Question: “Dear Megan, I am transitioning my child from bedtime pullups to sleeping with underwear. She has started off good with no bed wetting but has had a few nights wetting. She is six years old and does have special needs. I would like to know if you have any helpful tips in making this a successful encouraging process. ” ~ Andrea Beatty.
Thank you for your question, Andrea. Nighttime potty training is a very important step that often gets skipped during potty training; parents often assume that because their children are able to control their bladder during the day, they should automatically be able to do it at night too. Nocturnal bladder control is actually the hardest one to learn, in the four types of continence. I explain them a little bit here.
Your child’s readiness to be potty trained
I’m assuming that your daughter already has acquired the skills (motor, communication, social knowledge and awareness) to be potty trained during the day, and that her special needs are not actively interfering with her continence during the day. Before you even begin to think about nighttime potty training, your child must be completely potty trained during the day, otherwise it will be randomly successful, in other words you’ll besetting your daughter up to potentially fail. And even then, I would rather you keep her in pull-ups at night for a little while longer and have her wake up dry for a few weeks consistently, before beginning to switch to underwear.
When your child is ready for nighttime potty training, start priming her for the process by lavishly praising her every morning that she wakes up dry, pairing the feeling of being dry to a positive thing (your approval and attention).
As with most behavior modification, there are two components that I would try to manipulate to increase the likelihood of the ideal behavior (in this case, staying dry at night): what goes on before the behavior and what comes after the behavior.
What to do at nighttime (before nighttime potty training: antecedents)
Once your daughter is fully potty trained during the day (no accidents for at least 2-3 weeks), wearing underwear (no pull-ups) during the day, and waking up with dry pull-ups (for at least a couple of weeks), then here are a few tips to make the transition to nighttime potty training:
- Cut down or eliminate entirely all liquids a couple of hours before bedtime: that means no milk at night, make it an afternoon snack instead.
- Be also careful with food high in water content at or after dinner time: diuretics like tea or fruits like watermelon should also be consumed an hour or two before bedtime.
- Have her go to the bathroom right before bedtime, after brushing her teeth for example: you want her to have as empty a bladder as possible before going to sleep.
- Have a nightlight on in her room, light on in the bathroom, with an unobstructed path to the toilet, in case she wakes up at night.
- Keep repeating and assuring her that she can absolutely come get you at night, if she needs to go to the bathroom . Some children have bedwetting accidents not because they wet their bed during their asleep but because they didn’t want to wake anyone or don’t know to ask for help going to the bathroom at night.
- Have her repeat that message to you, several times and at different times during the day, so you can be sure she understands them.
What to do the day after (after nighttime potty training: consequences)
At this point, one or two things is going to happen — she will either wet her bed or not. Hopefully, if you’ve been careful with the process, she will be likely to stay dry. But, you have to be ready to differentiate your reaction and whatever consequences come after the behavior so there is a clear distinction for her as to which is the favorable behavior and which isn’t. To that extent,
- If your child is unsuccessful in staying dry at night: Punitive consequences (reacting strongly, scolding, yelling) don’t work as well as positive behavior support ; in other words, instead of punishing your child, even by showing displeasure or reacting strongly to the bedwetting, stay calm, simply change the sheets, while explaining that she will get a do-over. Then change the topic to the reward she can earn if she does.
- If your child is successful in staying dry at night: Praise her lavishly — call grandma and gloat within earshot, write a letter to Santa, tell the mailman, whatever, just make it a big deal that she was able to stay dry. Preferably, deliver a reward that you talked about and decided ahead of time. Give her the reward immediately as soon as she wakes up so she can make the connection between the treat or the praise and the act of staying dry at night.
- Once your child is successful in staying dry for a few nights at a time, up the ante a little bit and deliver the reward every two days instead of immediately the next day. This will ensure that the behavior does not become dependent on the immediate gratification of receiving a reward. Gradually increase the days she must stay dry before delivering her reinforcer. Eventually, the nighttime potty behavior will get established and you won’t need to reward it at all.
Bedtime behavior is trickier than daytime behavior modification. At night, the child is tired, sleepy, and less receptive to making an effort. Not knowing what your daughter’s special needs are, these are generally the things I would consider when planning to potty train a child for the nighttime. Typically, I would spend more time pairing her behavior with the consequences (reward versus no reward) through added repetitions and longer trial periods, assuming her special needs are mental; if they are physical, I would address the physical barriers hindering her successful potty training.
I hope the above gives you some things to consider in your approach to changing your daughter’s bedwetting behavior, Andrea. If you have specific questions, please don’t hesitate to ask!
What do you think, dear reader? Do you have a different answer? What would you advise Andrea?
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