Night time toilet training

Night Toilet Training

The development of bladder control in childhood is one of the major milestones we undergo in human development. You truly are a “big” girl or boy when you are finally out of nappies and dry throughout the night. For many children though, this process takes time and it is not the same for everyone.

A child usually masters daytime toileting before they can keep their bed dry at night. Don’t be concerned if your toddler wets the bed, because most children under the age of five years still urinate in their sleep, and one in 10 younger primary school children do too.

Don’t assume that your child can keep their bed dry just because they can manage their toileting when they are awake. It might help to think of staying dry at night as completely separate to daytime toilet use.

Children gradually learn to recognise the sensation of a full bladder and begin to hold on until a toilet or potty is found. Most children have gained daytime control by the age of 3 years; night time control takes a little longer - girls often achieve this earlier than boys. It is quite normal for children as old as 4 years to be still wetting the bed – and accidents may occur from time to time for a number of years.

So when is the right time to start night toilet training?
There really is no fixed time or date that can be applied. It is up to you the parent, guided by the child’s stage of development, and their willingness to participate in the process, to tackle the issue.

Guidelines for night time toilet training are mentioned below:

If your children are between three and four years of age and have been dry during the day for a few months, you could find out whether they would like to come out of nappies at night. Many children provide clues by mentioning their wet nappies or wet beds for that matter, which gives you the opportunity to introduce the topic and can be a great way of making it something that they want to do, rather than something they have to do. Your child may already be at the stage where they attempt to go to the toilet during the night or call out for your help.

If they are interested, before bed put them in ordinary underwear or pyjamas, let them go to the toilet right before it is time for bed. Once they are in bed give clear instructions about going to the toilet, if they wake up and feel the need to wee. Leave a night light on (so they can feel safe and can see where they are going) and give plenty of goodnight hugs and kisses and encouragement.
If the toilet is far away from the bedroom (i.e. down stairs or at the end of a long passageway) you may prefer to leave a potty beside the bed. Most important don’t forget to leave the bathroom light on! Let them know that it is also all right for them to come and wake you to take them to the toilet if they feel safer doing that and if they can hang on that long.

To begin with you might consider extra bedding protection, such as mattress protectors, Brolly Sheets  and a washable duvet liner. (Coming soon from Brolly Sheets) Give plenty of encouragement, even if the number of dry nights is few. The speed at which children achieve night time dryness does vary, often starting with one or two dry nights a week and building up slowly over a number of months.

However, if your child is wet every night for 2-3 weeks (or any period that causes laundry problems or other difficulties), try not to show your disappointment. Your child is perhaps not yet ready to become dry. You might at this stage wish to consider using absorbent night-time padded pants rather than reverting to nappies - and try again in 3-4 months’ time.


Night time toilet training observations;

• If your child wakes up every morning with a wet nappy, they’re not ready. If you take them out of night time nappies, they will wet the bed.

• Keep your child in night time nappies until most nappies are dry in the morning or until they are wet just before your child wakes. The nappy will be soaked and the urine warm.

• Praise your child for small steps - such as going to the toilet without the need for prompting, drinking good levels of fluid during the day; telling you when they’ve wet - and of course for any dry nights.

• Remember that it might take years for your child to reliably master night-time dryness.

• If your child is becoming anxious or frustrated, forget about night-time toilet training for a while.

• Try not to show your personal frustration during periods of bed wetting.

Some children take longer than others to master dry nights. In most instances we need to be patient and time will solve the problem. Most children grow out of bedwetting.

Approaches to avoid

Some approaches will only delay your attempts to help your child stay dry at night. Approaches to avoid include:
• Don’t criticise, humiliate or belittle your child for being a ‘baby’. Night time bladder control is a process of maturation. All efforts, no matter how small, should be praised.

• Don’t punish your child by making them stay in their wet sheets and pyjamas or getting them to wash the soiled bed linen. If your child is anxious, they are less likely to stay dry at night.

• Don’t deprive your child of fluids in the evening. Make sure they drink plenty during the day so that they are not very thirsty in the evening.

• Don’t talk about your child’s ‘problem’ to other people when the child is present, as this can make them feel ashamed and embarrassed.

Five years old and still not dry?

The vast majority of children who are not dry at night by the age of 5 years have nothing physically wrong with their urinary system. A small number may have a physical problem, such as an overactive bladder or a urine infection. If your child’s urine has a ‘fishy’ smell, if he or she has difficulty or pain in passing water, is constantly thirsty or is frequently wet during the day as well as the night, it is best to consult your GP.

Young children (5-7yr) may not yet have learnt to hold on or to recognize when they feel the full bladder sensation. They still need to develop bladder control.
Here are some suggestions to help accomplish this:

Food and drink
Encourage your child to drink a reasonable amount during the whole day (about 6-8 glasses, with 2-3 during the school day).
Cutting back on drinks does not help – the bladder tends to adjust to less fluid and as a result holds less, before feelings of fullness occur. However, be careful about fizzy drinks and tea or coffee, particularly last thing at night, as these can stimulate the kidneys to produce more than average amounts of urine.
Your child could experiment to see if cutting out particular drinks makes a difference. Do make sure that your child uses the toilet before going to bed.
Try to prevent your child becoming constipated, as this may irritate the bladder and result in more frequent urination. A diet with plenty of roughage may help, e.g. wholemeal bread, bran, cereal, baked beans and fresh fruit and vegetables.

Praise
Praise your child for dry nights, or if they wake by themselves, for using the toilet during the night Try not to show your frustration at wet beds, even though you may be feeling this way! A mattress protector (Brolly Sheets) can help ease your irritation at having to change the bed.

Waking up (or ‘lifting’)
You may be lucky and reduce the number and extent of wet patches in the bed, but this method does not in itself help your child to react to the sensation that the bladder is full - and wake up or hold on. If you do lift, it is important, where practical, to remember the following:
Make sure that your child is fully awake
Wake at a different time each night
Even if already wet, it is helpful for your child to go to the toilet


Seven years old (and older) and still not dry?

As well as continuing to do all the things mentioned above, talking to your child calmly about the problem can sometimes uncover fears or anxieties. It may also be reassuring for your child to know that all children find their bodies are good at some things and poor at others e.g. some are good swimmers or footballers, while others are less good at these things. It is also important to reassure your child that there will probably be others with this difficulty in the school class.

You could find out whether your child really wants to become dry at night. Gently asking your child what they think are the good things about being dry can give some idea of the extent of your child’s wish to be free of bedwetting. Wanting to be dry helps your child make sense of the methods you might be trying. If your child appears to be disinterested or not bothered, although it is understandably very frustrating for you as a parent, it is perhaps best not to pressurise them at this stage, but to encourage them to think about what the good things about being dry might be for the future.

Preparations for staying dry at night
Suggestions include:
 Make sure your child can manage to get out of bed and can easily remove their pyjamas. Encourage your child to practise pulling them up and down.

 Make a trip to the toilet part of your child’s bedtime routine.

 Talk to your child about going to the toilet at night-time. Work out your procedure together. Will they go to the toilet themselves, use a potty in their bedroom or wake you up for help?

 You may need to talk about your chosen night-time toileting procedure a few times. For example, you might say: ‘Come into my bedroom and wake me up when you need to go to the toilet, and I’ll help you’.

 Casually remind your child to get up in the night if they need to go to the toilet.

 If your child wakes up for any reason during the night, ask them if they want to go to the toilet before being tucked back into bed.

 Put a waterproof mattress protector on their mattress.

 Make sure your child has easy access and vision to find the toilet at night.

 Avoid pressuring your child. They’re keen to master toileting and anxious about disappointing you.

 If your child is dry in the morning, give gentle praise but don’t be concerned if they’re wet.

 Don’t get angry or frustrated at your child for wetting the bed. If the extra washing bothers you, buy pull-ups or use a Brolly Sheet to keep their bedding dry.

 Don’t punish your child for wetting the bed. They’re not doing it deliberately to annoy you. Be calmly reassuring, they need your guidance.