Jamie Glowacki follows the Journal of Pediatric Urology on the topic of night training. She also bases her approach on what she has seen work or not work countless times for her personal clients.
Children holding their pee all night or waking to pee depends on three things: physical/muscle development, intentional night training by parents, and the ADH hormone.
1. Physical/Muscle Development:
As the bladder develops and pelvic muscles become stronger, children can hold longer. Every child develops at a different rate, so some children will be able to hold it all night earlier than others. (The consultants in this group recommend waiting until the child stays dry a few nights on their own, or when the child turns 3, whichever comes first. Feel free to reach out for further details).
2. Intentional Night Training:
The child’s muscles often need to be trained to hold the pee in during sleep, or their body to wake when they need to pee. The body has to be trained to associate releasing pee with being somewhat awake. If the body associates releasing pee from the bladder with being asleep, and that continues when the bladder is fully developed, it becomes a habit that can stick around up to age 7.
3. Antidiuretic hormone (ADH):
The antidiuretic hormone (ADH) keeps the body from producing lots of pee into the bladder. The hormone increases with melatonin production. Right after melatonin is secreted, the antidiuretic hormone is secreted. The hormone is present at birth, and increases with age. This should not be solely relied upon for night training. Nocturnal Enuresis is a medical diagnosis if a child isn’t night trained by the age of 5.
The recommendation is to begin night training when the child either stays dry on their own for 5 nights in a row (in this case you can simply remove the pull-up and move on) or they turn 3. Whichever comes first.
Intentional night training should begin bottomless, or with a nightgown or long shirt if there is concern of the child being cold. Encourage your children to drink more in the morning and throughout the day and they will begin to follow that pattern. An adult would not drink a bunch of water right before bed in order to not have to get up to pee. That is a healthy pattern we can begin teaching during night training. During bedtime routine, offer the child a small cup of water if they are thirsty. My family uses toy cups from a play kitchen set that hold 2oz.
Most kids don't need 2 wake-ups for very long. Try dropping the second wake-up early on, between 3-7 days in, but keep the first wake-up for as long as needed. It is an easy one to do right before the last parent goes to bed. Even 3 months of this is not tiring for anyone involved. You will know if your child is ready to drop that first wake-up when you forget one night or skip it and they stay dry. If they wet the bed, add the wake-up back in for a while longer.
If your child eats a bunch of watermelon after a fun summer dinner, but they are already night trained, simply wake the child before the last adult goes to bed for just that night. Watermelon is a diuretic, so it is okay to go back to waking occasionally in situations like that.
If the child is 3 or older, a bedwetting alarm is an option. The DryEasy corded brand worked for my family. It worked for us in 1-3 nights. There are very inexpensive options out there. Many parents are concerned the alarm will wake the child so much that they will struggle to go back to sleep. That may happen, but remember it only takes a few nights. Most kids seem to fall back asleep just fine. For light sleepers, choose an option with a vibration setting so the alarm is not loud.
Be careful not to give negative or positive reinforcement for night training. This is an unconscious activity in most cases. If you have reason to believe your child is waking and then voluntarily peeing, for instance if you wake them up early one morning and their bed is dry, then you can show them it was dry and share, "thank you for keeping your bed dry!" to encourage them to call out in the morning to go to the potty or use the small potty in their room.
I understand the urge to night train in a diaper. It typically takes much longer. If a child is wearing a diaper, they should never be expected to keep it dry. I also understand the desire to wait to night train, even when your child stays dry more than 5 days. I encourage you to remove the diapers and go for it. Most children will begin using it again, and then night training is often more difficult when it is intentionally addressed.
Can you night train in a crib? You can. I have seen it go well. Some kids will call out each time they need to go, and the parent hears and wakes to the monitor quickly and the child holds it until they are taken to the potty. Ideally, a child should always have access to a potty. However, a child also has to be taken to the bathroom any time they are in public, so I don't see it as much different. Most children meet the height limit for a crib before night training is necessary. Switching a child out of their crib and night training at the same time seems like too many big transitions at once, but sometimes the two pair well together. A small potty in the child's bedroom is an excellent way to start.
Going on vacation? It is okay to use a pull-up/diaper on a night trained child on vacation to keep those beds clean. You may have to do some wake ups or a bedwetting alarm for a few nights after returning home from vacation to help your child get back on track, but it is worth not dirtying vacation mattresses.
Should you night train to fix nap and night diaper pooping?
It depends. Is your child also doing some poops in the potty? Then there is zero concern. Is the child only pooping in the nap and night diapers? If they aren't in distress, you can let this go without concern for a few months. If they are begging for a nap diaper or night diaper and pooping right away, address it sooner rather than later. Some kids wait until nap/night due to the relaxation and privacy of bedtime. Others wait due to fear of poop falling out of them into a container. I go more in depth on how to address this in my Poop Support Program at ohcrapwithashley.com/challenges
Night training is a highly debated topic in the urology world. If you need assistance with night training, the best option is a consultation which you can schedule on my Book Online tab.
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