Potty training after dark

. October 16, 2012.

When my first daughter showed signs of potty readiness at age two, I was more than ready to help her ditch the 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, and 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 four-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 that many parents need to adjust their expectations about nighttime dryness. According to Tai Lockspeiser, M.D., assistant professor of pediatrics 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 five years of age, and doctors don’t define bedwetting until children are six years old.

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 parents can’t speed up the developmental process, they can encourage dry nights with these simple steps.

Age matters

Start with realistic expectations. While eighty-eight percent of kids develop nighttime bladder control by age six, the timeline varies widely. Boys typically train slower 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.

Potty practice

The best way to encourage nighttime dryness is to practice good daytime habits, notes Steve Hodges, M.D., a pediatric urologist at the 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.

Encourage digestive health

“Constipation is probably the most underappreciated cause of bedwetting,” says Hodges. “It plays a role in thirty percent of the cases I see.” A full bowel puts pressure on the bladder, making nighttime accidents more likely.

Cut caffeine

Limit fluids two hours before bedtime, particularly caffeine-containing beverages.  “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.

Ensure nighttime toilet access

Ensure that kids have access to the toilet at night. Nightlights in hallways and bathrooms can help kids find their way easily. If the trek to the toilet is too far or involves stairs tots can’t navigate on their own, parents can place one of the small portable toilets commonly used for potty-training in their room at night.

The importance of health

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. “We also consider stressors or social challenges, like a move, a new school, or divorce,” says Lockspeiser.

Staying clean: Encopresis

What about kids who soil at night? Encopresis is the term for soiling in inappropriate places after age four. While nighttime soiling in preschoolers and school-age children is rare, it’s emotionally distressing for the family and socially isolating for the child, says Collins.

Healthy habits

First, take a look at their daytime bowel habits. “Chances are, a child who is soiling at night is holding during the day,” says Collins. Dietary changes, increased fluid intake, and changes to the child’s daily routine can encourage regular elimination during the day.

If improved 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 and holding habits. 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 children know that 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 a freelance writer and mom who writes frequently about kids sleep and health issues.