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Our 5 (nearly 6) year old son has had problems with potty training for a long time now.

When he sleeps at night, he wears diapers, as he is not aware of peeing during the night yet and does not wake up in time. So far that's ok, we've contacted a specialised doctor and it seems to be normal that some children take longer until they learn how to control that.

The practical problem:

Even though he wears diapers (slip type, which he can put on by himself) in the night, it happens very often (sometimes daily) that the bed is really wet when he awakes in the morning.

My question:

  • might it be the wrong diapers?
  • can anything be wrong with how he puts on the diapers?
    (We've tought him to make sure that the penis does not point upwards and that seems not to be the case.)
  • did anyone else have a similar problem and has a solution that worked for them?

Remarks:

  • we already try to reduce the amount of drinking during the evening meal
  • we already send him to the toilet directly after the evening meal
    and a second time later before he really goes to bed. He sleeps about 11 hours.
  • sure we use water-proof layers to protect the mattress, but exchanging and washing this layer and the fitted sheet nearly each day is quite a lot of work.
  • waking him up in the night for going to the toilet is quite difficult. He normally sleeps very soundly and when I try to wake him up for going to toilet he is kind of confused and mostly angry/grumpy.
  • he is sleeping in a loft bed which makes both waking him up or replacing sheets quite difficult

Important addendum: Toilet training for the night and medical aspects

In case you're having the same problem, one more remark might be important:

For our problems with encopresis and enuresis, which do last for years already, we consulted a doctor, specialized in this topic and still are in regular contact with her.

Concerning bed wetting in the night (and not at all waking up before to go to the toilet) she said:

Children do have to develop the hormonal processes which make them wake up if they need to urinate during their sleep. Some do earlier, some do later, but you definitely can not "teach" them to wake up in the night! That's why a solution with a sensor in his pants which gives an alarm to wake him up will most probably not make sense yet.

Hormone therapy

The only working solution here at this stage would be a hormone therapy, which suppresses the production of urine during the night (if I am not mistaken) and therefore reduces the urge to urinate.

  • That would be working instantly
  • and could apparently also be used punctually, e. g. if the child is sleeping at a friend's house or at a school camp)
  • but she would not recommend to use it permanently at this age (6) without urgent reasons (!)
  • and we also do prefer washing bed sheets over feeding our child hormones to avoid that.

(So for the given reasons we did not try that medicament yet.)

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(Small comment to add to what has already been answered). With our doter, we went with her to toilet when we went to bed. Maybe she already had slept 3 hours and by taking her to toilet (every night) the problem disappeared and is now gone. She goes up alone if needed (she is 6,5 now). About the diapers, I think you need to find a better diaper that adjusts to your child's body better. –  Sergio Oct 18 '13 at 20:52
    
I also think you just have to keep on taking him to the toilet in the night. You don't have to wake him up much - keep an old jug or even a potty in his room, have him sit up and pee into it, then he can go back to sleep and you can deal with it. We actually used to take my son all the way to the bathroom, after a few nights of grump/confusion he got used to it very quickly and would not even remember in the morning. –  Vicky Oct 21 '13 at 12:31
    
"have him sit up" was already difficult, when he had a normal small bed, but now with the loft bed this is practically impossible. –  BBM Oct 21 '13 at 17:34
    
Here are some general tips for other people who are looking for advice about bed wetting. nhs.uk/conditions/Bedwetting/Pages/Introduction.aspx –  DanBeale Feb 16 at 7:42
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4 Answers

up vote 10 down vote accepted

Three ideas (one you might not like, but if it works...):

  1. Make sure he goes to the bathroom just before bed. Did wonders for our daughter.
  2. Try some higher-absorbency pullups. Since he's almost 6, maybe move to GoodNights or something similar for older kids with bladder control issues. You might just be overloading the capacity of the diaper.
  3. If you can determine WHERE the leakage is coming from, attach a maxi pad (for menstruation) or a urinary incontinence pad to that part of the diaper, sticky side towards the diaper and absorbent side towards the skin. That will add some extra protection and hopefully help with leaks.

Also, for the fun part of cleaning the sheets and bed, we layered everything. Covered the mattress with a waterproof zipped liner, then placed a waterproof mattress pad on, then a waterproof liner, then fitted sheet, then top sheet & comforter. That way, when we have a leak, we only replace and wash the liner + sheets (and possibly comforter) rather than the mattress pad as well. And you can add additional layers of sheet + liner if you wanna just strip off the top soiled layer and have another beneath it to use.

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he already goes to toilet directly after the evening meal AND a second time before he really goes to bed. The mattress is already covered with a waterproof layer below the fitted sheet. The most problematic part about replacing is that he has a loft bed and that we have laundry nearly daily :-( We'll definitely see if there are better pullups. –  BBM Oct 19 '13 at 1:01
    
I feel your pain; having to wash sheets and a comforter and a mattress pad EVERY DAY wore on us too (not to mention our aquifer :> ). –  Valkyrie Oct 19 '13 at 11:34
    
+1 for all this, and just to add that it might be worth swapping out the loft bed (even just for a mattress on the floor) until he is dry overnight. [Edit: not as any kind of punishment, just for the practicality of it!] –  Vicky Oct 21 '13 at 12:29
    
I've now decided to accept this answer, as it contains good advice. Our solution: In phases where it happens more often, that the bed gets wet, we let him sleep on a mattress on the ground, so at least the changing of the sheets is much easier there. We did not yet find a relation with the chosen diapers, however we try to use an "eco" type of diapers and it seems highly probable to me, that they might be not as effective as the regular brands - but thats only an assumption (as we can not reproduce the same night with 2 different diapers). –  BBM Feb 16 at 3:04
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To @Valkyrie's excellent suggestions, I would add that mastering toileting is your child's "job," and at this age you might consider making him part of the clean-up process. If the sheets are wet in the morning, he has to help pull them, he helps wash them, he helps put them back on the bed. By making him responsible for these daytime activities, he may begin to internalize his night-time responsibilities. The more you take responsibility for his toileting, the longer it will take him to master it.

(Shame about the loft bed - that really makes it harder!)

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While I think that would be true if it were occasional night-time accidents due to not wanting to get out of a nice warm bed to go to the toilet, the OP's description makes it sound much more as though he simply has not yet developed the hormonal messengers necessary to suppress urine-production overnight, which means no amount of practice or work will help until his hormonal system matures further. –  Vicky Oct 21 '13 at 12:28
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Vicky is right - the doctor, specialized in this topic, said that children do have to develop the hormonal processes - some do earlier, some do later, but you can not "teach" them to wake up in the night... there would be only a hormone therapy working, but we do not want that (and the doctor also said, she would not recommend that without urgent reasons) –  BBM Oct 21 '13 at 17:37
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My younger son struggled with night-time wetting until he was 14. In his younger years, we weren't too worried about it; I had several friends who assured me he would grow out of it. He was a VERY heavy sleeper, and even if I went in to wake him for a bathroom break in the middle of the night, he didn't really wake up. I actually stopped doing that after I watched him bounce off the walls walking to the bathroom one night.

So, we had "night-time undies" (Good Nights pull-up type) that he changed into at bedtime every night. We put a waterproof cover on his mattress and used an extra-large rubber mat over his bottom sheet. Taught him to change his own pajamas and wet linens, and (as he got older) how to put them in the washer ... all the practical clean-up stuff.

When he turned 11, though, he joined Boy Scouts ... and then the wetting was a problem. It's embarrassing and a real problem if you're on a camping trip with 20 of your peers and you wet your sleeping bag. And by the time you get that bag home, there's no keeping the secret, because it REEKS. Not to mention finding a discreet way to change into his night-time undies without his peers finding out about his problem.

So we went to his pediatrician and explained the problem. Here's what I learned:

  • Boys have this problem more frequently and to a later age than girls.
  • By age 18, apx. 3% of boys will still be night-wetting on a frequent or regular basis.
  • If it lasts past the onset of puberty, it's likely to be a hormone issue. Especially in "late-bloomers."

The pediatrician prescribed desmopressin, and we had immediate improvement. He took the hormonal replacement supplement for three years, periodically taking a night or two off to see if he still needed it. With the onset of puberty at age 14, suddenly, he no longer needed it to stay dry at night.

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thanks a lot for your detailed answer. I imagine that at the latest the boy-scout-peer-pressure turned it into a "really big" problem. :-( That's not really encouraging, that it took so long, but as you say, there is a certain percentage with this problem. Did you also have problems with encopresis? –  BBM Mar 16 at 9:48
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No, we had only the eneuresis problem. For which I'm grateful. And yes, my son wasn't really bothered by the situation until he started going on campouts. I offered to get an alarm for him, or talk to his pediatrician about treatment options, but he didn't want to do either ... until the social embarrassment prompted him to ask for help. He's a very sensitive kid, so I didn't push him. Sometimes I regret not dealing with it sooner, but knowing him as I do, I think I took the right approach. –  Editormum Mar 24 at 15:24
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At the request of the OP I have added this as an answer and deleted the comment. I would like offer an alternative to the maxi pad suggestion: try wool long underwear. I have a heavy wetter (not toilet trained yet, but still...) and I had the same laundry issue as you. And it isn't easy changing crib sheets either, so I feel your pain. Anyway, you can find wool "longies" online and they are the ONLY thing that has worked. You lanolize the wool and it acts as a water resistant barrier. (The wool will initially repel the water, but once the inside layer is saturated, the wool starts to absorb-up to 40% of its weight.) Plus, they just look like pants, and may give his self esteem a boost. I think a wool mattress pad may be a good idea too, and will further protect the sheets/bedding. It should go on top of the fitted sheet. Trust me, I was skeptical about the wool, but it has been a life saver! I used to face wet stinky diapers, covers, pajamas, sheets, blankets and mattress pads daily, and I've swapped all that for a dry baby and washing/lanolizing the wool every two weeks, and changing sheets once a week like normal people do. Try wool! IMHO, for every situation where a synthetic fabric fails, there is a natural fiber solution.

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