My oldest daughter is 4 and has been potty trained for nearly two years. Sure, she has the occasional accident – what her pediatrician calls “busy little girl syndrome” – but, in general, she knows what she’s doing.
However, she’s still in training pants overnight. At her most recent well check, I asked her doctor if I should be concerned, or if my husband and I should start waking her up to use the toilet before we go to bed. Her doctor said no, that some kids continue to urinate in their sleep until they’re 8.
But, being a mom, I was still curious to know at what point we should be concerned, so I reached out to Zafar Quadir, MD, a pediatrician with the Banner Health Center in Chandler, Arizona, with a few questions.
First, let’s back up a bit to toilet training.
Dr. Quadir said the most important thing to consider is the child’s readiness.
“There is no magic age for toilet training,” Dr. Quadir said. “Every child is different. The best time to start is when they begin to show signs they are ready.”
(This explains why my 19-month-old stands up and says, “No,” anytime I sit her down on the training potty.)
Banner’s Health Library offers some advice for recognizing when a child is ready – which includes being able to walk well enough to get to the potty chair and to tell you when they are ready to go or that they need a diaper change – and offers some tips for getting started.
According to the American Academy of Pediatrics, “children may show signs of readiness at 18 months, begin training at 24 months, and stay dry during the day by 30 months to 36 months. Most children will stay dry at night by the time they are 36 months to 48 months old. Still, it is normal for some 3-year-olds and 4-year-olds to have accidents.”
Now, what about overnight?
“Even when kids have mastered the bathroom during the day, it can be years before they can reliably make it through the night without an accident,” Dr. Quadir said.
Once a child wakes up dry consistently, then you can try going overnight without training pants. Have them use the toilet before bed and put a plastic sheet under the cloth sheet to protect the mattress just in case.
If they continue to have accidents, try cutting off beverages a couple hours before bedtime. If that doesn’t work, talk to your pediatrician. It could be that they just aren’t ready yet, or it could be a sign of another problem such as constipation, a urinary tract infection, diabetes or stress – especially if your child has been dry and then starts wetting the bed again.
Dr. Quadir said if one or both of the child’s parents wet the bed as children, their child has a significant chance of wetting the bed, too. Bed wetting is also more common in children who have attention deficit hyperactivity disorder (although that doesn’t mean any child who wets the bed has ADHD).
“As doctors, we encourage parents to come to us with their concerns, so we can examine all possibilities,” Dr. Quadir said. “Parents need to be patient with their kids during this process and help them understand that it’s common and usually something they grow out of in time.”
As in other areas of development, parents should also be careful not to compare progress with other siblings and ask siblings not to tease them about it.
If problems persist in children older than 7, doctors may recommend a bed wetting alarm, which alerts the child when they first begin to urinate, or a prescription medication. These medications can either slow nighttime urine production or calm the bladder.
“The preference is to allow the child’s body the time to figure it out on its own,” Dr. Quadir said. “These interventions are really a last resort.”
If all goes well, then you’re done potty training (and paying for diapers or training pants). Hooray!