The Challenge of Incontinence for Kids with Challenges

I am honoured to work/teach with Julie Wiebe PT.  I’m very excited about this application of Dynamic Core for Kids and I am grateful  for her permission to re-post her recent blog.


Because I talk about incontinence, I often get pegged as the pelvic floor lady. Sometimes I get flack because some say I think “it’s all about the diaphragm”. But really… I am all about the system. I am suggesting a new approach to central stability that the pelvic floor just happens to be a part of. Its interaction with the diaphragm (and a lot of other moving parts) is critical not just for continence, but central stability, postural control, movement support, efficient function and optimum performance.

One of my favorite applications of these ideas is into the pediatric population with kids with significant motor, developmental, cognitive, and sensory challenges via an amazing collaboration with my brilliant colleague Shelley Mannell ( We have been teaching Dynamic Core for Kids to physical therapists, occupational therapists, and speech- language pathologists around the world since 2009. Course participants have applied the concepts to help kids with CP, Autism, Organ Transplants, Strokes, Brain Injuries, Sensory Processing Dysfunction, Developmental Coordination Disorder and so many more areas of need.

We are always excited to hear from past participants about clinical successes, but some of my favorite feedback notes are about triumphs in these populations in the area of continence. These children often cannot pursue traditional pelvic health programs (isolated voluntary contractions, biofeedback, behavioral modification programs, etc). Instead, we address continence for children with significant challenges by addressing the system of components that impact continence (pressure, muscular force, breathing to maintain GI motility, alignment, etc). Using optimized breathing mechanics in supportive alignment as the gateway into the system, we can impact core stability, postural control AND continence. Its win-win! (PS-These ideas work for typical kids and grown-ups too.)

Children with these kinds of significant challenges are generally referred to peds therapists for their movement, strength, gross motor function, gait, transfers, balance, activities of daily living, etc. It’s not often that the significant issue of continence is the primary reason kids are referred. But it is SUCH a significant issue in their life, and the life of their family. There are logistical, social, financial, hygiene, and emotional ramifications. This issue for these kids and families deserves attention alongside their other needs! By linking the components of the system and integrating them into the core strategies of the postural control and central stability, one of the intended consequences can be an improvement of continence.

The metric of success varies in this population. Success doesn’t always mean 100% dry because of the depth of challenge and complexity of issues for some of these children. For example, some aren’t able to appreciate cause and effect and cannot be toilet trained. However, it can lead to fewer accidents, more predictability for toileting for caregivers, and less diapers to drain the family budget, etc. Those are big wins.

But sometimes we get really cool letters like this one, from an Occupational Therapist working with school-aged children…

Good, no, GREAT morning Julie and Shelley!

I ABSOLUTELY had to write to you because I have GREAT news to share! My second client who I have been doing Dynamic Core for Kids (DC4K) Programming with to address his nighttime incontinence has been accident-free for 6 weeks now!!!!! Mom is over the moon happy, he will be able to go on his end of year school trip and summer camp, he is SOOOO proud! J Just for some background, he is a competitive level hockey goalie in grade 8, diagnosis of mild CP. Physically, you would not know he has CP besides some tightness in his calves, although some memory issues are present. We started the DC4K program in November and by the first week of March he was fully dry at night!!!!! SOOOOOO impressive! J I do have to admit he was quite easy to coach because he was already quite strong and had good body awareness. So once he improved the synergy of his systems with better control of his posture & breath, and learned to activate his core properly, things were smooth sailing!

Also another update on my first client, who has had AMAZING success as well!! He is a grade 7 boy with a diagnosis of Borderline Intellectual Delay, Learning Disability and ADHD who was having significant incontinence at night, as well as slow leaking during the day. This caused consistent odor, even with a steady hygiene routine. When we started working together on the DC4K program, he had very low strength and body awareness and coordination. After about a year of dedication from him and his guardian to continue to program at home consistently, this has improved significantly. He now has only very rare instances of nighttime incontinence (when his stress or anxiety is up), but his leaking during the day no longer happens!! And bonus: the odor has resolved completely!!! How WONDERFUL for him emotionally and socially, right! His guardian has shared how thrilled she is with the program and the success he has achieved!! J

Thanks again from myself, my clients and their families, for this wonderful and effective program! I will continue to keep in touch and share these successes with you! Keep up all your hard work to share this knowledge with therapists everywhere!!


A very very happy OT!


Beautiful! These are really life changing outcomes for these kids. It’s an exciting gift to give.


(The parents/guardians of both clients have provided their informed consent in sharing this information.)



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