ASK THE EXPERT:The delay between toilet training in the day and night may be frustrating, but is completely normal, writes DAVID COLEMAN.
PLEASE CAN you give me some advice on how to get my daughter out of night-time nappies? She is just over three and has been toilet trained during the day since last September. She was difficult to train as she was never particularly interested in it but we got there in the end. I feel that she should be finishing with the night-time nappy in the next few months but I am not sure how to go about it and there seems to be many schools of thought about lifting or not lifting, etc.
My main concern is that she has never woken up with a dry nappy and often wakes up with a dirty nappy and tells us that she did the poo while she was asleep. If she doesn’t wake up when she gets the urge, how are we ever supposed to get her through the night without a nappy?
On the face of it, toilet training seems straightforward and simple. In practice, however, there are many twists along the way. The delay between being trained by day and trained by night is often frustrating but completely normal. In fact, for most children, night-time dryness comes three to six months after day-time toileting is established.
Almost half of all children will wet the bed up to the age of three. Night-time accidents are very normal up to the age of seven with about one in 10 children still wetting at night.
There also seems to be a strong family component to bedwetting. Studies show that about three-quarters of children whose parents both wet the bed as youngsters will do the same.
Night-time dryness is much more linked to physical readiness than day-time toileting. You have noticed that your daughter doesn’t yet have dry nappies after the night and so it may simply be that she is just not yet developmentally ready. This is completely normal and so may simply require you to be patient until she is ready.
The fact that you describe that she was difficult to train would also lead me to think that she may be a later developer of bowel and bladder control. This is nothing to worry about as it just means that she needs to be older for these skills to kick in reliably and securely.
Staying dry at night is a bit more difficult for children to control as it depends on how deeply they sleep. If your daughter sleeps deeply, she may not get the messages from her bladder that it needs to be emptied.
Some children develop the capacity to hold wee, and so despite not waking they stay dry. Other children need to be alerted by the “I’m bursting to go” feeling that they will get in the night but may not know how, or be able, to respond to.
It can be helpful, therefore, to allow your child to feel that “bursting” feeling during the day by getting them to hold on to the wee for a minute or two longer once they know that they need to go. This gives their brain a stronger chance to experience and be aware of what that feeling is.
During the night then, your child may be more conscious of the feeling and respond to it by waking to go to the bathroom.
Restrict drinks in the evenings to give your daughter a better chance of staying dry. Liquid will, inevitably, be digested and most of it ends up as wee. If it has gone in, it must come out. In the same way, always insist on a final wee before she gets her night-time nappy on.
Some children also come to rely on their nappy and so have no motivation to try to stay dry. So, sometimes, simply removing a child’s nappy can kick-start the night-time control.
Once your daughter is not wearing her nappy, I think it is okay to lift her to the toilet before you go to bed yourself. You are right that there are conflicting views, as some people believe that you set up bad habits and that your child relies on being lifted and so never learns to wake themselves or to hold on to whatever is there. In my experience, lifting a child can delay night-time control, but that control will come eventually.
You mention that your daughter occasionally poos in her night-time nappy. Small babies quickly learn to poo in the day and it is very unusual for a child to poo in the night. So it is much more likely that on those occasions, your daughter either poos just before sleep (having waited to get her nappy on) or poos in the morning after she wakes.
Sometimes only patience and positive thinking are required and you will find that your daughter will mature in her own good time and dry nights will come with that maturity.
David Coleman is a clinical psychologist and broadcaster with RTÉ Television. Readers’ queries are welcome and will be answered through the column, but David regrets he cannot enter into individual correspondence. E-mail your questions to healthsupplement@irishtimes.com