437. Q&A: How can I get my child to be potty trained at night?

Dr. Sarah Bren (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello. Welcome back to the Beyond the Sessions segment of the Securely Attached podcast where we answer a listener question. I have Dr. Emily Upshur and Dr. Rebecca Hershberg here to weigh in.

Dr. Emily Upshur (00:55):

Hey.

Dr. Sarah Bren (00:56):

So nice to see you ladies.

Dr. Rebecca Hershberg (00:58):

Always a pleasure.

Dr. Sarah Bren (01:00):

So are you ready for our question of the week?

Dr. Emily Upshur (01:04):

Let’s do it.

Dr. Sarah Bren (01:06):

This mother writes in, “Hi, Dr. Sarah. Thank you for your insights on this topic and for the invitation to ask you about what topics are more pressing for us, your audience. Actually, I am facing my most challenging parenting tasks so far, getting my twins to stop needing nappies at night. I say most challenging because it is the first thing I have come across that I simply cannot teach. So after a brief and unsuccessful trial, I decided to give it a break, do some research and try again soon. I would love to hear your thoughts and wisdom on the matter. And if you have already covered this, but I’ve not heard the episode yet, I’d love to tune in.”

Dr. Emily Upshur (01:44):

Aw.

Dr. Sarah Bren (01:45):

Yes. First of all, I’m so glad that you are enjoying these episodes. And I think you’re actually hit on exactly the answer embedded in your question that we’re going to give you, which is she says it’s challenging because it’s something that she cannot teach. She also said that after an unsuccessful trial, she tried to give it a break and try again later.

Dr. Rebecca Hershberg (02:13):

We don’t know how old these kids are.

Dr. Emily Upshur (02:14):

I was going to say, did we?

Dr. Sarah Bren (02:15):

We don’t know how old the kids are.

Dr. Emily Upshur (02:16):

It almost doesn’t matter. My response is the same.

Dr. Sarah Bren (02:20):

Right? I think she did exactly what we probably are going to tell her to do.

Dr. Rebecca Hershberg (02:25):

100%. Except keep going with the break. Don’t stop breaking.

Dr. Sarah Bren (02:31):

So, okay. Let’s get into a little bit first your thoughts on, one, why she’s so right on in recognizing that this is too challenging because she’s tapping into something very real here.

Dr. Emily Upshur (02:46):

Well, I think something I just want to dispel that I think is actually important as you were saying that is a lot of the potty training books and a lot of the potty training strategies approach both day and night as the same or very similar. And so I just want to say that’s problem number one. I don’t do them at all similar. I do them completely different. I think of them as different beasts. And so I just want to say to this parent, these are different. Just to your point, Sarah, nighttime is a very unvolitional, there’s not awareness autonomy in decision making. And so it’s not surprising that parents are confused because every book and stuff that helps you learn about it says, and then, or in close proximity, you do night. And I don’t always agree that that is true.

Dr. Sarah Bren (03:32):

Right. You’re saying she can’t teach this, which you’re right. And the reason why you can’t teach it is because your child is unconscious. It’s very hard to access a learned skill when you are asleep. It is quite literally impossible. And so –

Dr. Emily Upshur (03:48):

Such a varying. I mean, I have three kids and one of them still wakes up every night and goes to the bathroom and the other two could sleep for 15 hours and that’s just their physiology. Right.

Dr. Sarah Bren (03:59):

Well, that speaks to two things. One is, it’s a very biological process going through the night and managing biological needs in the night. It could be that your body has gotten to the point where it can physically, the capacity to hold urine for 12, sometimes 12 hours. These kids are sleeping 12 hours many times, ideally. If you need 12 hours of sleep, chances are your bladder is not actually yet at the capacity to hold 12 hours worth of urine. That’s a bit of a…

Dr. Rebecca Hershberg (04:40):

Well, I remember a pediatrician telling me that by age four, only 75% of kids have developed a strong enough signal between their bladder and their brain that it can wake them up in sleep. That means there’s a full quarter of kids that by four, which I feel like some parents think is so late, literally don’t have the biological capacity. It’s just they can’t do it. The P signal is not going to be strong enough to interrupt the sleep. So if that’s 25% by age four, it’s certainly still a sizable. I mean, again, I don’t know the statistic, but there’s going to be a sizable amount of kids that still that’s the case for five, six. And the more I do this work, the more common I realize this biological piece. There’s a lot of kids who it just takes them a while to be potty trained at night

Dr. Sarah Bren (05:38):

Right.

Dr. Rebecca Hershberg (05:39):

Or toilet trained or whatever word you’re using.

Dr. Sarah Bren (05:42):

Well, there’s two variables. One is you either have to have the equipment to hold it, hold enough urine for that long a period of time, which comes with body size development, or your sensory system has to be well enough developed to wake you up if you have the urge to go. So it’s like either you hold it or you wake up. Those are the two options to not need to be diapered anymore, to be quote, potty trained at night. And different kids will solve that. I should say their bodies will solve that conundrum differently. You might find a kid who’s waking up dry because they physically could hold it that long. And you might find a kid who’s waking up dry because their body woke them up in the middle of the night and they went to the bathroom.

(06:32):

So again, neither of those things are learned in the sense of like a behavioral education. You can’t train that. So all this to say, let’s sort of take the pressure off us to be successfully teaching it because you can’t.

Dr. Emily Upshur (06:54):

I mean, I will say if we want to give some very concrete things, I will say like, don’t load your kid up on liquids before bed, that glass of milk before bed, don’t do it. Don’t put a bottle of water by their bedside.

Dr. Rebecca Hershberg (07:10):

Right. Wake them up for a dream pee. But I think what’s telling to me about this question is that she tried. Most kids, if they’re ready, if you do the things you’re supposed to do like those, it generally goes okay. It works. If it doesn’t, stop. Try again in six months. So it’s not that you can’t do it. It’s just that you kind of know after a few days if it’s going to be at all successful or not. And if it’s not, don’t make yourself crazy about it. Just keep going with the diapers or the pull-ups or whatever, and then try again in enough time. Don’t try a week later. Try several months later when all they’re at a new stage

Dr. Sarah Bren (07:57):

Actual physiological or neurological growth. And I think, just to be super clear, we’re being a bit glib, but I actually think this mom, I want to point out this mom’s intuition and attunement to the situation is on point. You gave it a shot because I’m assuming you recognized that there was some readiness because the way she’s describing it is like, this is a challenging task. It’s the first one that she’s come across that feels really challenging because she recognizes she can’t teach it. And that means it’s a sequence of tasks that she’s already built her way up to. But also, I think her intuition to say, “You know what? I briefly gave it a shot and it didn’t go that well. And I quickly said, let’s give it a break and we’ll try again later.” That kind of low pressure, low stakes attitude towards this, I think is going to be such a strength and an asset for this parent because really I think we can hopefully start to rethink potty training as more low stakes, low pressure. I think we tend to have more success when we do because it’s very likely to just kind of emerge with some support and scaffolding. I’m not saying like your kid will, you don’t have to do anything to help the process along, but oftentimes not as much as we think.

Dr. Emily Upshur (09:22):

I also think like I get these potty questions all the time. And one of the other things that I hear this parent, if we’re reading into this question saying this parent saying, “I think they’re ready to some extent.” There are other ways you can build competency. Have them change their own pull up in the morning. I really like to build skills around independence and competency, even if they’re without, again, really careful, like without that shame of I didn’t do this thing. It’s like, okay, but you can change yourself. You can get up in the morning and put your pull up in the bin and do these things that help build some of that confidence and competency without it having to be. So if this parent wants to move towards something like that, those are ways that they can sort of build on that without having to, if their child is still struggling to get through the night.

Dr. Sarah Bren (10:16):

Yes. And I think another kind of area in addition to sort of independent behavioral competency that can be something that we can start to strengthen is like Rebecca, when you were talking about this brain body connection of like, I noticed the cue and the cue is strong enough to elicit a response. Obviously it’s really tricky when this is happening when a child is asleep because it’s got to be very loud. But when they are awake, the more we strengthen that connection, that awareness of our body sensations, we’re helping to strengthen those neural connections so that theoretically that signal can get stronger faster or our awareness of that signal and what to do with it can be more wired across neural connections. And I say this for any type of potty learning really is one of the most important kind of things to, instead of practice, like one of the most important sort of skills to practice is noticing sensations.

(11:21):

The more I can – Yeah. The more I can help a child say, and you don’t have to do it around pee necessarily. It could be any internal cues to get better at tuning into that. So we could start with something that’s really easier for them to kind of like something more tangible for them perhaps. Or maybe not.

Dr. Emily Upshur (11:43):

I mean a lot of them are hard, right?

Dr. Sarah Bren (11:45):

And also there can be power struggles around the bathroom. So that’s not sometimes a place I need to start. So like I might start with if a kid is sitting in front of a delicious bowl of ice cream, I might say, “Ooh, I wonder if your mouth is watering. Can you notice? What is your belly saying to you right now? Does it say I want to eat this?” And so like helping just bridge that gap between noticing what’s happening on the inside a bit more and then expanding that outward to other areas for potty learning. When they are actually going to the bathroom, like let’s say they’re on the toilet or when they make that face in their diaper, you know they’re going and you’re like, “Ah, you’re peeing right now or you’re pooping right now. Do you notice that that feels like, what a relief.

(12:41):

Oh, that must feel like such a relief.” Or trying to help them just notice the sensations, start to make that connection more conscious. And I think that that probably helps with that wiring you were talking about, Rebecca, that’s going to eventually get loud enough to wake them up.

Dr. Rebecca Hershberg (12:56):

Absolutely. Do you guys ever get asked, I mean, I certainly do, so it’s sort of. But at what age do you worry when your kid is still peeing at night? That certainly comes up. And I guess I just want to spend a couple minutes just saying, and I don’t, by the way, have an exact age at all. I think it’s still actually fairly common that older than you think kids are peeing the bed. Seven, eight.

Dr. Sarah Bren (13:26):

Yeah.

Dr. Rebecca Hershberg (13:28):

But I think often when I’ve spoken with pediatricians about this and sort of worked with families this way, that’s a time to look at potential constipation. And there are ways that kids, this is, again, I’m not going to go into detail because it’s not my area and I don’t feel like it, but there are ways in which you can apparently be constipated without knowing you’re constipated. It doesn’t necessarily mean. You can have a blockage, I guess let me put it that way, and still be pooping regularly, if that makes sense. And so constipation is something to look at. And then certainly it can be impacted by psychosocial stress.

Dr. Sarah Bren (14:11):

Medications, as well.

Dr. Rebecca Hershberg (14:12):

Right. Certain medications. There are medications that can actually help it that sometimes parents will give their kid, let’s say before a slumber party or something. So again, I know that’s not what this episode is about, but I think if you have a child who’s much older than the kids that are in this parent’s question, who’s still peeing in their beds, it’s something I would say your first stop is to kind of talk to your pediatrician about it. But it’s not terribly unusual. And also there is an age, I would say, that all three of us would likely agree that it is worth looking into kind of why has the learning not happened?

Dr. Sarah Bren (14:50):

Right. And this is not a diagnostic thing necessarily, but there is also sometimes an overlap between late potty learning and/or accidents, what we sometimes call enuresis, which is pee accidents or encoparesis, which is poop accidents and neurodiverse presentations. That does not mean that if you have a kid who’s peeing the bed, that they necessarily are neurodiverse. But sometimes there is that overlapping piece of the Venn diagram there as well. It happens more often in kids with neurodiverse profiles.

Dr. Emily Upshur (15:27):

Right. And I think that just really comes back to that interoception, like taking cues from inside of your body and having them come to conscious awareness in the prefrontal cortex. So I think it’s one of those things where we work on it with typical kids, we work on it with neurotypical kids, but it does run its course. And I agree, Rebecca, as much as we normalize it, there’s certainly at some point, if it feels not age appropriate to a parent, again, I implicitly trust a lot of parents on like, oh, well, now this is really crossing over.This parent and this is a bit different because it sounds like…

Dr. Sarah Bren (16:07):

Or if your kid is bringing it up as a point of distress for them, or if it’s getting in the way of their social lives.

Dr. Rebecca Hershberg (16:12):

Right, going to sleep away camp. Going to sleepovers.

Dr. Emily Upshur (16:13):

Exactly. Doing typical behaviors. And then I think that’s exactly right. All those getting another set of eyes on the situation is always a good place to go.

Dr. Sarah Bren (16:25):

But I’m so glad that this mom wrote this question in because we actually have not done an episode. We’ve done lots of episodes on potty learning, but we have not done one about night weaning and night potty learning.

Dr. Emily Upshur (16:37):

We can leave it with the thing I always say, which is I promise they’re not going to college in a pull-up. That much I can promise you.

Dr. Sarah Bren (16:48):

Thank you so much, Emily and Rebecca. It’s great talking with you and we’ll see you again soon.

Dr. Rebecca Hershberg (16:54):

Bye.

Dr. Sarah Bren (16:57):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.