Supporting your child with daytime wetting

What can this support help with?

• For families to feel more confident understanding and managing their child’s continence
• Developing your understanding of how the body produces urine
• Developing your understanding of the common causes of daytime wetting
• Developing your understanding of the importance of fluid intake

What if I need further support

If you and your child have not made progress within 6 weeks and you require additional support, please access the next stage in the pathway by requesting a place on the focussed support group workshop.

Module 1: Understanding your child’s body

Module 2: Understanding your child’s body and behaviour

Module 3: Skills for managing your child’s continence at home and across different settings

Slide 1

Hello and welcome to the supporting your child with daytime wetting workshop.

This workshop includes 3 modules:

1. Understanding your child’s body
2. Understanding your child’s body and behaviour
3. Skills for managing your child’s continence at home and across different
   settings

You are accessing Module 1. The focus of this module is to provide you with an understanding of your child’s body including how the bladder works, how the bowels work, How the bladder and bowels impact each other, and the importance of drinking fluids.

The content of this module is aimed at healthy developing children as well as a children with a range of additional needs.

Slide 2

The roadmap shows you what support is available on the Daytime Wetting pathway and how you can move through each stage.

The first step, “Support for all”, includes 3 modules of pre-recorded health education videos. You are currently watching module 1. Once you’ve finished all 3 modules, you can start trying the strategies at home for next 6 weeks.

If you feel things are not improving, or if you’re finding it hard to put the strategies in place, you can get in touch with us to move on to the next stage on the road map.

The second stage, Focussed Support, allows you to join a group workshop facilitated by an ICAN Nurse. In this session, we look at common challenges and help you troubleshoot and overcome the challenges. After the workshop, we encourage you to keep using the strategies for another 4 to 6 weeks. It is important to understand that it can take several weeks before your child may make progress towards achieving daytime dryness.

If you have completed the workshops and still feel you need more help, you can contact us to access specialist support with an ICAN nurse. At this stage, we work closely with you to create a plan that’s tailored to your child and your family.

All the way through the pathway, our goal is to empower you with the skills, confidence, and tools to support your child to achieve daytime dryness.

Slide 3

You have now completed module 1 of the Supporting Your Child with Daytime Wetting workshop. Please go on to complete the next module 2 “Understanding your child’s body and behaviour”.
Please try to utilise the tools and strategies learned from this workshop with your child at home. Be consistent with your management plan.

If you have not made progress within 6 weeks and your require additional support please access the next stage in the pathway by requesting a place on the Focused Support Group Workshop.

Slide 1

Hello and welcome to the supporting your child with daytime wetting workshop.

This workshop includes 3 modules:

1. Understanding your child’s body
2. Understanding your child’s body and behaviour
3. Skills for managing your child’s continence at home and across different
   settings

You are accessing module 2.

The focus of this module is to provide you with an understanding of how the bladder empty’s, how their body tells their brain they need to use the toilet, and how your child’s behaviours can contribute to daytime wetting.

The content of this module is aimed at healthy developing children as well as children with a range of additional needs.

Slide 3

Passing urine is quite complicated. There are muscles that stretch and squeeze and muscles that hold our wee in. If these don’t work together properly, it can make it difficult to pass urine effectively.

This means that we need to consider your child’s understanding, behaviour and physical ability to pass urine. Your GP will have done some basic checks to make sure your child has the physical ability to pass urine before you were referred, so we’ll focus on understanding and behaviour.

Slide 4

There are 3 main behaviours we see in children who are experiencing daytime wetting.

Withholding is when a child hold’s their poo in because they don’t want to go to the toilet. This can be due to having had a painful poo in the past and being scared of the poo hurting again or because they think toilets are dirty.

Some children avoid the toilet for other reasons, possibly because they are busy playing and don’t want to stop to go for a wee.
The term smearing is used to describe children spreading poo on walls, furniture, themselves, anywhere apart from the toilet and potty or pants and nappy.

Slide 5

The strategies you can use to help with this include having regular toilet time, we recommend sitting on the toilet for a wee every 90 minutes to 2 hours; at school this can be before school, at break, at lunch and at the end of the school day. Keeping a positive attitude is very helpful in supporting your child, try not to tell them off for having an accident, they probably didn’t mean to do it. Having a rewards chart where your child gets a sticker for things they can control, rather than being dry, helps with this. These could be things like drinking well, having regular toilet time or helping to clean up after an accident. Setting goals for your child can also be helpful, whilst this can be being dry through the day or night, things like drinking well and having regular toilet time are also good goals.

Slide 6

There are a few reasons why people may not fully empty the bladder. They could be in a rush, they could not be feeling very relaxed, or they could be sat in the wrong position to empty their bladder.

Slide 7

Thing’s you can do to help your child relax on the toilet will be different for every child. Try whatever your child likes to do to help them relax.

Slide 8

Toilets are designed for adults, if your child is small or slim, it may be difficult for them to sit on the toilet comfortably. Use a step if they can’t reach the floor or a child’s toilet seat if they can’t sit on the toilet properly.

Girls should sit up with their legs slightly apart and boys should sit and pull back their foreskin to ensure no wee gets stuck in there and dribbles out after. We know boys may not want to sit on the toilet, but it does put them in the ideal position to empty their bladder properly. It’s not forever, just while you get their wetting sorted.

Slide 9

Emptying the bladder requires use of the right muscles. Children are likely to be confused about ‘how’ to urinate, often they are ‘squeezing’ the bladder when they should be ‘relaxing’ it, this causes incomplete emptying but there are ways that can help them do this.

Slide 10

These are some things you can do with your child while they’re sat on the toilet to help them relax the bladder.

Singing, practicing breathing exercises and whispering are all good. With younger children, they can blow bubbles or blow on a paper windmill to blow out gently. Placing a hot water bottle on their tummy whilst weeing can also help.

Slide 11

Pelvic floor exercises help to strengthen the muscles to help hold wee in, this video explains how you can help children to learn to do this.

Slide 12

This video refers to interoception in autism but it’s relevant to everyone!

Slide 13

You have now completed module 2 of the supporting your child with Daytime Wetting workshop. Please go on to complete the next module 3 “Skills for managing your child’s continence at home and across different settings”.

Slide 1

Hello and welcome to the supporting your child with daytime wetting workshop.

This workshop includes 3 modules:

1. Understanding your child’s body
2. Understanding your child’s body and behaviour
3. Skills for managing your child’s continence at home and across different
   settings

You are accessing module 3.

The focus of this module is to provide you with skills for managing your child’s continence at home and across different settings.

The content of this module is aimed at healthy developing children as well as a children with a range of additional needs.

Slide 2: Learning objectives

The learning objectives for this module are to support families to effectively manage their child’s continence needs by:

• • developing skills in recording stool diaries and addressing constipation that may be contributing to your child’s wetting
  • developing skills in recording fluid intake and output charts
  • co-ordinating your child’s toileting plan across different settings and care givers

Slide 3: Building a toileting routine

Establishing a predictable toileting routine is important because it helps children learn to recognise their body’s signals and develop healthy bladder habits. Regular, and timed toileting reduces the likelihood of holding urine for too long or missing early cues that lead to accidents. A consistent routine also provides a sense of structure and security, which is especially helpful for children who may experience anxiety or for those children that are easily distracted with other activities. Over time, these repeated, positive toileting experiences build confidence, strengthen bladder control, and support long-term continence skills.

Slide 4: Communication tools

You could use visual tools such as “now and next cards” to help your child understand their toileting routines to reduce anxiety.

Slide 5: Positive reinforcement

Positive reinforcements with praise and rewards will help to make toileting a positive experience. Children enjoy receiving rewards. Try make sure you set small achievable goals with them.

And remember to reward for effort rather than achieving the task.

Slide 6: Poo diary

Keeping a stool diary is important because constipation is a common contributor to daytime wetting in children. Recording how often your child opens their bowels, the stool consistency, and any difficulty passing stools, can help you identify constipation. If constipation is suspected, it’s essential to see your GP for assessment and appropriate treatment, which often includes laxatives. Constipation rarely resolves with diet and fluid changes alone, so timely medical support helps ensure your child’s bladder and bowel can return to healthy function.

Slide 7: Fluid Diary

Keeping a fluid diary is important to help you monitor your child’s fluid intake and support them to achieve their fluid targets. Dehydration is a common contributor to daytime wetting – so it is important your child drinks their recommended fluid targets discussed in module 1.

Recording your child’s toilet time can help to build routines and help communicate your child’s routines between other care givers. Additionally, it can help you to spot patterns and address any issues that may be contributing to episodes where your child is wet.

Recording your child’s voided volumes at least 3 times a week can help you to identify your child’s bladder capacity. It can take several weeks of consistency in drinking plenty and regular toileting before your child’s bladder capacity increases.

Slide 8: Who will support your child?

It can be helpful for you to map out who looks after their child each day and think about how to share the toileting and behaviour management plan with everyone involved. Children make the best progress when they receive the same messages, routines, and expectations across all environments, whether they are with parents, relatives, school staff, or childcare providers. By ensuring all caregivers use consistent reminders, language, and reward systems, children experience clear and predictable support, which reduces confusion and strengthens their progress toward achieving daytime dryness.

Slide 10: Helpful websites

There are lots of helpful websites and apps that you can draw ideas from to help you start your toilet training journey

Slide 11: Helpful apps

These apps can be downloaded via the Apple App store or Google Play Store.

Slide 12: The end of the module

You have now completed module 3 of the Supporting Your Child with Daytime Wetting workshop.
Please try to utilise the tools and strategies learned from this workshop with your child at home. Be consistent with your management plan.

Slide 13: How to access further support

If you have not made progress within 6 weeks and your require additional support please access the next stage in the pathway by requesting a place on the Focused Support Group Workshop.

Our workshops help you create a positive home learning environment to support your child to achieve daytime dryness. You’ll learn practical strategies to use at home, plus tips on encouraging your child to adopt healthy bladder and bowel habits. Explore the workshop details and FAQs below to find out how we can help you.

About our workshops for parents and carers

We offer sessions for parents and carers of children aged 5-16 with persistent daytime wetting. The courses are free for parents and carers who has been referred into the Daytime Wetting service by their GP.

The workshops are very informal and give practical advice on helping your child and will give you the chance to:

• Understand the common causes of daytime wetting
• Understand healthy bladder and bowel habits
• Overcome common challenges experienced by parents when supporting their child with strategies to achieve daytime dryness
• share ideas with other parents and carers whose children are experiencing daytime wetting

The workshops are for parents and carers only.

What software/apps do I need to participate in the workshop?

The workshop is hosted via Microsoft Teams which you can down load here: Download Teams Desktop and Mobile Apps | Microsoft Teams.

What if I need further support

If you and your child have not made progress within 6 weeks and you require additional support, please access the next stage in the pathway by requesting a Specialist Support appointment with an ICAN Community Nurse.

Some families may require further support following our support for all and focussed support packages.

Our specialist support can ensure that those children and families who may need additional support can access the right professional for more tailored support.

Families are required to complete both our support for all and focussed support packages before accessing our specialist support package.

We have clinics in 3 health centres across Leeds. Our clinic sites are:

• Reginald Centre, LS7 3EX
• St Georges Centre, LS10 4UZ
• Wortley Beck Health Centre, LS12 5SG

Details on how to access this additional support are available when attending one of our workshops.

• 1 to 1 support with an ICAN community nurse including a continence assessment and personalised management plan

If you suspect your child has constipation with one or more of the following signs or symptoms:

• Dry poo
• Infrequent pooing (Less than 3 times in a week)
• Painful poos
• Regular watery poos
• Very smelly or dark poo
• Straining
• Large poos that block the toilet
• Soiling

Contact your GP for an assessment and commence laxative treatment if required.

• A child’s average bladder capacity can be worked out using this equation: age + 1 x 30 = average voided volume
• Therefore, the bladder capacity for a 5-year-old is: 5 + 1 x 30 = 180mls
• Urine is produced form the kidneys at around 60mls per hour
• Therefore, a five-year-old should be able to stay dry for 3 hours
• The ability to ‘hold on’ increases with age
• The expected number of voids per day is between 6 and 8

Please try to utilise the tools and strategies learned from this workshop with your child at home. Be consistent with your management plan

• Pelvic floor exercises help to strengthen the muscles to help hold wee in.
• Start checking their bladder volumes (by getting them to wee into a jug and measuring it).
• We recommend sitting on the toilet for a wee every 90 minutes to 2 hours.
• Having a rewards chart where your child gets a sticker for things they can control (like sitting on the toilet), rather than being dry, helps with this.
• These could be things like drinking well, having regular toilet time or helping to clean up after an accident.
• Setting goals for your child can also be helpful, whilst this can be being dry through the day or night, things like drinking well and having regular toilet time are also good goals.
• Drink plenty of clear fluids (diluted squash or water) and avoid too much milk as it can make any co-existing constipation worse. Continue to avoid bladder irritants such as tea, coffee, cola, fizzy drinks, citrus or berry juices.
• Fluids will help to keep the urine well diluted so that it does not irritate the sensitive bladder lining. They also keep the poo soft and are really important in preventing dehydration and constipation.
• Your child should be drinking a minimum of the daily amounts shown below for their age.

• NICE Guidance for managing childhood constipation.
• ERIC is a children’s charity which provides information for parents and professionals around common bowel and bladder problems.
• Bowel and Bladder UK is a charity which provides information for anyone with a bowel or bladder problem.
• The Poo Nurses resource for parents and professionals around the management of childhood constipation.
• Bristol Stool chart tool used to assess the different types of poo.
• Compass UK