Dr Catherine
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4-7 years

Hi Dr Catherine, my son is now 4 1/2 and he still needs a nappy at night. When he does not have much liquid at night he can be dry (only a few nights here and there) but generally a wet nppy most mornings. What are the steps to start the "no" nappy at night process? I was just going to go cold turkey and put some matress protectors on so that he feels the wet in the night (or at least try it he may not!) but wondered if there are any steps I can take before this to save having to wash loads of linen everyday. Thanks Fiona

Hi Fiona, the best indicator that your son is moving toward achieving nighttime continence is an increase in the number of nights where he wakes up dry. Unlike daytime wetting, nighttime wetting is not conscious, which is why it is incredibly challenging to train a child at night. Where the ‘wetness’ cue is important for helping children associate wetness or wee with the feeling of needing to empty their bladder during the day – the same association does not apply at night, so unfortunately the cold turkey approach typically meets with very little success (and loads of frustration!). The treatment of nighttime wetting is often linked to the cause. there are a number of reasons why children continue to wet at night. Some do so because their body produces larger than normal amounts of urine overnight and their bladder is unable to store it until morning. This usually continues until the amount of urine produced decreases or children learn to wake-up in response to a full bladder. Others do so because they are unable to wake in response to the signals that their bladder sends to their brain telling them to wake-up and go to the toilet. The best way to encourage healthy bladder habits is to encourage your daughter to drink water regularly throughout the day, about 1 to 1.5 litres is encouraged for children his age. While it is fine to taper off in the evening, avoid restricting fluids altogether. Make sure he fully empties his bladder just before bedtime. With time your son will become dry, however if you are anxious for this to happen sooner rather than later, then you could make an appointment with your GP to discuss treatment options. In the meantime, it is perfectly fine to keep him in DryNites overnight, this way you do not have to cope with constant wet sheets and changes of bed linen. All the best! Regards, Dr Cathrine