“Night training” is the training stage in which the goal is to achieve continence of urine overnight. This is accomplished by marrying awareness of physiological readiness with behavioral strategies. It is not something you wait for. It is something you actively work on with your autistic child. Just because your child won’t be dry at night until their body and brain matures is no reason to sit back. You have a role to play in supporting your child to navigate this feeling confident and in control. Bonus Round: when you actively work on the skills needed for nighttime dryness, your child will be building essential self-regulation and communication skills that they need during the day at school, in therapy, and at home.
Physiological Management of Nighttime Dryness
If a child’s brain isn’t mature enough, or their bladder isn’t large enough, they cannot remain continent for all those hours. Neither can be boosted. Making a child “hold it” for hours during the day will only do so much to stretch the bladder, and can risk daytime accidents or even result in “lazy bladder”. This is condition in which consciously ignoring sensory feedback for urgency diminishes the signals. When a child does sense urgency, it is an almost immediate need for elimination. That could mean many accidents or many bladder infections. Flushing out the bacteria that are present in the urethra is one of the most efficient ways to reduce the risk of a UTI. Identifying readiness for night training is a matter of observing longer periods of continence without sudden urgency during the day, and decreasing amounts of wetness in a night diaper in the morning.
Yes indeed; it means that if you don’t look for information… you won’t have any!
Monitoring every morning diaper and charting every continent period of the day isn’t necessary. But ignoring these signs will either lengthen the amount of time a child wears a night diaper or increase the number of times you change a sodden bed. The costs to an older child’s self esteem when they strap on a diaper or wake soaked in urine are high. Too high. Pay attention and help your child feel supported instead.
Explaining why they can’t consume large amounts of liquid in the 2 hours leading to bed may be difficult for younger kids or children with language and behavioral issues. Build their vocabulary and their ability to understand that they need to drink their milk, water, or juice with their dinner. Serve child -friendly foods for dinner with high water content, such as watermelon and soup. Making sure that they are fully hydrated at dinner and understand how to hear the word “no” all day long are two goals for the pre- night training period. With a nod to Ray Charles’ song, night time is not the right time to learn how to handle redirection and frustration. Work on that during the day. Many ASD kids use drinking as a calming strategy, particularly if they are sucking through a spout/straw. Give them alternatives for calming in the evenings. If you don’t have any ideas, ask their OT. This is our “wheelhouse”.
Getting Them Awake at Night to Stay Dry
Once the brain and nervous system has matured, and the child’s bladder has grown large enough to hold a reasonable amount of urine, the ability to wake sufficiently and respond in a timely manner to urgency signals and urinate in the middle of the night is both a physical and a behavioral skill. A child without a sleep disorder will awaken more easily. A child that is sleep deprived, has sleep apnea, or is sedated due to medications may not. Being able to awaken and sense urgency in that barely-awake state is somewhat age-dependent. For kids that take sedating PM medications, what they take and when they take it could make all the difference. Medication dosage and dose timing could be the barrier to nighttime continence at older ages. The prescriber won’t know that this is happening unless you tell them. So tell them.
For neurotypical kids, getting up and going to the potty at night is (mostly) accomplished with their cooperation and motivation. They want to achieve the point where they don’t awaken in a puddle. They want to avoid being awakened and brought to the bathroom after a few hours of sleep. They want to ditch the diaper at night. They can problem-solve with you and talk with you about how they want to be helped.
None of that could be true for an autistic child.
Explaining might not be enough. You may have to reward cooperation, or investigate resistance further. Some kids are afraid of the dark. Some are agitated by turning lights on. Motion-sensor lights at baseboard level are helpful but not shocking. All hazards to incoordinated walking to the bathroom must be removed before the race to the potty. That could mean picking up toys before story time. A child who says they “can’t hold it” isn’t going to gingerly walk around the LEGOs. Neither are you!
Rewards may have to be mentioned every night. And accidents given little discussion at the moment but more discussion later. A child who isn’t strongly motivated at night can find that having to help you do laundry in the morning, instead of reading or playing before the bus, might grow some motivation. Dump the wet linens in a bucket/tub of water at night to get them ready for the wash in a few hours. Never shame an incontinent child. Make it simply the natural consequence of their refusal to participate. Some kids actually want a moisture sensory on the bed. While they aren’t fond of the sound/vibration, they have a concrete motivator and a way to remember success: bed alarms are memorable!
Looking for more information on potty training your autistic child?
I wrote a book for you!
The Practical Guide to Toilet Training the Autistic Child: Sensory-Motor Secrets for Success is available on Amazon (where else?) as a handy paperback.
Filled with useful information, not charts and theories, it guides you from pre-training your child all the way to teaching them how to safely and independently use the public toilet. I address fecal smearing, diet and medication complications, and how to teach wiping. Really. You have to teach that!
Grab a copy today, because even if your child is months or years away from formal training, my “collaborative diapering” strategy means that you can start training readiness skills now. You need some too, so my book explains what you need to learn in order to be the best potty coach ever!
