote that. So when
• 5:12
  Speaker 3: I talk to parents, I address all three. So reducing
• 5:16
  Speaker 3: the risk of urinary tract infection that is a benefit
• 5:20
  Speaker 3: for the first year of life, so after the age
• 5:22
  Speaker 3: of one, that's no longer you know, a benefit. And
• 5:29
  Speaker 3: the risk of a urinary tract infection in boys is
• 5:33
  Speaker 3: extremely low at baseline, so about one percent of boys
• 5:37
  Speaker 3: get urinary attract infections. So I don't use that as
• 5:43
  Speaker 3: a medical reason to recommend circumcision unless my patient has
• 5:51
  Speaker 3: other congenital abnormalities or medical conditions that would put them
• 5:56
  Speaker 3: at increase risk of urinary attract infection. So penile cancer
• 6:02
  Speaker 3: cancer is a scary word and uh, but the risk
• 6:05
  Speaker 3: of penal cancer is extremely low, like about one in
• 6:07
  Speaker 3: one hundred thousand men get diagnosed with pen l cancer
• 6:10
  Speaker 3: every year, and it's more associated with the inability to
• 6:15
  Speaker 3: retract your for skin as an adult and hygiene. So
• 6:20
  Speaker 3: not a medical reason to for me that I would
• 6:24
  Speaker 3: use to to recommend circumcision. And then transmission of sexually
• 6:29
  Speaker 3: transmitted diseases. A lot of this data comes from you know,
• 6:32
  Speaker 3: countries where HIV is much more you know of an issue,
• 6:37
  Speaker 3: and access to care and.
• 6:38
  Speaker 2: Access to condoms is not you know, is a problem.
• 6:42
  Speaker 3: So in the United States, where you know, access to
• 6:46
  Speaker 3: appropriate protection is less of an issue. It's just really
• 6:50
  Speaker 3: not applicable. So I would never circumcise the boy and say,
• 6:54
  Speaker 3: you know, you can have unprotected sets.
• 6:56
  Speaker 2: That's not that would not be okay.
• 6:58
  Speaker 1: All right. So I want to get like a bottom
• 7:00
  Speaker 1: line question about the circumcision, which is it sounds like
• 7:03
  Speaker 1: basically your sort of like take on this is that
• 7:06
  Speaker 1: there are not a lot of like positive reasons to
• 7:09
  Speaker 1: do this. Is that right?
• 7:10
  Speaker 3: Yeah, So I just I leave it up to the parents.
• 7:12
  Speaker 3: I say, it's a personal decision. It sometimes is a
• 7:15
  Speaker 3: cultural one, a religious one.
• 7:17
  Speaker 2: And if you.
• 7:18
  Speaker 3: Know, you prefer your kid's penis to appear circumcised, that's okay.
• 7:25
  Speaker 3: I'm happy to do it. And if not, then that's
• 7:27
  Speaker 3: okay too. So I leave it up to them.
• 7:31
  Speaker 1: Yeah. Yeah, this it's interesting because it's one of the
• 7:33
  Speaker 1: things I talk about in cribshet as an example of
• 7:35
  Speaker 1: something where like maybe there are some small costs, maybe
• 7:39
  Speaker 1: there are some small benefits, and it's like and it's
• 7:42
  Speaker 1: also so personal, like people sort of say on the internet,
• 7:45
  Speaker 1: like you should do this, you should not do it,
• 7:46
  Speaker 1: But like the lady on the internet like doesn't know
• 7:48
  Speaker 1: what your son's penis should look like, Like it's not
• 7:50
  Speaker 1: really any of her.
• 7:52
  Speaker 3: So people feel very like some people feel very very
• 7:55
  Speaker 3: strongly absolutely one way or the other.
• 7:57
  Speaker 1: Yeah, So one thing to ask is, you know, actually,
• 8:00
  Speaker 1: when I was a kid, circumcision was like like we
• 8:03
  Speaker 1: were like way above half, but now I think we're
• 8:06
  Speaker 1: down more like fifty fifty percent.
• 8:08
  Speaker 3: In the US, Yeah, about sixty percent of kids are
• 8:12
  Speaker 3: our boys are circumcised and forty percent are so.
• 8:15
  Speaker 2: And it kind of varies state to state.
• 8:17
  Speaker 1: If you do not circumcise, is there are there hygiene
• 8:20
  Speaker 1: things you should be aware of with the boreskin?
• 8:24
  Speaker 3: Yeah, So a newborn uncircumcised penis, the foreskin is covering
• 8:32
  Speaker 3: the tip.
• 8:32
  Speaker 2: Of the penis and it's tight.
• 8:34
  Speaker 3: So that's called pimosis, and that is very normal during
• 8:38
  Speaker 3: childhood and with growth of the penis and erections, like yes,
• 8:43
  Speaker 3: babies get erections, that tightness loosens up and eventually kids
• 8:50
  Speaker 3: are able to retract fully.
• 8:51
  Speaker 2: The timing of that varies, so sometimes kids.
• 8:54
  Speaker 3: Are able to retract fully by age two and then
• 8:57
  Speaker 3: other times it takes up until like the preteen years,
• 9:02
  Speaker 3: and it is never okay to force fully retract the foreskin,
• 9:07
  Speaker 3: so you're pediatrician, for example, you should not you know,
• 9:12
  Speaker 3: pull the foreskin back forcefully, causing tears in the skin
• 9:15
  Speaker 3: or you know, bleeding or discomfort. That's not necessary. It
• 9:20
  Speaker 3: is okay to like manipulate the foreskin and pull it
• 9:22
  Speaker 3: back gently and see how far it goes back over time,
• 9:26
  Speaker 3: and eventually you'll notice that the adhesions underneath, so the
• 9:30
  Speaker 3: stickiness of the skin to the tip of the penis,
• 9:34
  Speaker 3: become less and you can see more of the tip
• 9:38
  Speaker 3: of the.
• 9:38
  Speaker 2: Penis called the glands.
• 9:40
  Speaker 3: And then as it's you know, as you're able to
• 9:43
  Speaker 3: attract more and more, then it's you know, appropriate to
• 9:46
  Speaker 3: retract and clean underneath when the foreskin naturally relaxes, and
• 9:52
  Speaker 3: at an age appropriate.
• 9:53
  Speaker 2: Time, like during potty training or a little bit after.
• 9:57
  Speaker 3: Then, you know, teaching kids and you know, teaching boyster
• 9:59
  Speaker 3: to sort of pull back as far as they can
• 10:01
  Speaker 3: comfortably to pee and to wash underneath is part of
• 10:05
  Speaker 3: you know, part of routine hygiene for an uncircumcised boy.
• 10:10
  Speaker 1: Okay, all right, so we did the penis. I'm sure
• 10:12
  Speaker 1: there's many other questions about the penis, but but we're
• 10:15
  Speaker 1: gonna move on to the sort of set of questions
• 10:18
  Speaker 1: people had about daytime potty training and so, so, like
• 10:23
  Speaker 1: one version of this one thing people ask is just
• 10:27
  Speaker 1: like my kids holding their pee all the time, how
• 10:30
  Speaker 1: many times do they have to pee? Are they going
• 10:32
  Speaker 1: to be sick if they never pee? What's a regular
• 10:34
  Speaker 1: amount of time?
• 10:35
  Speaker 2: How many times today should repeat? Yeah, so so after
• 10:41
  Speaker 2: potty training.
• 10:42
  Speaker 3: So one of the things that I focus on is like,
• 10:44
  Speaker 3: potty training is really important, but what happens after potty
• 10:47
  Speaker 3: training is actually just as important and sometimes more important.
• 10:51
  Speaker 3: Kids are really good at prioritizing, and they often have
• 10:55
  Speaker 3: much better things to do than go to the bathroom. Yes,
• 10:58
  Speaker 3: and hold is very common, but it does it can
• 11:03
  Speaker 3: get you into trouble. So holding promote stasis of urine,
• 11:08
  Speaker 3: like you'rein just sitting there in the bladder. And especially
• 11:11
  Speaker 3: for girls, you know, our your wreathros are short. Bacteria
• 11:14
  Speaker 3: does slip into our bladders, and our job is to
• 11:17
  Speaker 3: flush our bladders out regularly.
• 11:20
  Speaker 2: And the same thing for kids.
• 11:22
  Speaker 3: You know, kids should be peeing about every you know,
• 11:25
  Speaker 3: one to three hours is normal for a toddler. And
• 11:29
  Speaker 3: then you know, as you grow and your bladder capacity
• 11:32
  Speaker 3: is more than every two to four hours, is fine
• 11:36
  Speaker 3: beholding past that you know does promote bacterial growth, and
• 11:41
  Speaker 3: bladders don't like to be overdescended, like the bladder muscle
• 11:44
  Speaker 3: itself doesn't like to be overstretched. And but you know,
• 11:49
  Speaker 3: ignoring those signals is just like part of childhood. It
• 11:52
  Speaker 3: does take a little bit of awareness. So like during
• 11:57
  Speaker 3: ponty training, parents are often like very on top of
• 12:00
  Speaker 3: their children, you know, are peeing and when they're pooping,
• 12:03
  Speaker 3: and sometimes you know, I see diaries during potty training. Yeah,
• 12:07
  Speaker 3: but have a spreadsheet spread yes, that's yeah, right, So
• 12:13
  Speaker 3: but afterwards we forget about it, right, and we don't
• 12:16
  Speaker 3: really think about how often our kids are peeing. And
• 12:19
  Speaker 3: then you know, we're at Target and we're in the
• 12:22
  Speaker 3: checkout line and then all of a sudden, it's like,
• 12:23
  Speaker 3: oh my god, I have to go now, and that
• 12:26
  Speaker 3: that's like, those are the habits that I try to
• 12:29
  Speaker 3: like work on because it can get you into trouble
• 12:31
  Speaker 3: with your own attract infections. So by far, the two
• 12:35
  Speaker 3: most common risk factors for your inn attract infections and
• 12:37
  Speaker 3: children are holding and constipation. So I often talk about
• 12:44
  Speaker 3: holding and constipation when I see your car and you'r
• 12:46
  Speaker 3: an attract infections and kids. And you know, holding obviously
• 12:52
  Speaker 3: is you know, much more like bladder related, but you know,
• 12:55
  Speaker 3: somewhat related to constipation.
• 12:57
  Speaker 2: And my spiel is like, you know, two things need
• 12:59
  Speaker 2: to have been.
• 13:00
  Speaker 3: For your bladder to empty in a healthy way. One
• 13:03
  Speaker 3: is your blader muscle needs to squeeze, and that's like reflexive.
• 13:06
  Speaker 3: We don't tell our bladders to squeeze.
• 13:08
  Speaker 2: But the second is that our pelvic floor muscles need
• 13:11
  Speaker 2: to relax. And that is.
• 13:13
  Speaker 3: Something that I see, yeah, yeah, and and it affects
• 13:17
  Speaker 3: pee and poop. Right, If kids cannot relax our pelvic
• 13:21
  Speaker 3: floor muscles, they get into the habit of holding. They
• 13:24
  Speaker 3: sometimes have pain with youurination. So like if your child
• 13:27
  Speaker 3: has pain with your oination and your in tests are negative,
• 13:31
  Speaker 3: chances are they're having like pelvic floor tightness or spasms.
• 13:35
  Speaker 3: And that's where we struggle, and they're you know, shout
• 13:39
  Speaker 3: out to all of my pediatric pelvic floor physical therapists,
• 13:42
  Speaker 3: like they work on that with kids who really struggle,
• 13:46
  Speaker 3: like you know, past sort of baseline recommendations of like
• 13:50
  Speaker 3: p more frequently, spread your legs when.
• 13:52
  Speaker 2: You pee, try to relax like they actually with you know,
• 13:55
  Speaker 2: some older kids work on that specifically and it really helps.
• 14:01
  Speaker 1: So somebody has a question to like very specific, can
• 14:03
  Speaker 1: I get a UTI from the bubble bath?
• 14:06
  Speaker 2: Oh? So that this is like there's one paper that
• 14:11
  Speaker 2: suggested that. Yeah, and now I answer about that answer
• 14:14
  Speaker 2: this question all the time.
• 14:16
  Speaker 3: So really, you know, no, it's it's more the irritation
• 14:23
  Speaker 3: that the bubble baths cause externally that can promote like
• 14:27
  Speaker 3: stickiness of you know, the tissue to the bacteria. So
• 14:30
  Speaker 3: I think if you use just gentle soap, it's it's
• 14:33
  Speaker 3: not you know, no, but can you cause like some
• 14:37
  Speaker 3: skin rashes and irritation.
• 14:38
  Speaker 1: Yes, But like basically you don't need a bubble bath.
• 14:41
  Speaker 1: You don't need a bubble bath, is what you're telling me.
• 14:43
  Speaker 3: Yeah, but like you know, I get asked this all
• 14:46
  Speaker 3: the time, like, oh, they're wearing their bathing suits for
• 14:49
  Speaker 3: a long time, Like that's really not a cause of
• 14:52
  Speaker 3: urine attract infections that can cause east infections.
• 14:55
  Speaker 2: But yeah, I think it's more like habits. It's more
• 14:58
  Speaker 2: constipation being less frequently than you should. That's what puts
• 15:02
  Speaker 2: kids at risk.
• 15:04
  Speaker 1: So what So one thing I wanted to pull in
• 15:06
  Speaker 1: about the sort of frequency of the of the p
• 15:09
  Speaker 1: is a lot of people ask the question, you know,
• 15:10
  Speaker 1: my kid is with the frame of like my kid
• 15:12
  Speaker 1: is regressed, And I wonder, like they used to be
• 15:15
  Speaker 1: like perfect and now and then you know, we were
• 15:17
  Speaker 1: potty trained, and then now they're they don't know when
• 15:19
  Speaker 1: they HP, or they're or they're kind of peeing and
• 15:22
  Speaker 1: in other ways. And I wonder if some of that
• 15:25
  Speaker 1: is this kind of like you were paying so much
• 15:27
  Speaker 1: attention and then you've just stopped paying attention and then
• 15:30
  Speaker 1: they're like they're sort of developmentally normally they'd like rather
• 15:33
  Speaker 1: play with their trucks than pay attention to when they
• 15:36
  Speaker 1: need to pee.
• 15:37
  Speaker 3: Absolutely, I approached that problem a little differently, like at
• 15:41
  Speaker 3: different ages, right, Like if you if a parent comes
• 15:43
  Speaker 3: in and their four year old were was perfectly potty
• 15:46
  Speaker 3: trained for you know, eight months, and then all of
• 15:48
  Speaker 3: a sudden they regress like totally normal. If a twelve
• 15:52
  Speaker 3: year old came in and they were perfectly you know,
• 15:54
  Speaker 3: potty trained and started and now just started having accidents,
• 15:59
  Speaker 3: I'm a lit a little bit more investigative and like
• 16:03
  Speaker 3: kind of questioning what is going on by far with
• 16:07
  Speaker 3: little ones, I focus on like, okay, let's talk about
• 16:10
  Speaker 3: habits again, and let's just sort of, you know, do
• 16:13
  Speaker 3: a bladder diary.
• 16:14
  Speaker 2: Let's start keeping track of things. And most of the time,
• 16:17
  Speaker 2: when I.
• 16:17
  Speaker 3: Describe like here's what a perfect urology patient looks like,
• 16:20
  Speaker 3: let's try to mimic that for the next two to
• 16:22
  Speaker 3: three weeks and see what happens, most of the time
• 16:25
  Speaker 3: parents are like, oh, we're you know, we're good. The
• 16:29
  Speaker 3: other thing is, you know, constipation can cause decreased signals to.
• 16:33
  Speaker 2: You know, the brain.
• 16:34
  Speaker 3: It kind of messes up the signaling, and so if
• 16:37
  Speaker 3: your child suffers from constipation I would definitely like, let's
• 16:41
  Speaker 3: treat that.
• 16:41
  Speaker 2: First and then you know, work on habits.
• 16:45
  Speaker 3: A lot of poop in the rectum like pushes up
• 16:47
  Speaker 3: against the bladder also like not not a good thing.
• 16:50
  Speaker 2: So I talk a lot about constipation.
• 16:52
  Speaker 1: I know this is not your you're you're not like
• 16:55
  Speaker 1: a poope doctor specifically, But one of the things people
• 16:59
  Speaker 1: ask a lot about is miralaxe, so as a sort
• 17:03
  Speaker 1: of standard treatment for constipation. And there's the sort of
• 17:06
  Speaker 1: thing there's like idea going around that it's poisonous, which
• 17:09
  Speaker 1: I don't believe it's not true, but love your opinion.
• 17:14
  Speaker 2: So I think Marillacs should be in the water, like
• 17:16
  Speaker 2: I think it it like you're not in the poison camp. No,
• 17:20
  Speaker 2: not in the poison camp. Absolutely not.
• 17:23
  Speaker 3: I give it to my son every day, whether he's
• 17:24
  Speaker 3: constipated or not, Like no pediatric urologists, child is constipated.
• 17:30
  Speaker 3: And if you need a little bit of myr relaxe
• 17:31
  Speaker 3: to soften your stills, it's perfectly safe. So I've talked
• 17:35
  Speaker 3: to my gi friends about this, you know, because there
• 17:38
  Speaker 3: was you know, one article to suggest, like you know,
• 17:40
  Speaker 3: neurocognitive issues and you know, questioning the safety of maralacs.
• 17:44
  Speaker 2: Really, it is safe. It is not poisonous.
• 17:48
  Speaker 3: And I think it is perfectly appropriate to like increase
• 17:51
  Speaker 3: hydration and increase fiber in the diet. Like that's always
• 17:54
  Speaker 3: the right answer to start off with. But it's okay
• 17:57
  Speaker 3: if you're you know, child isn't drinking you know, the
• 18:00
  Speaker 3: perfect amount of water a day that you know, you
• 18:04
  Speaker 3: add a little bit of me relax in their you know,
• 18:07
  Speaker 3: and their drinks. And it doesn't have to be like
• 18:10
  Speaker 3: a full capful, and it can be like a teaspoon
• 18:13
  Speaker 3: or a tablespoon.
• 18:14
  Speaker 1: Yeah, I think the thing people sometimes miss on this
• 18:17
  Speaker 1: I think you see in the data is that like
• 18:19
  Speaker 1: if they like, once kids get constipated, then they get afraid,
• 18:23
  Speaker 1: Like then it's painful and so and then they get afraid,
• 18:25
  Speaker 1: and so the feedback there is very bad. So even
• 18:28
  Speaker 1: if you weren't going to use it like sort of
• 18:30
  Speaker 1: for a long period of time, getting past the initial
• 18:33
  Speaker 1: constipation is really crucial.
• 18:35
  Speaker 3: Yes, one of the things that I like wish parents
• 18:39
  Speaker 3: knew even prior to potty training. There are a few things,
• 18:42
  Speaker 3: but one of them is that you know, please do
• 18:45
  Speaker 3: not start potty training your child if they're constipated, because
• 18:49
  Speaker 3: you know, pain with pooping is such a strong trigger
• 18:55
  Speaker 3: for children and it creates like for some kid's fear
• 18:59
  Speaker 3: of going to the back room, you know, not not
• 19:04
  Speaker 3: wanting to poop on the toilet, and you know, avoiding
• 19:09
  Speaker 3: pooping and holding in your poop, And.
• 19:11
  Speaker 2: It takes a little it takes a while.
• 19:13
  Speaker 3: To sort of retrain and expose them enough to get
• 19:18
  Speaker 3: back to okay, like pooping can be comfortable. So again,
• 19:24
  Speaker 3: like constillation is just a really important thing to consider.
• 19:27
  Speaker 3: I would really aggressively treat that prior to even like,
• 19:31
  Speaker 3: you know, starting the potty training process, which is sometimes
• 19:35
  Speaker 3: like not an obvious thing.
• 19:37
  Speaker 2: Yeah.
• 19:37
  Speaker 1: No.
• 19:39
  Speaker 2: Oh, And in addition, during.
• 19:41
  Speaker 3: Potty training, if your child is prone to constipation, like
• 19:45
  Speaker 3: keep the mirror, lax on board or whatever you're doing
• 19:48
  Speaker 3: for constipation, because I can guarantee you they're going.
• 19:51
  Speaker 2: To get constipated. Because this is just like a whole
• 19:54
  Speaker 2: new yeah, whole new thing.
• 19:56
  Speaker 1: Okay, So our last question about nighttime at potty training,
• 19:59
  Speaker 1: because one, this is, as I understand it, quite different
• 20:04
  Speaker 1: than potty training during the day. But there are a
• 20:08
  Speaker 1: number of books about potty training which are like quite
• 20:13
  Speaker 1: specific about the need to do nighttime potty training at
• 20:16
  Speaker 1: the same time, including the book somebody had in the
• 20:19
  Speaker 1: comments a book Oh crap says like if you don't
• 20:21
  Speaker 1: potty train at night by whatever three, like your child's
• 20:25
  Speaker 1: muscles will start to atrophy. I mean, like I don't
• 20:28
  Speaker 1: know which muscles, some of them.
• 20:29
  Speaker 2: Probably urinary related.
• 20:31
  Speaker 1: So what is your what is your take on sort
• 20:34
  Speaker 1: of nighttime potty training same time later do it aggressively?
• 20:38
  Speaker 2: Yeah, so like nighttime.
• 20:40
  Speaker 3: So yeah, I get really confused about these recommendations. And
• 20:43
  Speaker 3: I hear this all the time. From parents too. It's
• 20:46
  Speaker 3: completely separate, Like it's just a completely separate box than
• 20:50
  Speaker 3: daytime training.
• 20:52
  Speaker 2: Your child can be perfectly you know, potty trained during
• 20:55
  Speaker 2: the day and still struggle with nighttime.
• 20:57
  Speaker 3: I you know, what I tell parents is like, you know,
• 21:00
  Speaker 3: nighttime wedding is very common, and like twenty percent of
• 21:04
  Speaker 3: five year olds what the bed, you know, ten percent
• 21:08
  Speaker 3: of seven year olds what the bed. So it is
• 21:12
  Speaker 3: it's something that comes later. It's not something that you
• 21:15
  Speaker 3: can actually train. It's usually due to it's a little
• 21:19
  Speaker 3: bit multifactorial, but it's usually due to like slightly smaller
• 21:22
  Speaker 3: bladder capacity, maybe not you know, having enough hormone in
• 21:28
  Speaker 3: your system to like reduce the amount of urine that
• 21:30
  Speaker 3: you make at night. But most of the time it's
• 21:33
  Speaker 3: because they're just really sound sleepers. There is like a
• 21:35
  Speaker 3: genetic you know, component to all of this. If you
• 21:38
  Speaker 3: have a family history of bed wedding, then you're more
• 21:41
  Speaker 3: likely to be a bed.
• 21:41
  Speaker 2: Wetter, Like your child is more likely to be a
• 21:44
  Speaker 2: bed wetter.
• 21:45
  Speaker 3: So, you know, I tell parents, like, I'm not really
• 21:48
  Speaker 3: going to entertain like aggressively treating bed wedding until like
• 21:54
  Speaker 3: seven at the minimum age.
• 21:56
  Speaker 1: So that would be like so that's where I want
• 21:59
  Speaker 1: to be thinking about like seven eight as kind of
• 22:01
  Speaker 1: the that's what the.
• 22:02
  Speaker 3: Referral process starts. Yeah, that's when the referral process starts.
• 22:07
  Speaker 3: Most pediatricians are comfortable with reassuring parents that you know,
• 22:11
  Speaker 3: if you have a family history, if you have these
• 22:13
  Speaker 3: risk factors, then it might take a little longer, but really,
• 22:19
  Speaker 3: you know, it's a perfectly appropriate to see a pediatric
• 22:21
  Speaker 3: urologist after that point. And what I talk about usually is,
• 22:27
  Speaker 3: you know, these are your options. There are medications that
• 22:30
  Speaker 3: help with with potty training, but they're mostly band aids,
• 22:33
  Speaker 3: like maybe used for sleepovers or camps. And then like
• 22:38
  Speaker 3: the dreaded bed wedding alarm, which is really the only
• 22:41
  Speaker 3: thing that's been proven to sort of like nif the
• 22:43
  Speaker 3: problem in the bud and get to the root of
• 22:45
  Speaker 3: the problem, which I'm not excited about using, like until
• 22:50
  Speaker 3: there's some buy in from the patient, Like the patient
• 22:53
  Speaker 3: has to be either bothered by the bed wedding and
• 22:57
  Speaker 3: okay with.
• 22:57
  Speaker 2: Like somebody waking them up at night or thing waking
• 23:00
  Speaker 2: them up at night.
• 23:02
  Speaker 1: And I think what's interesting about this with with kids
• 23:05
  Speaker 1: is that you can experience many of us had as parents,
• 23:08
  Speaker 1: is like my like, my kid was in it pull
• 23:10
  Speaker 1: up like until you know, he was pretty old and
• 23:13
  Speaker 1: and then just one day it was just like it
• 23:16
  Speaker 1: was just like was done. Like one day he just
• 23:18
  Speaker 1: was like Okay, now I'm like now I've kind of
• 23:20
  Speaker 1: understood the idea of waking up. And it happened two
• 23:22
  Speaker 1: nights in row, and then he never like he never
• 23:24
  Speaker 1: beat in the bed, he never paid again.
• 23:26
  Speaker 2: Yeah, so exactly.
• 23:28
  Speaker 3: I mean I think eventually that you know, arousal system
• 23:33
  Speaker 3: part of your brain like gets a little bit more
• 23:35
  Speaker 3: sensitive to your little you know, ladder signal. I do
• 23:39
  Speaker 3: think that there is some evidence to support like perfect
• 23:44
  Speaker 3: think about daytime habits, so like there are things that
• 23:46
  Speaker 3: you can't control, and nighttime wedding is just like something
• 23:48
  Speaker 3: that I tell parents, like you really can't control that,
• 23:51
  Speaker 3: but you can control daytime habits. And there is evidence
• 23:54
  Speaker 3: to suggest that perfecting daytime habits actually like doesn't solve
• 23:59
  Speaker 3: nighttime problems, but sets your child up for success. So
• 24:04
  Speaker 3: if your child is holding during the day and like
• 24:06
  Speaker 3: ignoring those signals, not purposely but like just again they
• 24:09
  Speaker 3: have better things to do than go to the bathroom,
• 24:12
  Speaker 3: then guess what, Like when they're asleep, Like forget it,
• 24:14
  Speaker 3: They're never going to respond to those signals when they're asleep.
• 24:18
  Speaker 3: So like regular you know, bathroom breaks during the day
• 24:23
  Speaker 3: is something that you know can promote like that, you know,
• 24:29
  Speaker 3: ability to respond to those signals, I.
• 24:33
  Speaker 1: Supacial, and so they'll just to like sort of reiterate
• 24:37
  Speaker 1: this last point.
• 24:39
  Speaker 2: You know.
• 24:39
  Speaker 1: You your view is like basically, if my kids weren't
• 24:41
  Speaker 1: a pull up, if they're still peeing at night, and
• 24:43
  Speaker 1: I want to have them wear a pull up until
• 24:45
  Speaker 1: you know, when they're five or six, that is like
• 24:47
  Speaker 1: a totally reasonable approach to the world.
• 24:50
  Speaker 3: Totally fine, Yeah, absolutely, I think I mean you may
• 24:54
  Speaker 3: want to consider, like a lot of parents ask me,
• 24:56
  Speaker 3: like when do I pull that pull up?
• 24:58
  Speaker 2: Like when do I take it away? I would just
• 25:01
  Speaker 2: like for the sake.
• 25:02
  Speaker 3: Of you know, like producing the torture and the you know,
• 25:06
  Speaker 3: laundry load. You know, I think expecting at least fifty
• 25:11
  Speaker 3: percent dry nights is reasonable, like at least just so
• 25:16
  Speaker 3: we're not you know, going the laundy downs and it
• 25:19
  Speaker 3: crazy like really discouraging for kids.
• 25:21
  Speaker 2: You know, it depends on.
• 25:22
  Speaker 3: Like how your child hopes with setbacks, and if you
• 25:26
  Speaker 3: think that they're not going to cope, Well, then just
• 25:28
  Speaker 3: keep the pull up on.
• 25:29
  Speaker 2: It's fine. Yeah, all right.
• 25:31
  Speaker 1: Well, I feel like we could talk for like a
• 25:32
  Speaker 1: billion years, but I'm gonna I have a thirty minute
• 25:36
  Speaker 1: Instagram live role because of people's attention span. So I'll
• 25:39
  Speaker 1: just say thank you so much, and we will post
• 25:42
  Speaker 1: this and we will post the audio in the podcast,
• 25:46
  Speaker 1: and so we will have all kinds of ways for
• 25:48
  Speaker 1: people to keep listening.
• 25:50
  Speaker 2: Thank you, thank you so much, Thank.
• 25:52
  Speaker 1: You everybody, thanks for listening. If you like what you heard,
• 26:00
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• 26:03
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• 26:06
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• 26:09
  Speaker 1: parentdata dot org. Talk to you soon,