Bedwetting

A child’s ability to control their bladder develops as they get older. Nighttime bladder control is typically the final milestone in a child’s potty training, and wetting the bed during sleep is an expected part of development for infants, toddlers, and even young children.

Bedwetting is typically defined as nighttime wetting that happens more than twice a month after a child completes potty training. Bedwetting is common, and it’s important for caregivers to understand that it is involuntary and that a child should not be blamed or punished when it occurs.

Bedwetting may cause frustration for caregivers and children alike. Fortunately, it typically resolves in time. Caregivers can help their children develop nighttime bladder control by offering them support and help in building healthy bedtime routines.

What Is Bedwetting?

Bedwetting, also called nighttime or nocturnal enuresis, occurs when a child who has already finished potty training urinates while in bed. Bedwetting may be a primary condition or secondary to medical or emotional issues.

  • Primary bedwetting: The most common cause of nighttime wetting, primary bedwetting occurs when a child has not yet learned to control their bladder overnight. A period of primary bedwetting is a normal and expected part of childhood development.
  • Secondary bedwetting: Secondary bedwetting occurs when a child begins to wet the bed after experiencing no episodes for a period of at least six months. This type of bedwetting is less common and may be related to changes in physical health, emotional health, or sleep patterns.

While many children are able to consistently control their bladder through the night by the time they are 5 to 7 years old, it may take longer for others. Bedwetting is twice as common in boys and children assigned male at birth.

Age
Estimated Percentage of Children Who Experience Bedwetting

5 years old

15%

6 years old

13%

7 years old

10%

8 years old

7%

10 years old

5%

12 to 14 years old

2% to 3%

15 years old

1% to 2%

Although bedwetting usually resolves on its own as a child gets older, it may become a problem in certain situations, including when:

  • Episodes interfere with a child’s ability to spend time with friends or family
  • Bedwetting reoccurs after six months without an episode
  • A child experiences other symptoms, such as daytime wetting, pain, fever, or blood in their urine
  • Bedwetting persists despite at-home strategies to address it

If caregivers are concerned about bedwetting or other symptoms, it is important to talk to a pediatrician for support, advice, and medical testing if needed.

Why Do Kids Wet the Bed?

Research suggests that bedwetting results from a combination of factors. Often, wetting the bed occurs because a child is still learning to control their bladder through the night, which is a normal part of childhood.

Other factors, such as genetics, urine production at night, and certain underlying health issues may also affect whether a child wets the bed. Fortunately, it is uncommon for nighttime wetting to be caused by physical or emotional issues, and kids generally grow out of bedwetting over time. Parents with concerns about the causes of bedwetting should talk with their child’s pediatrician.

Bladder Development

Bladder control is a developmental process like walking, talking, and sleeping through the night. Infants have no control over their bladder and may urinate when their bladder is full or when they are stimulated by feeding or playing.

As a child gets older, their bladder grows to hold more fluid. Children then begin to become aware of when their bladder is full and learn how to control when they urinate. Daytime control of urination typically develops months or years before nighttime bladder control.

Not all children develop at the same pace, and some kids take longer to have daytime or nighttime urinary control. Sometimes this can be a sign of delayed maturation, which typically resolves naturally as the child’s nervous system continues to develop.

Genetics

Bedwetting tends to run in families, and parents who experienced bedwetting themselves are more likely to have children who also wet the bed.

Nighttime episodes occur in as many as 50% of children who have one parent who experienced bedwetting. Around 70% of children experience bedwetting if both of their parents were affected during their childhood.

Nighttime Urine Production

Children may wet the bed because their body is making too much urine at night. Signs of excessive urine production include soaking through undergarments — including those meant to absorb liquid — and producing a large quantity of urine in the morning despite having wet the bed during the night.

In some cases, excessive urine production is related to drinking too many fluids late in the day. It may also be tied to a problem with a hormone involved in urine production.

Some researchers believe that problems with antidiuretic hormone (ADH) may contribute to bedwetting. Also called vasopressin, this hormone affects the body’s fluid balance, blood pressure, and kidney function. Some children who wet the bed may have irregular cycles of ADH production, causing the body to make too much urine at night.

Other Causes of Bedwetting

Although it’s uncommon, bedwetting may also be caused by underlying medical issues. Several health conditions increase the risk of bedwetting, including:

While emotional problems were once viewed as a common cause of bedwetting, experts no longer believe this to be the case. Instead, psychological or emotional issues may develop at the same time as bedwetting or because of the impact that bedwetting can have on a child’s mental health.

What to Do When Your Child Wets the Bed

How a caregiver responds to bedwetting has the potential to help or harm a child’s progress in developing nighttime bladder control. Experts recommend several steps to turn nighttime episodes into lessons that support positive development.

After a child wets the bed, caregivers should ask the child to try to use the bathroom and then help them find dry clothes. To speed up late night bedding changes, caregivers can prepare the bed in advance using towels, extra sheets, or absorbent pads where the child sleeps.

Caregivers can also prearrange several layers of bedding, alternating fitted sheets with plastic mattress covers. When a child experiences bedwetting, they can simply remove the top layer of sheets without having to completely redo the bedding.

In the morning, caregivers should have the child shower or bathe and help clean up any soiled bedding or towels.

How to Help Kids Stop Bedwetting

Though children typically stop wetting the bed on their own as they get older, caregivers can try several evidence-based strategies to help children learn bladder control and stop bedwetting. Caregivers may also find it helpful to ask children over the age of 4 for their own ideas about how to stop bedwetting.

Encouragement and Motivation

Motivating a child to change their behavior, also called motivational therapy, is often the first approach recommended by pediatricians. Motivational therapy involves creating a plan to reduce bedwetting, keeping track of results, and giving the child rewards to reinforce progress.

Experts suggest rewarding all positive behavior, including using the bathroom prior to getting into bed, helping change and clean soiled bedding, and sleeping through the night without wetting.

Motivational therapy for bedwetting requires that both the caregiver and the child stay positive and engaged. While it is normal to have some setbacks while using motivational therapy, caregivers should remain encouraging and never use punishment or shaming.

Evening Routine

Developing consistent bathroom routines throughout the day may help a child reduce nighttime bedwetting episodes. These routines can include:

  • Drinking most fluids early in the day or afternoon
  • Using the bathroom every two to three hours during the day
  • Going to the bathroom twice before bedtime, around 30 minutes apart
  • Avoiding fluids that irritate the bladder, like caffeine, soda, citrus juices, and sports drinks

Other routines that may support the development of nocturnal bladder control include:

  • Using night lights to make the bathroom easier to find
  • Putting a portable potty in the child’s room if it is far from the nearest bathroom
  • Preparing clean pajamas, towels, and bedding to make nighttime cleanup easier
  • Avoiding the use of diapers and training underwear unless the child is away from home
  • Encouraging the child to help with cleanup but without using this as a punishment

Bedwetting Alarms

Bedwetting or moisture alarms involve attaching a sensor to a child’s clothes that alerts a child at the first sign of moisture. The goal of bedwetting alarms is to help a child learn to recognize when they need to urinate at night so they can get up and go to the bathroom.

Early in the process, caregivers may need to wake the child up when the alarm makes a sound. Over time, the child usually begins to wake up with the alarm and get to the bathroom before wetting the bed.

Bedwetting alarms can be purchased without a prescription. When used consistently for three to four months, bedwetting alarms often work well in helping children develop nighttime bladder control. To further reinforce positive habits, caregivers can record a child’s progress and offer rewards for dry nights and proper use of the alarm.

Bedwetting Interventions That Are Not Recommended

Bedwetting is a normal part of child development that requires caregivers to have patience and understanding. Unfortunately, some children are teased by siblings or disciplined for nighttime episodes. These children may develop problems like low self-esteem and begin to perform poorly in school.

Experts encourage parents to not blame, punish, or otherwise admonish children for bedwetting. Reacting to bedwetting with blame or anger can cause stress and worry, which can make bedwetting worse.

When to Go to the Doctor

A caregiver who is concerned about a child wetting the bed can consider contacting a pediatrician for tailored advice and support.

While bedwetting is rarely caused by an underlying medical problem, caregivers should call their child’s pediatrician if they observe signs of a potential underlying medical issue, such as:

  • Bedwetting that begins after weeks or months of dry nights
  • More frequent thirst or urination than usual
  • Pain or burning during urination
  • Foot or ankle swelling

Diagnosing the Cause of Bedwetting

Bedwetting is not a diagnosis; instead, it’s a symptom that may be related to a child’s developmental stage or another underlying cause. To diagnose the cause of bedwetting, a pediatrician may talk to the child and their family and perform a variety of tests.

Before medical testing, a doctor may begin by asking a child and their caregivers a series of questions to help narrow down potential reasons for bedwetting. Questions may include topics related to a child’s development and history with bedwetting, such as:

  • Whether episodes occur during the day, night, or both
  • If there have been periods of nighttime dryness
  • How often bedwetting occurs
  • If there is a family history of bedwetting
  • What challenges in the family are caused by bedwetting
  • If any previous attempts to address bedwetting have been tried
  • Whether there are any other medical or developmental concerns

A pediatrician will also ask caregivers to record a child’s fluid intake and bathroom habits in what is called a voiding diary. This diary includes information such as when and how much fluid a child drinks and when the child uses the bathroom. A record of a child’s bowel movements may also be included because constipation can contribute to bedwetting.

Based on the child’s developmental and medical history, a pediatrician may recommend one or more tests to narrow down the cause of bedwetting.

  • Physical exam: A physical exam looks for medical causes of bedwetting, such as evidence of delayed growth or development, symptoms of constipation or pinworms, and signs of sleep apnea.
  • Urine testing: A doctor will likely recommend a urinalysis to detect potential signs of diabetes or a urinary tract infection.
  • Imaging tests: Imaging tests are only used in select children who have additional daytime symptoms, a history of urinary tract infections, or signs of abnormalities in the spine or urinary tract.

Once a child’s doctor has diagnosed the cause of bedwetting, they may recommend treatments based on the child’s needs.

Medical Treatments for Bedwetting

If an underlying medical cause of bedwetting was found, a pediatrician may recommend starting by treating that condition.

In many cases, a child’s doctor determines that the cause of bedwetting is not a medical issue, so there may be no treatment besides education, support, and patience. In these instances, a pediatrician may suggest one or more approaches to help a child with bedwetting.

  • Education: A pediatrician may start by educating children and their caregivers about bedwetting. Important points include normalizing nighttime wetting, discouraging punishments, and describing behavioral strategies to reduce episodes.
  • Medications: Doctors may recommend medication to treat an underlying health issue or to reduce nighttime urine production. A pediatrician may wait until motivational therapy or bedwetting alarms have been tried before recommending medication, which can come with side effects.

Although bedwetting can be a challenge for both children and caregivers, parents should rest assured that this experience is a normal part of childhood. With education, encouragement, and persistence, children typically grow out of bedwetting.

References

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Michael Breus, Ph.D - The Sleep Doctor is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan and Good Night!