When my autistic son was 6 and a half years old, he was potty-trained during the day, but still wearing Pull-Ups at night. Any attempt to put him in underwear at night ended up with him waking up completely soaked. I had nightmares that he’d be going to college in nighttime training pants. Then, I came across a tool designed specifically to help with nighttime potty training: alarm underwear! Alarm underwear wakes up your child when they’ve wet the bed, to help with behavioral modification.

They may sound a little out there, but I thought I’d give it a try.

It took about five weeks of really awful sleep, but in the end, it worked and was completely worth it.  If your child is potty-trained during the day, but you are struggling to get them nighttime trained, here are the steps to make this happen. 

The Plan

The main idea behind this alarm underwear technology is that it detects any moisture in the underwear and will set off an alarm to wake up the child.

“Urine alarms are safe and effective tools for treating bedwetting, or what is referred to clinically as nocturnal enuresis,” says Dr. Henry Roane, vice president of clinical services for Elemy. “When the child begins to urinate, the electrical circuit is triggered and an alarm sounds. The alarm is not particularly loud, but it is enough to cause a natural startle response that results in contraction of the bladder. Consequently, the child wakes up before they completely void.”

But just having the alarm underwear on your child is not enough to teach them to stay dry at night. As a parent, you need to be fully committed to helping your child understand the point of it. “The parent can use this night waking as a teaching opportunity to help the child go to the toilet to complete urination,” explains Dr. Roane.

What does it mean? It means you or a partner will be sleeping near your child. Every time that alarm goes off, you wake up your child, bring them to the toilet, and tell them to urinate. Do this without judgment; use a calm voice with no sense of anger or disappointment. You need to praise and encourage any sense of improvement. Then remove the underwear and replace it with a clean pair and change any bedding as needed. Go back to bed until the next time the alarm goes off. 

This process took us five weeks. Progress did not go in a straight line; there were good nights followed by bad nights. But sticking with it and encouraging my child made a big difference. 

Purchasing the Gear

You will need to invest in a few things before you start. 

  • The alarm underwear. In my research, I discovered several different bedwetting alarm options. I opted for the underwear that has the alarm built-in because it had no wires to bother with at night. There are several options, including an alarm that clips onto regular underwear. Many children have sensory issues that would make it difficult for them to try a new underwear style, so that might be a good choice. Whichever system you choose — wireless or wired — be sure you have plenty of extra briefs. And be ready to do a lot of laundry. 
  • Waterproof your child’s bed. You will need to prep yourself for many quick nighttime changes. Having waterproof underpads close to your child’s bed is essential. It’s up to you whether you want to use the disposable or cloth kind, but I recommend the cloth version for comfort. (You will want to have these on hand much longer than the underwear system. Your child may have accidents even after you think you are “done.”) Underpads are easier to change in the middle of the night than sheets. Also, if you don’t already have a mattress protector over your child’s bed, now is the time to purchase one. 
  • Nightlights and flashlights. You need to be ready to get your child up in the middle of the night to use the bathroom. To ensure they can get back to sleep quickly, it’s important not to turn the lights on. Have several well-placed nightlights along the path from your child’s bedroom to the bathroom and a flashlight to help navigate. 
  • Laundry detergent and cleaning supplies. There will be a lot to clean up.

The Prep Work

To make the magic happen, it will take some careful planning on your part. To set you and your child up for success, here are some points to consider. 

  • Consider your sleep set-up. When we did this training with my son, he shared a room with his twin sister. We considered moving him or her out of the room to a different space to avoid waking her up but eventually decided against it because of a lack of space. We had a futon in the area right outside their bedroom, which is where the parent slept while “on duty” for the alarm going off. 
  • Make a sleep schedule. If possible, get a co-parent or another adult to help you get through these weeks. You might want to schedule it as one night “on duty” and one night “off duty.” My husband and I divided the night in half. He took the first shift for being on call for any alarms going off. Sometime around 3 am we switched, and I took over. This ensured that we were guaranteed at least a few hours of sleep every night. Whoever was on duty could doze off on the futon. 
  • Tell your child what is going on. Before you begin, explain the situation to your child. If your child can hold a conversation, this is the way to go. If, like mine, your child is nonspeaking and needs more visual support, a social story might be a better option. It’s fairly simple to create a social story using simple presentation software such as PowerPoint or Google Slides, but there are also apps available to help. There are also several picture books available that can help. 
  • Test the gear. Read the directions and try pouring a little water on the underwear to see what happens. You may need to reposition the alarm location or decide whether you use batteries or plug it into a wall. We had several technical snafus before we got the alarm to work properly. 
  • Have your child try it on. Before actually using the alarm, get your child comfortable with what they are wearing. My son had a huge tantrum when it came to wearing new underwear, and we had to hide his usual options before he gave in. Giving your child some time to explore the new situation will make things easier. 
  • Avoid giving your child any beverages after dinner and encourage urination before bedtime. If you are not already doing these things, it will make life easier for you if there is less urine in their body from the start.

Rewarding the Success

It took a while for my son to have any success. The alarm would go off, we’d bring him to the toilet, and he’d have nothing left to pee; it was already in his underwear. But we stuck with it, and within a few nights, when the alarm would go off and we’d bring him to the toilet, there actually would be urination. This felt like a cause for celebration. Stick to less stimulating rewards such as verbal praise, high fives, and hugs. You want your child to be able to fall asleep again.

When my son finally went for a full night without the alarm going off, we rewarded him with a chocolate-covered granola bar for breakfast, which was uncommon in our home.

“With potty training, voiding on the toilet is a novel behavior, and with positive reinforcement, that behavior will happen more in the future,” says Sarah Lewis, M.Ed., BCBA, a behavior analyst for Elemy. “A positive reinforcer is something that is added to one’s environment following a behavior that results in an increase of that behavior in the future.” 

Be prepared for setbacks. When I thought he had it down after that first dry night, he wet his bed the following night.  But eventually, he did get there. My son is almost 15 years old now; this whole experience feels like a distant past. He now stays dry all night long. 

“To date, approximately 100 research studies have shown urine alarms to be equally or more effective than other treatments for bedwetting, including medications,” says Dr. Roane. He notes that combining a urine alarm with reinforcement-based procedures and some medications seems to work better than urine alarms alone. Ultimately, every child will be different, and it may take some trial and error, but know that there are tools available that can help your family reclaim your nights.

Resources to Help With Nighttime Potty Training

If your child is receiving therapy, talk with their Board Certified Behavior Analyst (BCBA) and Registered Behavior Technician (RBT) about additional support.

Here are some resources to help you and your family in your nighttime potty training journey.