For parents embarking on the journey of toilet training with their child, the transition from diapers to underwear can feel like a monumental milestone. Yet, while daytime toilet learning is often approached as a behavioural achievement, night-time toilet learning operates on an entirely different plane.
Nocturnal enuresis (wetting at night) is a very misunderstood area of child development and many parents are left frustrated, and children feeling disappointment in themselves for a presentation which isn’t even within their control. Let’s delve into the facts about night time toilet learning so you can assist your child better, and understand their abilities and needs.
Challenging the Notion of Night-Time Toilet Training
In the realm of toilet learning at night, there exists a fundamental misconception: that night wetting is a behavioural factor. Know that being lazy or wilful is almost never a reason for a child's loss of bladder control. In a small number of cases, behaviour may play a role but in majority of cases, behaviour is not a cause of night wetting. Many parents base resolving night waking with training a child to wake up and use the toilet during the night.
Attempting to train a child to wake up at night to use the toilet not only misinterprets the natural progression of night-time toilet learning but also risks disrupting their sleep patterns. Fragmented sleep, characterised by frequent awakenings to respond to bladder cues, can lead to fatigue, daytime drowsiness, and compromised cognitive function. Moreover, this approach may inadvertently reinforce night awakenings, perpetuating a cycle of disrupted sleep and bedwetting.
Instead of fixating on nocturnal toilet training, I encourage parents to delve into the depths of why ongoing or persistent night wetting is occurring. It’s essential to approach night-time toilet learning with patience, understanding, and empathy. Recognising the inherent variability in the maturation of hormonal regulation, you can empower your child to navigate this developmental milestone at their own pace. By reframing our perception of night wetting from nocturnal training to hormonal regulation, we navigate a process that honors the natural rhythms of childhood development and promotes optimal well-being.
Understanding the Role of Hormones
Unlike its daytime counterpart, night-time toilet learning hinges not on behavioural mastery, but on the intricate interplay of biological factors. The ability to stay dry at night is governed by the production of two key hormones: antidiuretic hormone (ADH) and vasopressin.
Antidiuretic hormone, also known as vasopressin, are often used interchangeably, but they are not exactly the same. While both hormones are produced in the hypothalamus and stored in the posterior pituitary gland, ADH is the form of vasopressin primarily involved in regulating water balance, while vasopressin encompasses a broader range of physiological functions.
These hormones work in tandem to regulate the body's urinary function, ensuring that urine production slows down during sleep and that the brain receives the signal to wake up if the bladder is full.
Antidiuretic Hormone (ADH)
Antidiuretic hormone, also known as vasopressin, acts as a guardian of urinary regulation during sleep. Its primary function is to signal the kidneys to conserve water, thereby reducing urine production and promoting water reabsorption into the bloodstream. This slows down urine production, and the ADH helps maintain fluid balance in the body and prevents excessive urination during sleep.
Vasopressin
Vasopressin serves as the messenger between the bladder and the brain, relaying crucial signals that inform the brain of the bladder's fullness. Upon detecting a full bladder, vasopressin sends a signal to the brain, prompting the brain to wake up. This intricate communication between the bladder and the brain ensures that children awaken when their bladder reaches capacity, allowing them to empty their bladder and maintain dryness through the night.
During childhood, the maturation of these hormonal systems varies from child to child. For some, the production of ADH and vasopressin may kick in early, leading to dry nights at a young age. For others, it may take longer for these hormonal processes to mature, resulting in bedwetting, or enuresis, well beyond the typical age of toilet training. Either way, achieving dry nights will require additional support, patience and understanding as their bodies adjust to the hormonal shifts.
An Unknown Interruption
A missing link with the art of staying dry at night for children lies in the balance of oxygen levels and hormonal regulation within the body. And this balance can be interrupted through mouth- breathing. When a child breathes through their mouth instead of their nose, they over-breathe which results in lower absorption levels of oxygen, triggering a cascade of physiological responses. One such response involves the heart's production of atrial natriuretic peptide (ANP), a substance that influences urinary function.
ANP acts as a signalling molecule, prompting the kidneys to produce additional urine during the night; this is known as nocturnal polyuria, and can lead to increased urine output during sleep, increasing the risk of bedwetting episodes.
Promoting nasal breathing habits in children can have profound effects on their overall health and well-being, including improved sleep quality and reduced bedwetting incidents. For children struggling with bedwetting associated with mouth-breathing, addressing underlying breathing issues is crucial for achieving dry nights. Common culprits triggering mouth breathing include allergies, nasal congestion, or structural abnormalities that impede nasal breathing and promote mouth-breathing habits. By identifying and addressing these underlying factors, you can help your child breathe more comfortably through their nose, restoring oxygen levels and alleviating the production of ANP.
If you would like to know if your child’s night wetting is related to an underlying issue, such as mouth breathing, start with reviewing my Underlying Issues Check List.
Navigating the Night-Time Toilet Learning Journey
For parents navigating the complexities of night-time toilet learning, patience and understanding are paramount. While it can be tempting to compare your child's progress to that of their peers, it's essential to remember that every child's journey is unique. Night-time toilet learning is a complex biological process that unfolds according to each child's unique developmental timeline, and it not a beahvioural issue. This is absoutely necessary to understand when addressing your child’s night time toileting issues.
By understanding the role of hormones, addressing potential contributing factors like mouth-breathing, and reframing our approach to toilet learning, you can trust in your child's innate ability to master this developmental milestone in their own time. By fostering a supportive and understanding environment, you can move away from the concept that night wetting is a behavioural issue which needs parental intervention and focus on the real trigger to persistent nocturnal enuresis.
If you need help with your child’s night sleep, whether it be nocturnal enuresis or anything else, I’m here to help!
You can always schedule a free 15-Minute Discovery Call to connect:
Forever bringing sleep to families,
Shereen x
I'm Shereen Nielsen, a certified Sleep Consultant specialising in infants and children from birth to 15 years old. With over seven years of experience, I've assisted over 4000 families in achieving better sleep. Additionally, I serve as a lecturer and mentor, guiding aspiring sleep consultants on their path to certification through my internationally recognised online Sleep Consultant Course.
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