Fri 11, Feb 2022
Although it is usual to begin toilet training between two and three years of age, like any developmental milestone, there can be tremendous variation, but commonly day training occurs before night. Try not to compare your child with other children (even their siblings!) and instead respond to their individual needs and personality. It is important to encourage children to respond to messages from their bladder and bowel - teaching them to ‘listen to their body’ and taking their time to use the toilet - no rushing, no straining.
If at the age of four to five, despite your best efforts your child is experiencing regular daytime wetting (urinary incontinence) or soiling (faecal incontinence) it is suggested you make an appointment for a medical assessment with your GP, a pelvic health physiotherapist or continence nurse with specialised paediatric training. This is because it needs to be determined if there might be some underlying bladder or bowel problem, such as constipation, that needs to be addressed.
Wetting at night whilst asleep is within developmentally normal limits until the age of five years, and after that is called bedwetting, or nocturnal enuresis. It is quite common and after that age about 15% of bedwetting children become dry each year. However, “growing out of it “cannot be relied upon for many children. Therefore, treatment may be recommended from 7 years onwards (occasionally in a younger child) especially if the child wets most nights of the week.
There are several reasons why your child may be bedwetting, the commonest being that it is passed down in families. If there are day bladder issues these need to be assessed and addressed first. The following factors are relevant and a child may have one or all of them affecting their bed wetting The bladder storage ability is smaller than expected for the age of the child
The child’s kidneys may produce a lot of urine at night. This may reflect a greater fluid intake late in the day, or a lack of the circadian rhythm that develops and slows urine production at night. The child does not wake to the message of a full bladder and get up and go to the toilet to empty their bladder. This is called arousal dysfunction and there are many factors which can influence this. Parents often perceive this as ‘being a deep sleeper’ but in fact, it is the ability to rouse that is letting the child down. It is important to always remember that children cannot control what happens to their bladder whilst asleep – wetting is not their fault, neither is it done on purpose. If there is soiling at night whilst asleep this needs to assessed straight away.
A few of the simple strategies to help with bed wetting are:
• Using a night light so the child feels safe getting up at night to go to the toilet
• Discussing with the child if they are waking due to their bladder at night and if so, what may be worrying them and preventing them from going to the toilet.
• Drinking regularly throughout the day so children are not particularly thirsty after dinner – many children drink almost nothing till after school and then fluid overload late and close to bed time. Some fruits have high fluid content (such as watermelon, grapes and oranges) and having these close to bed time also adds to fluid intake.
• Avoiding carbonated sugar and caffeine containing drinks which can affect some sensitive children.
• Managing constipation effectively and getting help to do so if necessary.
After the age of 7 years treatment should be considered. It has been shown that becoming dry at night has a major beneficial impact on children’s self-esteem and sleep quality. Treatment consists of addressing contributing factors firstly. One of the most effective treatments for bedwetting is the use of a bedwetting alarm. Basically there are two sorts of alarms – a mat that lies on the bed attached to alarm box, and a body worn alarm. They both work. We know that treatment is more effective if the use of such an alarm is supervised by an appropriately trained health professional and research has shown us that after 10 to 20 weeks, 66% of children maintained 14 consecutive dry nights using an alarm compared with only 4% with no alarm treatment. There are also medications that can be helpful, especially if there are day problems as well, or in an older child.
For children and adults to be reliably dry at night two things are needed – a bladder that stores a good amount of urine and a brain that wakes us if we need to empty the bladder during the night. There are many factors that affect both of these abilities. Bed wetting can be treated, even in older children who have not succeeded in becoming dry previously.
For sensitive and confidential advice, the Continence Foundation of Australia has many free resources and you can speak confidentially to a Nurse Continence Specialist on the Continence Helpline on 1800 33 00 66.