Dr Catherine
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4-7 years

What are you meant to do when your child just doesn’t seem to be able to toilet train overnight? My five year old was out of daytime nappies before she was two, but is still wetting heavily at night. Are we doing the wrong thing by continuing in nappies? Should we go cold turkey? Or is the mysterious “hormone” myth not actually a myth and it’s just a matter of waiting until she wakes dry more regularly?

While there is some debate about the use of absorbent pants at night as to whether they ‘encourage’ children to wet the bed, overall the research suggests that wearing absorbent pants neither prolongs the process nor helps children become dry quicker. The main advantage of absorbent pants is that they help parents and children manage the bedwetting more effectively and reduce the associated laundry that comes with constant wet sheets. In saying this it is important that children feel comfortable wearing them, the way parents handle the situation is critical to ensuring children come out the other end with their self-esteem in tact and feeling confident. In terms of causes, the most common include (1) an overproduction of urine overnight – children who have low-levels of ADH (this is the 'mystery' antidiuretic hormone that you refer to) produce four times the amount of urine as those who have the hormone and are therefore at a greater likelihood of exceeding their bladder capacity overnight (and explains why his bladder seems to keep filling). If this is the cause children generally stop wetting their bed when their ADH levels return to normal; (2) Difficulty arousing from sleep in response to a full-bladder – these children are unable to detect the signals sent from their bladder to their brain telling it it is full and needs emptying. These children will stop wetting when their body matures to a point where they can wake-up in response to their full bladder; and (3) a genetic disposition – children who wet the bed are more likely to have a family member who also wet the bed as a child. If you were at all worried about your daughters wetting then I would certainly recommend following-up with your GP. Kind Regards, Dr Cathrine