Dr Richard C. Woolfson
Although many children gain bladder control at night without any difficulty – usually soon after they gain that control during the day – a surprisingly large number of young children don’t acquire this skill so easily. Statistics show 20 per cent of children aged seven years still occasionally wet their beds at nights, as do approximately 3 per cent of teenagers aged 14 or 15 years. Boys usually take longer to gain bladder control at night than girls; their neurological and physical systems need more time to mature. Once the process of night-training begins, the child might master the skill in a matter of weeks or he may take months. Despite popular opinion, there is no evidence of a link between bed-wetting and deep sleep; in fact, a child is more likely to wet himself when moving from deep sleep to a lighter sleep. Depriving him of drinks before sleep seems sensible, but his bladder will steadily fill at night even without a glass of water at bedtime.
In most cases, professionals cannot say why a five-year-old gains bladder control at night faster than another does. However, the most common causes of bed-wetting are:
1. Physical development. There is a connection between delayed physical maturity and delayed ability to control one’s bladder at night. A child who reaches puberty later than his peers may encounter difficulty gaining night control when young.
2. Weak training. Toilet training doesn’t always go according to plan, perhaps because the parents fail to take a consistent approach or allow it to become a source of confrontation.
3. Urinary problems. Where night-wetting is a long-term problem, seek a medical assessment of your child because there may be associated physical abnormalities in the urinary tract.
4. Psychological stress. When a child has been reliably dry for several months and then suddenly begins to wake up with a wet bed, always look for something that may be troubling him.
A popular training technique to help a child aged five or six years gain bladder control at night is a “star chart”, which is a small chart on which a gold star sticker is placed whenever he wakes up in the morning with a dry bed. By explaining the concept to your child so he knows clearly how to achieve a star, he may be motivated towards achieving success. The effectiveness of the star chart lies in the fact that it focuses on your child’s successes, not his failures, and that it involves praise for what he gets right, not reprimands for mistakes. If you think a star chart might be suitable for your child, try this approach for at least four weeks before deciding if it works.
No matter how irritated and disappointed you may feel on seeing yet another wet bed, stay calm. An outburst of fury fuels the tension between you and your child – he needs support, not undisguised rage. It’s also important that you and he work together in a positive way when teaching him night control. Use encouraging language when talking about it; avoid using the phrase “wet bed” and instead talk only of “dry bed” or “not a dry bed”. Whatever approach you choose, apply it consistently. There is no point in praising your child one morning for having a dry bed, then ignoring the same outcome the next morning.
Toilet training your toddler