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Toilet training and Bedwetting

Toilet/potty training

Using a potty is a new skill for your child to learn. It's best to take it slowly and go at your child's pace. Being patient with them will help them get it right, even if you sometimes feel frustrated.

Bedwetting

Bedwetting happens when your child makes more pee at night than their bladder can hold; unfortunately, young children often don't wake to the feeling of a full bladder, which means that they wet their bed whilst they are sleeping. It can run in families, and boys are more likely to wet the bed than girls.

See below for further information and advice on these two topics.

When to start?

Using a potty is a new skill for your child to learn and most parents start thinking about potty training when their child is between 2 and 2 and a half, but there's no perfect time as all children are different and it is important to wait until your child is ready. You might feel your child is ready to start potty training when you notice the following:

  • Your child can get on and off of the potty
  • Your child can pull their clothes and underwear down
  • Your child can follow instructions
  • Your child knows when they have a wet or dirty nappy and they tell you this
  • Your child can stay dry for an hour or two
  • Your child knows when they are doing a wee and they tell you this
  • Your child knows when they need to do a wee or a poo and they may tell you this in advance

How to start?

Remember, you cannot force your child to use a potty. If they're not ready, you will not be able to make them use it. 

  • Choose a time when there are a few other big changes such as house moving or a new sibling arriving
  • Keep a potty next to the toilet
  • Once you have chosen a time to start, swap nappies or pull-ups for pants
  • Encourage your child to sit on the potty regularly, particularly after meals and at any time you know your child normally does a poo
  • Encourage boys to sit down to wee - this helps them to empty their bladder properly and makes sure they can poo as well if they need to
  • Don't make a fuss if they have an accident but do praise them when they succeed and you could try using a sticker chart

Night-time potty training

Night-time potty training might take longer than daytime potty training. If your child's nappy is dry or very nearly dry in the morning, they may be ready for night-time potty training. Make sure that your child uses the potty just before bed and then make sure it is nearby in case they need to use it overnight. If possible use a waterproof sheet and have clean bedding and pyjamas to hand. If things aren't going well, stick with nappies for a little longer and try again later.

Potty training with a disabled child

Some children with a long-term illness or disability find it more difficult to learn to use a potty or toilet. The charity Contact has a parents' guide on potty training with a disabled child. Visit the Contact website for further support and ways of getting in touch with other parents with a disabled child.

What to do when there are problems?

If after you start potty training, it appears that your child was not quite ready, go back to nappies/pull-ups and try again in a few weeks. If you have any other concerns about potty training, talk to your health visitor and/or GP.

Further information:

Video

In this video from the NHS, a health visitor gives advice on when you should start potty training with your child.

The good news is you don't need to wait until children grow out of bedwetting - treatment is now available and recommended from the age of 5 years.

However, up to the age of 5 years, wetting the bed is normal. It usually stops happening as your child gets older without the need for any treatment:

  • up to 1 in 5 5-year-olds wet the bed
  • 1 in 20 10-year-olds wet the bed
  • about 1 in 50 teenagers wet the bed
  • about 1 in 100 teenagers continue to wet the bed into adulthood

If your child is under 5, you don't need to see your GP about their bedwetting unless:

  • It happens a lot and is upsetting them
  • They're constipated despite you changing their diet
  • They have also started wetting themselves during the day, but had been dry most days for a while
  • They go to the toilet a lot during the day (for example, every hour), they can't hold on for even a few seconds or minutes, peeing is painful, or they're peeing less than 4 times a day
  • Your child has started wetting the bed again after being dry for more than 6 months

How to help bedwetting?

  • Give your child enough water to drink during the day
  • Make sure your child goes to the toilet regularly, around 4 to 7 times a day, including just before bedtime
  • If possible use waterproof covers on their mattress and duvet

  • Do not punish your child – it is not their fault and can make bedwetting worse

Ask your health visitor or school nurse for advice if you are worried.

For commonly asked questions and excellent practical information about the treatment of bedwetting, use the Eric website.

There are many sensory issues associated with sleep including:

  • Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
  • Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired. 
  • Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.

Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold?  Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference. 

Click here for more information on sensory issues.
 

Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites

Visual Resources | Autism West Midlands 
Visual Supports | Autism Toolbox Autism Toolbox

Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.

Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.

 

What might help 

Keeping a sleep diary 

A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help. 

The Sleep Charity have templates you can download; one for teenagers and one for younger children. 

Seeking advice and help from sleep services 

There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page. 

Understanding sleep cycles 

The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.

As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production.  Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.

Setting a waking time consistently even in holiday times, which is called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm. 

Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity

Prescriptions of melatonin

Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.

 In Shropshire, Telford and Wrekin the Community Paediatric Service and the CAMHS (BeeU) Service) can prescribe melatonin for children and young people who meet ALL of the following criteria.

  1. the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis is not required but the child must be being seen by the service, not on a waiitng list)
  2. sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
  3. behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.

GPs are unable to prescribe melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist). 

Further support 

Click on the link below to visit a page with information about

  • national websites and sleep organisations
  • local community services in Shropshire, Telford and Wrekin.