The word enuresis derives from the Greek word ‘to make water.’
When children initially start potty/toilet training, we can’t expect them to be dry at night, overnight. Taking precautions to protect the bed such as using waterproof sheets and putting them in pullups to sleep in is a sensible option, along with expecting night-time wetting. While in a deep slumber, a child’s muscles relax, making them unable to notice they need a wee until they are wet.
Regressive behaviours like bedwetting don’t keep children awake though, sleeplessness is usually a symptom of laying in wet pyjamas or bedding. This can be a good motivator for not wetting the bed in the future, being wet, cold, and uncomfortable at night is not a nice feeling.
As long as we don’t get mad or upset with our child, this is how they will learn.
PREPARE IN ADVANCE
We can help minimise the frustration to ourselves by changing sheets immediately, with minimum fuss, by always making their bed up twice, with two layers of waterproof sheets and normal sheets, just in case. This preparation means if they have an accident during the night, this limits the time and disruption of having to completely remake the bed. Simply throw off the top layer of wet sheets and waterproof, then underneath there will be more dry sheets and another waterproof sheet.
The actual issue of bedwetting does need exploring, but shouldn’t prevent them from sleeping once their pyjamas and bedding has been changed.
If they are under five, then it shouldn’t present much of a concern, especially in the toilet training stages. Making sure they use the toilet just before bed so they don’t fall too deeply asleep and have an accident or wake up needing to go to the toilet in the middle of the night helps.
It’s also a good idea to limit or stop the amount of fluid they drink prior to bedtime, offering only sips of water after four thirty pm, not milk or juice.
SEEK MEDICAL ADVICE
If they have not gone more than a few months dry at night after successful potty training in the day, they could have a developmental issue with their bladder, this can be hormonal and usually nothing to worry about. There are treatments available, and you can discuss these with your doctor.
They could also have a small bladder capacity, if this is the case, you will probably notice that they urinate often throughout the day and find they are often desperate to go. They may wet at night due to emptying their bladder too frequently during the day.
Either way, it’s always advisable to consult your GP if you are concerned at all. If they’re still bedwetting past six years of age, medical causes, as well as emotional factors, need to be looked into with their doctor to rule out any medical condition.
Once they have been dry at night for several months to a year but then regress back to wetting at night, this nocturnal enuresis would suggest some sort of emotional stress or anxiety is responsible. If your GP has ruled out a physical problem such as a water infection, we can be proactive by looking for any apparent patterns, such as, do they only bed wet on certain days such as school days and not at the weekend?
Does it happen early on in the night or toward the end near morning time, when mum is on night watch or dad, how often a night/a week/ a month does it occur?
Are there any causes that influence the episode, such as, have they been emotional throughout the day because they fell out with their best friend or because dad is working away for the night?
Our children’s fears and insecurities may seem so trivial and insignificant to us, but the smallest changes can have a huge impact. Looking at what is currently going on in other areas of their life is helpful.
This is where the U URSELF Routine comes in handy, we can notice if another area such as their eating or exercising and play habits have changed too.
We may even already be aware of a possible cause of emotional stress for them such as having a new baby sibling, bereavement, moving to a new house, starting childcare, or a parent leaving home.
All of these things can be stressful for a small child, emotionally challenging, and are common underlying causes of regression.
If stress and anxiety is the culprit, we have to handle the situation just as empathetically and positively as we would a physical medical condition that is also out of their control.
BOOST THEIR SELF-ESTEEM
This means praising them when they call out mid flow in the middle of the night for making good progress by noticing as it is happening, how we react in response will either help or hinder their progress at this point. Getting frustrated and saying things such as ‘why didn’t you get up and go straight to the toilet sooner, or, not again, or, I thought you had grown out of this’ will only damage their self-esteem. This is the next part of the U URSELF Routine that we will explore in the next blog ‘Esteem’
What we want to do is focus on what we want them to achieve, not on what we don’t want. Highlight the positives, such as the dry nights, and ignore the wet ones as best we can in the presence of our children.
We can encourage and motivate them by offering to buy them some nice new pjs or bedding with their favourite tv cartoon characters on them once they have successfully gone a whole week with a dry bed. How we phrase that reward is important, so keep it positive and focused on the dry bed. Instead of saying you can have a new pair of pjs if you don’t wet the bed. We want to motivate them for staying dry, not put pressure on them not to wet the bed. When they do succeed going one night dry, we want to make the biggest fuss possible by showering them with praise and exaggerating how happy we feel for them, this is a chance to give their esteem a boost!
MOTIVATE TO PROGRESS
What we don’t want our children to do is form a habit of bedwetting for either attention or feeling they have no control over their bedwetting.
In no circumstances should we encourage this behaviour further and be tempted to bring back the pull up training pants for bed time.
Once out of nappies and pull ups for several months, they are through with that baby phase of development. What they need most now is responsibility over their progress, they can’t do this by going backward in how we treat them. They need to feel the wet cold discomfort to register they are wet, and this is something we want to motivate them to avoid in the future.
A nice cosy, warm, dry, comfortable nappy or pullup, only motivates them to stay passive in their development. There’s no urgency to progress by controlling their bladder. I’ve potty trained many toddlers over the years, and I’ve always used pants and knickers over commercial pull ups, a cheap pack of pants are usually cheaper than pull ups, and we can throw the soiled ones away if needs be, the same way we would a disposable nappy. But children learn far quicker by having accidents that they can feel and see.
A pull up still feels like they are wearing a nappy, so I’ve found when parents choose this as a toilet training option, progress is much slower. I know pull ups are safer, easier, and less messy, but long term, they just delay the process. A couple of weeks of accidents, patience, and practise in real pants is the quickest and best long-term, effective, solution.
GIVE THEM RESPONSIBILITY
I always find that children who are given responsibility over their own lives, no matter how young, overcome challenges and progress quicker than those whose parents do everything for them and take control. This doesn’t mean not helping or being involved as a parent and leaving them to sort out themselves, but taking a back seat at times. It’s natural to want to love, protect, support, and do everything for them, but this can serve to make them feel as though they are a passenger on their journey of life. Events and experiences are out of their control and influence. There often seems little point in them making much of an effort to try or change.
Helping strip their wet bedding off their bed and putting it in the washing machine with your help, then choosing what fresh bedding goes back on their bed next or what pyjamas to wear all involve them in their own self-care. Instead of feeling low self-esteem at what can be an embarrassing time, they now display self-love and respect. They are helping themselves, and we are allowing them to feel good in a situation that could make them feel bad if handled insensitively.
It’s their bedwetting issue to address and solve. This way, they’ll look for solutions rather than feeling helpless and resigned to a life of wet nights, forming a habit that may be difficult to change later on. Now, in no instance are they responsible or to blame for their bedwetting, we are not suggesting that ever, but if anyone has any influence over changing it, they do!
And they will feel confident to try if they are given encouragement to do so. Our aim is for them to take conscious control over their issue, not be a passive allower.
Fostering this self-reliance is what will help them to build self- confidence, making them feel they can handle situations themselves.Tweet
They don’t feel guilty or as though we are punishing them if they feel they are helping in some way and having choices and responsibility.
SEEK THE CAUSE NOT THE SYMPTOM
Children want to be independent, that is why there is often conflict and tantrums, because they want to be able to do things for themselves. Managing conflict and tantrums is covered extensively in my soon to be published book, The Powerful Proactive Parent’s Guide to Present Parenting. But let’s just say for now that their bad behaviour isn’t always that bad.
The less of a big issue we can make out of their bed wetting, and the bigger the fuss we can make over a dry bed, the quicker the preferred behaviour will become a habit. We can best help, however, by uncovering the source of their underlying emotional issue or anxiety they are currently experiencing and focusing on that, rather than the presenting symptom of bedwetting. Once that has been addressed, the bed wetting, in time, if not left long enough unaddressed to become a habit, will resolve itself.
If you would like an issue covered in next month’s blog posts, please email me the issue to firstname.lastname@example.org