Q&A about bedwetting with Jenni Trent-Hughes
Wet sheets, icky pants, poo refusal: not really the kind of thing you think you're signing up to when you have children, is it? But it's something we probably all have to deal with (to a greater or lesser extent) at some stage in our parenting lives – and, heaven knows, we could all with some no-nonsense, practical advice on how to cope.
Cue agony aunt Jenni Trent-Hughes (right). Here, as part of the Mumsnet DryNites area, we're publishing her answers to the questions Mumsnetters have put forward about bedwetting and toilet-training issues in general.
And, for double-duty thoroughness and help, we've asked Dr Penny Dobson, founder of the award-winning UK bedwetting-support charity ERIC, to add some additional expert advice on some of the most-commonly-asked questions.
Panadaeis: My four-year-old daughter wets the bed every night. She starts Reception in September and I'm hoping she will be dry at night by then, but I've been advised to stop trying as she isn't ready. Is there anything we could do to help her to be dry at night? I was a late starter at night-time dryness and was made to feel a failure as my siblings were all dry by the age of four or so. I wasn't dry till about nine or ten if I recall correctly, so might there be a hereditary link?
Jenni: I'm afraid there are no magic tricks and you can find that too much trying can actually delay the achievement you're trying to obtain. If all her other developmental milestones are on track, and there are no health issues, then yes, it's best to continue as you are. No pressure, lots of encouragement, and nothing to make her anxious. There is quite a lot of evidence to suggest that there can often be a hereditary connection as well - in my family it went from my mother to my son and it had been passed down to her as well. However, don't worry because, as you saw with your own siblings, there is no definite pattern so maybe she will be part of the majority of children and be dry at night within the next year or so.
Dr Penny Dobson adds: It may be reassuring for you to know that about 21% of children aged four and a half, wet the bed at least once a week. So you are not alone with this challenge! But you are right that there is often a hereditary link. We know that when both parents were late in becoming dry at night, their children have a 77% chance of also being late. But when only one parent was late, this percentage reduces to 43%. As in your case, it can result in a "competition" between siblings – but I think that you can play an important part as a parent in helping the family to accept that this is a normal part of growing up and nothing to be ashamed of. You could ask your daughter what she thinks might be better about becoming dry – and see if she wants to take the step of leaving her pull-ups off for a night or two (but still use bed mats and bedding protection). But, as you rightly suggest, it's best to go at your daughter's pace with this – as she needs to feel that she is ready. I assume that your daughter is drinking good levels of water-based fluids (about six to eight cups a day)? This in itself can help the bladder to hold more fluid.
Greatgooglymoogly: My pull-up-wearing four-and-a-half–year-old son is dry at night but only three-quarters of the time. Should I take him out of pull-ups or does he need to be completely dry first?
Jenni: There are varying schools of thought on this one. Some people say that taking them out of pull-ups at this point will speed the process along. Others say that the accidents that occur the other quarter of the time can be a setback in the child's confidence. I tend to err on the side of caution and say, when eight out of ten nights are dry, then try it and see what happens.
Beattiebow: My five-year-old daughter started school last September. After being dry at night for years, she started wetting the bed in the summer holidays just before school, due to anxiety we think. We started putting her in pull-ups to save the washing but she has never weed in her pull-ups. Every so often, we forget to put her in them, or she insists she will be OK and, more often, than not she wees. So what can we do?
Jenni: Firstly, have a gentle conversation with her, trying to get to the bottom of her feelings about school. Her initial fear of the unknown is perfectly understandable but you might want to see if there are other reasons that she is unhappy about the concept. Secondly, there is a trick which is worth a try: assuming that she wears regular pants to school and is not having accidents in the daytime, go out and buy a pack of her regular pants in a slightly larger size, then at night put them on over the nappies. Make a big fuss about the pants ("Ooooh, aren't these pants pretty") and don't acknowledge putting on the nappy. Do this for about two weeks then one night "forget" the nappy and see what happens.
Coca: My six-year-old daughter has recently started wetting the bed. She's has never had any issues like this: potty training at two was easy, and she went straight to sleeping without nappies too. She's happy at school and I don't think she has any other problems. When I asked her why she didn't go to the toilet, she either says she couldn't be bothered or that she is scared to walk to the toilet. We keep the landing light on and the loo is right by her bedroom door – and, if she needs the loo, she can also call for me. I started wetting the bed suddenly at seven and it lasted for a couple of years, so I wonder if it could run in the family?
Jenni: When you started wetting the bed at seven, do you remember the circumstances? Had anything happened, such as a change in school, the arrival of a new sibling, the death of a pet – anything different than the way things were before? How did your parents handle it and how did you feel about their methods? Is there anything that you'd like to try with your daughter? The thing is that, as she'd already stopped, if she has started having accidents again, it's possible that something is on her mind. One way to approach it is to ask her how things are at or school or with friends - any questions that you feel might lead you to an underlying issue, if there is one. But don't ask the questions more than one at a time – no more than one a day. If that doesn't bring any joy, then the next port-of-call should probably be your GP, in case it's just something simple like a kidney infection. If she gets the health all-clear, then you could consider asking the GP to refer you to someone for your little girl to talk to.
Pinkfluffyworld: My younger daughter, who recently turned four, was dry during the day by two and a half, but is still in pull-ups at night. However, my older daughter was dry at night before she turned three. My younger daughter wants to get out of pull-ups, so I put her to bed without, but then sneak one on around 10pm. The main problem is that she does not wake up when she wees in the bed - she quite happily sleeps through the night and wakes up vaguely damp but smelly! A friend has told me that apparently there is some sort of hormone they need to stay dry through the night - any advice?
Jenni:The hormones your friend is referring to are Arginine Vasopressin (AVP) or (ADH) Antidiuretic Hormone. The average age for production to be at the right level can be about five or six but, of course, there are some children for whom it happens earlier and many for whom it happens later. In our house, it was at about the age of eight and a half. I would very much advise against the "sneaking one on" tactic. Either put it on when she is awake, aware and participating – or don't put one on at all. Try to imagine if you went to sleep in your pyjamas and woke up wearing a coat! Disorienting to say the least and could add stress to the situation. Be patient a little bit longer. Use bed pads. Try to make a game of putting on the pull-ups. Anything that will cut down on the stress level for both of you. There is still a while to go before we need to complicate the situation.
PinkyBurgerhead: My son is four and has never ever woken up dry, so is still in nappies. Do we wait for him to wake up dry one day before letting him go it alone? What if this never happens?
Jenni: I think we can safely assume that "never happens" isn't on the cards but happening when we want it to happen might be a different issue. Four is still quite young, as the majority of children start being dry somewhere between five and six – and that isn't a vast majority, either. Most children benefit from the nappy to pull-up pyjama pants to bed pad and underpants progression. But take it slowly, don't rush it, be patient and however stressful it might get (and it might never get stressful, so don't anticipate that it will) and be supportive of your child and his efforts. That will make the entire process a lot easier on all of you. I'd say wait until five, then start the process.
Fivegomadindorset: I have a daughter who was four in January and is due to start school in September. She was doing well with her toilet training, right up until last November when she had constipation, and since then it has all gone to pot. She is now on medication (Lactulose and senna) and will not poo in the loo at all – only in a nappy or she soils her pants. She also has up to four wee accidents in a day. She is better when she's out but equally as bad at nursery. I'm concerned that this will continue when she starts school. Any suggestions? She does suffer from anxiety and has certain OCD tendencies.
Jenni: I have double-checked the contraindications for both these medications and there was nothing to indicate a connection. It's actually common for some children to develop issues with constipation as a reaction to the process of toilet training. You mention anxiety and certain OCD tendencies, so I would say it's quite possible that the issues are connected. I don't know if you've mentioned it to your GP but, if not, then you could, and ask for a referral to someone who could talk to her about the sources of the anxiety, and possibly provide strategies to that would help. It's amazing what child therapists can figure out, and change through different play exercises.
Penny: This is a very common problem and, with a gentle consistent approach, will sort itself out relatively quickly. First of all, you need to get the constipation under control – if the combination of senna and Lactulose is not effective then I'd recommend you follow the new NICE guidelines, which recommend a laxative called Movicol Paediatric Plain. This is a powder which can be mixed into drinks, and is available on prescription from your GP.
You then need to get her pooing happily, and getting over over the bad experiences she had previously with the constipation. We generally suggest you meet the child halfway and allow special 'poo' nappies which are kept in the bathroom. The child is encouraged to use these nappies and is praised if they ask for the nappy – they are taken to the bathroom and the nappy put on. They are encouraged to stay in the bathroom until they have emptied their bowels, then the nappy is taken off – again, lots of praise for doing a poo – and knickers put back on. Once this is an established routine, the nappy is then only allowed if the child sits on the toilet. We then work on removing the nappy altogether. (There is a leaflet available called 'Understanding toilet refusal - the child who will only poo in a nappy', which is free from PromoCon 0161 834 2001).
If there are any wetting/pooing accidents in between trips to the bathroom, then these are treated in a very low key way with minimal interaction, so the child clearly knows what is expected. An associated reluctance to wee on the toilet is common as they know that, if they sit on the toilet to wee, there is a chance they will also poo! Once the reluctance to use the toilet to poo has passed, the wetting accidents should resolve.
StainlessSteelCat: My four-year-old son is starting Reception in September. He has been going to a nursery part time and refuses to do a poo there. I haven't got any really coherent reason out of him for this; my best guess is that he doesn't want to ask the staff there to wipe his bottom. At home, he can more or less wipe his own bottom but often refuses to do so despite us refusing to do it for him. For a few months, he was wiping his own bum, but seems to have regressed. What can we do to encourage him to wipe himself? With him starting to go for five days a week in September, I don't want him to develop the habit of never doing a poo at school.
Jenni: I have come across this before and it often stems from an accident where they wiped themselves, got a bit of poo on their hand or their hand has got a bit smelly. They don't realise what's happened and, sometimes, it will be a while before they notice. Then they feel "Eeew!", and they don't want to be involved in the process. What works quite well is the good old reward chart.
Put it up next to the loo and, every time he does it himself, he gets a gold star. Then, when he earns three (it'll have more impact if it's a low number at that age), he gets something that he enjoys/likes/wants. That way it will become a habit because the reward has more power than the fear of wiping himself. This usually works quite well and in no time - hopefully by September - he will be completely comfortable with the process.
Fearnelinen: My son is ten and still wets the bed at least two or three times a week. We went to see an enuresis nurse for two years, tried alarms, drugs, limiting drinks after 6pm and measuring bladder capacity. We eventually gave up seeing her as she had exhausted all her avenues. He knows he is supposed to drink loads in the day but never does and then complains of thirst at about 7pm and whines or cries when I say no. He just doesn't seem to want to be dry. Where do I go from here? I'm completely lost. He can't keep wetting; he's entering puberty.
Jenni: This is a tough one, but not as unusual as you might think. It might not seem it but I suspect he really does want to be dry – being wet is not pleasant and certainly not at that age. Since you mention an enuresis nurse, I am assuming that the GP has tested him for the possibility of various physical conditions? The next thing is, has he ever seen a counsellor to talk through the situation? Quite often, bedwetting may seem like the problem but is often the symptom of an underlying and easily sort-able issue. I would say that after all the different approaches you've already tried this might hold the key.
Penny: Let me reassure you that about one in 20 ten-year-olds still wet the bed at night – so you and your son are not alone with this problem. But I can appreciate how frustrating it must be for both of you, having tried a number of treatment approaches without success. I wasn't sure what your son feels about his bedwetting, or what he sees the advantages would be in becoming dry at night. I ask this because he needs to have reached the stage of really wanting to become dry before you have another go with a treatment approach – particularly with the enuresis alarm. Sleeping through the alarm is a common issue, particularly when the child is not really engaged with the whole process; it is hard work, as you know – and it disrupts sleep. But it remains an effective approach and could be re-considered with greater effect at a later stage when your son really wants to be dry.
In the meantime, I suggest that you continue to encourage your child to drink well during the day (although I appreciate it is a challenge; ERIC has a "Water is Cool in School' drinking bottle which might help at school). About six to eight glasses a day is about right, depending upon the temperature and the amount of physical activity – so I wouldn't limit his drinks in the evening – particularly if you feel he is not drinking enough during the day. Do make sure that he goes to the toilet before bed, and you could praise him for doing this without prompting from you.
Releasethehounds: My daughter is six-and-a-half and became dry at night when she turned four. She has then gone through dry periods of anything from a week to seven months! However, she still randomly and regularly wets the bed and there seems to be no pattern to it. I know there's no real treatment before she turns seven but, in the meantime, I'm just looking for handy hints. She doesn't drink fizzy drinks and I don't restrict her drinking, as I am told this can make the problem worse. She's quite a laidback child and doesn't really seem to care that she wets the bed, and I never tell her off for it.
Jenni: I know there are some people who feel that restricting drinking can make the situation more difficult. But I would say that the problem might stem from how you go about it rather than the restriction itself. I am of multiple-decades in years and if I drink a lot before I go to bed you can be sure that I’ll be up in the middle of the night. And if I don’t drink before bedtime – then I won’t. What I would do is keep a journal for a few weeks. What has she eaten for dinner? What did she drink? What kind of mood is she in? Has anything special happened? Gather this information quietly without making a big issue out of it. Then note the nights where she has an accident and if there is a pattern it will probably appear in the information you have gathered. Quite often there is a pattern in events and we don’t notice it. Also having this information will be very useful if you see an enuresis nurse. And pat yourself on the back for not telling her off - the calmer and less stressed you are in your handling of the situation, the better it is for all concerned in the long run.
AlaskaNebraska: What are your qualifications to be an agony aunt?
Jenni: I've been working on issues with children and families for over ten years. I did a series for Discovery, called Toddler Taming, which involved going around the country helping families solve issues with their young children. Then I did a series for Five, called Dinner Doctors, that involved helping people resolve issues involving their children and food. I am an ambassador for two children's charities, and have published two books that include sections on various children's issues. I've also taught parenting seminars in schools, written and contributed to dozens of child-related articles. There's more but I would say that my most relevant qualification is as the mother of a wonderful 15-year-old: learning on the job.