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When my first daughter showed signs of potty readiness at age 2, I was more than ready to help her ditch diapers. Before long, she was proudly sporting Elmo underwear and staying dry all day long. I was ecstatic. As a potty-training novice, I was certain it would be a matter of weeks before she was dry at night, too. Of course, reality wasn’t nearly as neat and tidy. Although daytime training was quick and easy, nighttime dryness proved elusive. Months passed. She pottied like a pro during the day but clung fiercely to diapers at night. After two long years (and many unsuccessful attempts), she finally started waking up dry, and we packed away the diapers for good. In retrospect, it was no big deal: it’s highly common for a 4-year-old to wear a diaper to bed. Eventually, most kids achieve nighttime dryness without intervention. But I could have avoided some anxiety if I’d known all of that going in. Our situation was far from unusual; experts say many parents need to adjust expectations about nighttime dryness. According to pediatrician Tai Lockspeiser at The Children’s Hospital in Aurora, Colorado, nighttime bladder control is a maturational process that can lag behind daytime bladder control by months or years. Twenty percent of kids still have nighttime accidents at 5, and doctors don’t consider it bed-wetting until a child turns 6. So it’s completely normal, even expected, for kids to take their time with nighttime potty training. But the delay leaves many parents like me stuck in a waiting game, wondering when daytime potty learning will carry over into nighttime dryness. While you can’t speed up the developmental process, you can help encourage dry nights with these simple steps.
Start with realistic expectations. While 88 percent of kids develop nighttime bladder control by age 6, the timeline varies widely. Boys typically train more slowly than girls, says Lockspeiser. Kids who are exceptionally deep sleepers and those with developmental delays may have more difficulty with wetting as well, she says.
The best way to encourage nighttime dryness is to practice good daytime habits, notes pediatric urologist Steve Hodges at Wake Forest University Baptist Medical Center. Children should use the toilet as soon as they feel the urge — holding can strain the bladder and worsen nighttime wetting, he says. And using the toilet before bedtime is a must. “Constipation is probably the most underappreciated cause of bedwetting,” says Hodges. “It plays a role in 30 percent of the cases I see.” A full bowel puts pressure on the bladder, making nighttime accidents more likely.
Cut Out Caffeine
Limit fluids to two hours before bedtime, particularly caffeined drinks. “Caffeine is a diuretic, so it promotes urination. Drinking it before bedtime will make it harder for kids to stay dry at night,” says Lockspeiser.
Easy Nighttime Access
Make toilet access easy at night with lights in hallways and bathrooms so kids can find their way. If the trek is too far, place a portable potty in the child’s room.
Skills versus Pills
Doctors may recommend treatment options for persistent wetting that doesn’t resolve by age 6. Bed-wetting alarms, called enuresis alarms, help children learn to stay dry by waking them at the first sign of wetness. With regular use, they’ll soon awaken on their own. Medicines like desmopressin can help prevent accidents by slowing nighttime urine production. But it doesn’t help to correct a bed-wetting habit, says psychologist Robert W. Collins, who specializes in childhood toileting problem. He prefers alarms, since “Medications don’t enhance learning to give kids the skills to stay dry.” See a doctor if a child who has been potty-trained and dry at night for months begins wetting at night. A urinary tract infection is a common culprit for sudden wetting. But so can be social changes, like a move, new school, or divorce.
Managing Nighttime Soiling or Constipation
What about kids who soil their underwear at night? Encopresis is the term for soiling in inappropriate places after age 4. While nighttime soiling in preschoolers and school-age children is much rarer than bed-wetting, it’s also more emotionally distressing for parents and socially isolating for children, says Collins. His website, soilingsolutions.com, is a resource for parents dealing with encopresis. First, take a look at your child’s daytime bowel habits. “Chances are, a child who is soiling at night is holding during the day,” says Collins. Changing your child’s diet and having him drink more can help encourage regularity during the day. If better daytime habits don’t resolve the problem, families can progress to more advanced encopresis treatment, which may include supplements, suppositories, and behavioral therapy to treat severe constipation. The good news: These treatments have a high success rate and kids benefit from increased confidence and self-esteem as the condition improves.
Parents’ attitudes are highly important as kids develop nighttime control. “Treat it as a problem-solving exercise — a family science experiment,” says Collins. Above all, make sure that children know nighttime wetting or soiling is not their fault. Maintain a relaxed, supportive attitude, and you’ll pave the way for a future filled with clean nights and happily dry mornings.
Malia Jacobson is an award-winning parenting and health journalist and mom of three. Her most recent book, Sleep Tight, Every Night: Helping Toddlers and Preschoolers Sleep Well Without Tears, Tricks, or Tirades, is available on amazon.com.