Q. My 6 year old son has been toilet trained since he was 3, but he still wears pull-ups at night. We've tried to limit how much he drinks at night and all kinds of bribes, but nothing has worked. I'm considering taking the pull-up away to see if this will motivate him. Any suggestions?
A. This is a common misconception about toilet training. Daytime and Nighttime skills are completely independent of each other. A child may toilet train during the day and then it may be years before he is dry at night. Each milestone requires a certain level of both brain and body maturity. It's actually normal not to be dry at night until age 7.
To be dry at night, a child must have the bladder capacity to hold his pee all night long (and some kids really do have a teeny bladder). And, he must be able to wake up when the urge to pee occurs during sleep.Most kids who still pee at night are deep sleepers who just don't have the nervous system maturity to be awakened by the feeling of needing to pee. So, if you leave your son in bed without a diaper, he will just awaken in a pool of pee. He won't be motivated by wanting to be dry or by any bribe you can offer (you have already tried that)--because it's not about lack of desire. It's about brain and body immaturity and a small bladder that can't hold it all night.
If he is 7, still wetting the bed, and really wants to be dry at night, then I recommend a bedwetting alarm (sold online for about $50--and sometimes reimbursed by health insurance) to do "behavioral training". A child can train his brain to awaken at the first sense of wetness. And after a few weeks, he'll awaken to the urge to pee. Yes, it really works for an older child who is committed to solving the problem.
For now, no caffeine and no liquids after dinner. The less he drinks, the less pee he will make at night. And, don't worry about it or punish him.
P.S. Bedwetting runs in families. But no one ever talks about it at Thanksgiving dinner.