Can Your Special Needs Child Stay Dry through the Night?



Nighttime continence is one of the mountains to climb on the way to complete toilet training.  I wrote two books on special needs potty training,( The Practical Guide to Toilet Training the Autistic Child: From Diapering Differently to Using Public Facilities and The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!)  and readers tell me that the last 2 chapters are the ones that sold them on my approach.

What are the final chapters?  Dealing with the “bumps in the road” and moving from daytime dryness to fully independent toileting in all locations and times.


Staying dry at night is both one of the “Bumps” and one of the criteria that kids need to reach to be able to be considered fully trained.

Most of the ability to stay dry at night is physiological.  The wiring has to be there.  The brain inhibits urine production at night once a child enters deep sleep.  Their bladder expands to hold more urine, and the sphincters are strong enough to keep urine in the bladder until the child can get to the potty.  Problems like brain damage from seizures and chronic constipation will play havoc with nighttime dryness.  Chronic UTIs will too.  A child with sleep apnea or insomnia may be so exhausted that they don’t wake up fast enough or fully enough to respond.  Oops.  These issues have to be addressed because not doing so will frustrate the child and all of the adults in the house.  Think you can rush brain wiring?  You are not going to be able to make that happen.  You monitor the situation (how many dry mornings and successful midnight trips?) and respond with rewards and consequences for ignoring elimination urgency.

What is elimination urgency at night?  A child is awakened by their body’s signaling of a full bladder.  They get up immediately and get to the toilet in time.


And this is when nighttime toilet training often becomes behavioral training:  the child has to want to respond to their sensory signals.  They either want to avoid an accident or they want to be rewarded for avoiding an accident.  Bed alarms can wake a sleepy child, but they can’t make a child get out of bed.  Nighttime training may need to include rewards and consequences once physiological abilities aren’t an issue.  Kids may have to be part of stripping a wet bed and washing wet sheets in the morning.  They may have to change their wet pajamas and put on clean pajamas instead of being undressed and redressed.  This should be a pain for them, not just a pain for their parent.  

It is only fair to explain to a child that we understand that it is annoying to have to get out of a nice warm bed to go pee.  We don’t like to do it either.  But we do.  If a child has few responsibilities during the day, or is not taking responsibility for their actions and inactions during the day, they will be unlikely to wish to take this one on.  So adding responsibilities around the house, and placing consequences on their choices, could be the answer to this problem.  Once they understand that not getting out of bed to pee costs THEM, and costs them every time they make the wrong choice, it gets easier to help them stay dry at night.

Want more help?  I wrote 2 books that could answer your questions:



Both of my “Practical Guide” books are available on Amazon!

By Cathy Collyer

I am a licensed occupational therapist, licensed massage therapist, and certified CBT-i sleep coach in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment. It has been a joy to help people of all ages improve their ability to grow and thrive! Occupational therapists are focused on enhancing a client's functioning in everyday life. We are practical healthcare providers, interested in teaching, adapting actions and environments, and building a client's useful skills for living their best life, regardless of their challenges. I am the author of five books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training the Autistic Child". I lecture on many subjects, including sleep, trauma, and development. Contact me to learn more about how I can help you achieve YOUR goals!

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