Daytime dryness is achieved long before nighttime dryness in most cases. Often, toddlers are using the potty exclusively throughout the day with no accidents but continue to have accidents at night. It is quite likely that your toddler is sleeping too soundly to recognize the need to go to the bathroom. It's also possible that he feels the urge but does not want to get out of bed. The Brazelton method suggests that parents not wake children to take them to the potty during the night. He believes that this is another form of stress or pressure placed on the child and discourages parents from doing so. In the child-oriented approach, it's recommended that parents observe children for dryness during the day to determine nighttime capabilities. If your toddler is able to stay dry for four to six hours at a time during the day, try allowing him to sleep in big boy underwear at night. If he is not ready, don't fret; eventually he'll be ready. Often it is peer pressure that forces the issue; if your child's friends are showing off their new big boy underwear, he may be more likely to work on nighttime dryness.

This brings up the discussion regarding long term bedwetting. Daytime dryness is often achieved before nighttime dryness. In most children, nighttime dryness is achieved by three to four years. The average child may not stop having nighttime accidents until he is four or five years old, and it is still a common problem for six-to eight-year-olds. In fact, nocturnal enuresis (bedwetting) affects almost 8 percent of eight-year-olds. The number of children in the United States who are affected by bedwetting is approximately 5 to 7 million, numbers that should give most parents a little reassurance. Boys tend to have more problems than girls. Often children who are bedwetters have parents who were bedwetters.

The reasons for bedwetting are not well understood. Several different factors may contribute to bedwetting, including genetics, a small bladder capacity, stress, and an inability to recognize when the bladder is full. If both parents were bedwetters, there is a 77 percent chance that their child will be a bedwetter. This is reduced to 44 percent if just one parent was a bedwetter. If neither parent wet the bed as a child, the child still has about a 15 percent chance of having nighttime accidents. Having a small bladder capacity is another factor that may influence nighttime accidents. If a child's bladder cannot hold as much urine as his peers', or if there is a lack of the hormone vasopressin (helps regulate production of urine at night), nighttime dryness is delayed.

One other factor thought to contribute to nocturnal enuresis is an inability to recognize when the bladder is full. In other words, the child is a really deep sleeper and has difficulty rousing himself when the bladder attempts to signal that it is ready to be relieved.

Steps to Help Your Child Control Bedwetting

Until your child is able to reach maturity (this age is different for each child) and basically outgrow nocturnal enuresis, here are a few steps you can take to help increase the number of dry nights at your house:

• Reassure him that this is normal at his age and is not his fault. Make sure he knows you understand he is not wetting the bed on purpose.

• Do not punish him or blame him for wetting the bed. Do not allow other family members to tease him about wetting the bed.

• Avoid allowing your child to drink large amounts of fluid for the two hours just prior to bed time. (There is debate over whether or not this fluid restriction is effective).

• Always have him use the potty as the last thing he does before hopping into bed.

• Protect the mattress with a waterproof layer or mattress pad.

• Allow him to help change the wet linens after an accident. This creates a matter-of-fact environment so he can better realize accidents happen.

• Consider helping your child with bladder stretching exercises. Encourage him to increase the amount of time between urination during the daytime and increase this time in small increments. This may help the bladder hold more urine at night.

• Practice an awakening routine. Wake your child approximately two to three hours after he goes to bed and help him to the potty. You may wish to do this when you go to bed or you may want to set an alarm to wake him.

• Avoid caffeinated drinks. Caffeine is a bladder irritant.

• Use disposable briefs until your child is able to experience several dry nights in a row. It is recommend that he have at least seven dry nights before attempting underwear again.

If these measures don't help your child achieve nighttime dryness, you may wish to consider a bedwetting alarm, though such an alarm should not be considered until your child is older than seven or eight years. The bedwetting alarm works by sensing, via small electronic sensor in the underwear when the first drop of urine touches the sensor. The alarm then sounds, waking your child and letting him know it's time to get to the restroom. This, in theory, teaches your child to respond to a full bladder and take appropriate measures (i.e., go to the bathroom). This method boasts a 70 percent success rate after two to three months of use.

For the school age child who wets the bed, the medications Imipramine and DDAVP (desmopressin) can be taken for bedwetting. Both are effective in reducing the number of accidents your child has but will only work as long as your child continues to use them. These medications are generally reserved for use on special occasions such as sleepovers, summer camp, and overnight trips. These medicines must be titrated to the right dose for your child and directions must be followed explicitly. If you have strong concerns about your child's bedwetting and want to try medication, seek the advice of your health care provider. Remember, you must be patient; the cure for bedwetting most frequently is the “tincture of time.” If your school age child is having accidents during the day, has signs of a urinary tract infection, has blood in his urine, or is experiencing problems with self-esteem, contact your health care provider.