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Dr Catherine
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2-4 years

The last two nights my 3yo has refused to wear a nappy to bed but still wets the bed - where do I start with night toilet training? She has been daytime trained for a year now so she knows what to do. We have a night light in the bathroom, and before I go to bed I put her on the toilet but sometimes that is too late. Do you have any other helpful tips?

The time between achieving daytime control and nighttime continence is quite variable with many children not achieving nighttime control until school age. Bedwetting is typically not seen as an issue or condition until children are at least 5 or 6 years of age - with the majority of children up to the age of 7 outgrowing this phase on their own. Unlike toilet training, which is conscious and deliberate, nighttime bladder control is more dependent on maturation of children’s nervous systems and bladder so it is much more challenging to train a child a night. Training at night usually involves the use of a conditioning alarm (also commonly referred to as a bedwetting alarm), this works by helping your son learn to recognise the need to pass urine and either wake-up and go to the toilet or learn to hold on until morning. The conditioning approach is based on the theory that by repetitively waking a child at the time of urination the child becomes conditioned into recognising that urination is about to occur. This method requires a great deal of commitment on behalf of the family, as parents need to take initial responsibility in ensuring their child wakes in response to the alarm. Treatment can take up to 6 months, with about a third of children experiencing relapse. Motivation is a big factor in determining success which is why we often do not recommend introducing the alarm before the age of 6. In the meantime you can encourage healthy bladder habits by getting your daughter to drink water regularly throughout the day - limit dairy intake after 6 pm and avoid foods and drinks high in sugar and caffeine (like hot chocolate) as these can stimulate the kidneys. If your daughter continues to refuse to wear nappies you could try her in DryNites these are made to look more like undies and can be more appealing to older children who have outgrown the nappy stage.All the best,