Coping with bed-wetting

Potty training a toddler can be a daunting prospect, and the thought of tackling bed-wetting even more so.

Bed-wetting – or primary nocturnal enuresis, as it's also known - is the most common reason parents bring toddlers to paediatricians, with more than 500,000 children in the UK affected. However, in most cases bed-wetting is just a normal part of development, and children eventually grow out of it. Girls tend to stay dry through the night earlier than boys.

Potty training itself should not begin until your baby is around 18 months old, and you shouldn’t become concerned about dryness until around the age of three. A toddler will learn to hold their bladder and use the toilet during the day before they can stay dry through the night. Bed-wetting in toddlers is only considered a problem after the age of five.

When starting potty training, do not expect your child to be able to immediately go through the night without accident; this will come towards the end of the process. Nappies should be used throughout potty training, and still used at night even when a child has moved on to using pants during the day. Most children are fully potty trained at around thirty-three months, but you shouldn't be concerned if yours is a little later than this.  

When aiming to move from dry days to dry nights, you should first have achieved several goals:

• Your toddler knows when they need to use the toilet and can do so on their own.
• They can make it through the day without accident and have been doing so regularly for some time.
• Your toddler has had several nights of dry nappies - nappies should not be removed at night if your baby still wakes up wet every morning. 

Causes of bed-wetting

There are many causes of bed-wetting, and many of them depend on where you are in the process of potty training. Primary nocturnal enuresis – or bed-wetting - occurs when a child has not been dry through the night long-term, and is common throughout the process of potty training.

Secondary nocturnal enuresis can occur when a child has been dry through the night for long stretches of time, and frequently happens after potty training is thought to have been successfully completed. Primary bed-wetting should not be a huge concern because it is most likely caused by the fact your child has yet to develop the ability to wake up and use the toilet, or has yet to begin producing the hormone that slows urine production at night. It is the development of one or both of these that allows a child to stay dry all night.

Secondary bed-wetting can be a cause for concern. It may have several causes, including an infection or constipation, both of which can cause pressure on the bladder. These will have other symptoms, such as your child feeling uncomfortable. In either case, see your paediatrician.

When a child has been dry for long periods of time and begins bedwetting again it can be a sign of new fears or insecurities caused by an unfamiliar event or change in the child’s environment. Causes can include moving home, parents’ divorce or the arrival of a new sibling. In these situations, extreme patience must be exercised to help the child cope. Other minor causes which may contribute to bed-wetting are too many liquids or caffeine near bed-time. 

Bed-wetting also often runs in families. If both parents wet the bed when they were young, there's an increased likelihood that their child will do it too.

Solutions         

If you are experiencing primary bed-wetting, meaning your child is not completely potty trained, be patient. Many children will experience bed wetting until the age of five, or even older. To encourage aid dry nights, encourage your child to use the toilet before bed. Many parents also believe in waking their child up to use the toilet at night to condition them to waking up on their own

However, if your child is having problems with bed-wetting after they have been potty trained for some time, different methods will be necessary as the causes will be different. If there is obvious emotional stress in your child’s life that could be the cause, try to ease their mind about this and help them feel more comfortable in new situations. Be supportive by praising your child on dry mornings. Do not punish or shame them for bedwetting as it is almost never done on purpose, and adding more stress to the situation will only make it worse.

One idea is to use a star chart, with the days of the week and a sticker for every morning that your child does not have an accident. Another solution is a bed-wetting alarm, which sets off a bell at any sign of wetness. The idea is that this conditions your child to wake up when they need to use the toilet. However, these cannot be used until the age of five, when bedwetting is no longer common.

Younger kids can wear pull-ups, while it might be helpful to use waterproof mattress covers for older children. Some experts suggest getting your child to help you change the bed and clean the bedding, although this shouldn't be viewed as a punishment. It may help your child feel better knowing that he or she helped out.

No matter what the situation, try and be as patient as possible. Heap praise on your child when they have a dry morning, and try not to get too exasperated by the extra loads of laundry.