Quick Answers
Bedwetting, also known as nocturnal enuresis, is common in children. Here are some quick answers about why a child may still wet the bed:
– Delayed development of bladder control during sleep. Many children’s brains are not yet able to wake them up when their bladder is full. This is the most common cause of bedwetting.
– Small bladder capacity. Some children simply have smaller bladders that fill up quickly overnight.
– Deep sleepers. Some children sleep so deeply that they do not awaken to signals from a full bladder.
– Genetics. Bedwetting can run in families, indicating there may be a genetic component.
– Stress or changes. Stressful events or changes in routine can trigger bedwetting episodes.
– Medical causes. In a minority of cases, there may be an underlying medical cause like a urinary tract infection, diabetes, or sleep disorder.
When is bedwetting a concern?
Bedwetting is very common up until about age 7. Experts consider it a problem starting at around age 7 to 8 years old. While frustrating, it is usually not a sign of any serious medical or emotional issues. Some key facts on bedwetting:
– Affects approximately 5-7 million children in the U.S.
– More common in boys than girls.
– 15% of 5-year-olds wet the bed regularly.
– Just 5% of 10-year-olds wet the bed.
– Less than 1% of those older than 18 years old wet the bed.
So if your child is still wetting the bed after age 7 or 8, it would be reasonable to consult your pediatrician. But in most cases there is no major cause for concern, as children will eventually outgrow bedwetting on their own.
When to see a doctor
While bedwetting is usually not serious, it’s a good idea to have your child evaluated by their doctor if any of the following apply:
– Bedwetting begins again after at least 6 months of dry nights
– Wetting occurs multiple times per night
– Other symptoms are present like new daytime accidents, pain or straining when peeing, strange color or smell to urine
– Bedwetting accompanies constipation
– Your child is feeling embarrassed, ashamed or withdrawn due to the bedwetting
– Bedwetting persists past age 7 or 8
Your pediatrician can help rule out any underlying issues, provide reassurance if there are no medical concerns, and come up with a treatment plan to help your child achieve dry nights. Don’t hesitate to raise the issue – doctors are very accustomed to supporting families dealing with bedwetting.
Common causes
There is often no clear cause of bedwetting identified, but some of the more common reasons include:
Delayed development of nighttime bladder control
A child’s body makes antidiuretic hormone (ADH) to slow urine production while sleeping. Many bedwetters simply do not yet have a mature enough nervous system to properly regulate ADH at night. As a result, the bladder overfills and the child wets the bed. They sleep right through it, because the brain has not yet associated a full bladder with the need to wake up.
This is the most common cause of bedwetting, and the good news is kids do eventually outgrow it as their nervous system matures. This cause of bedwetting will often resolve on its own by adolescence.
Smaller bladder capacity
Some children simply have a smaller bladder that fills up quickly during the night. They may produce urine at normal rates, but their smaller bladder reaches capacity faster.
These children may benefit from urinating right before sleep, restricting fluids in the evenings, using nighttime diapers to increase bladder capacity, and scheduled nighttime awakenings to empty the bladder. As the child grows, their bladder also grows bigger which can resolve this cause of bedwetting.
Very deep sleep
Some children are such sound sleepers that they do not wake up to the signals from a full bladder. Their body is producing urine at normal rates and their bladder is a typical size, but the child sleeps so deeply that the brain does not rouse them to wake up and use the bathroom.
Parents can help a very deep sleeper by using alarm systems that alert at the first sign of wetness, restricting fluids before bedtime, scheduled night awakenings, and positive reinforcement when they have a dry night. As the child ages and sleep patterns change, this cause typically resolves on its own.
Genetics
Bedwetting often runs in families. Studies show that 77% of children with frequent bedwetting had a parent who wet the bed as a child. Additionally, 44% of children with frequent bedwetting had a sibling who also wet the bed frequently.
The tendency towards bedwetting can be inherited. If one or both parents were bedwetters, a child is more likely to struggle with it as well. Genetic causes may interfere with production of ADH or lead to smaller bladder capacity. While frustrating, inherited bedwetting will often resolve on its own over time like bedwetting from other causes.
Stress and changes
Major stressors or changes to a child’s routine can trigger or worsen bedwetting. Starting a new school, moving homes, arrival of a new sibling, or other stressful life event can lead to anxiety and bedwetting episodes. Once the period of change or stress passes, the bedwetting often ceases again.
Parents should be understanding, patient and supportive of the child during times of stress or transition. Temporary use of nighttime diapers or pullups can spare the child embarrassment until the stressor passes and dry nights return. Reassurance helps relieve anxiety contributing to accidents.
Rarer causes
While most bedwetting has no medical cause, occasionally there may be an underlying condition contributing to accidents:
Urinary tract infection (UTI)
Bacteria that enter the urinary tract can cause inflammation and infection of the bladder or kidneys, increasing urge and frequency of urination. Nighttime incontinence and new daytime accidents may signal a UTI. Doctors can treat UTIs with antibiotics, which typically resolve the infection and related bedwetting.
Diabetes
High blood sugar levels from diabetes mellitus can cause excess urine production and bedwetting. Other diabetes symptoms may include increased thirst and daytime urination. Diagnosis and insulin treatment of diabetes typically halt related nighttime accidents.
Constipation
Severe constipation puts pressure on the bladder, reducing its capacity and ability to hold urine. Treating and preventing constipation helps resolve associated bedwetting. Adding fiber, increasing exercise, and ensuring regular toilet habits can relieve constipation.
Sleep apnea
Interrupted breathing during sleep prevents restful sleep, leading to excessive tiredness, which contributes to bedwetting. Treating underlying sleep apnea with CPAP devices or surgery may help resolve the bedwetting.
Anatomical defects
Rarely, a physical issue like an unusually small bladder or malformed urethra causes incontinence. Conditions like spina bifida or myelomeningocele that affect nerves around the bladder can also contribute to bedwetting. Surgery may correct anatomical defects.
If there are other symptoms along with bedwetting like new daytime accidents, pain or straining with urination, changes in urine color or smell, or constipation, see your doctor right away to check for a contributing medical issue. Without other symptoms, an underlying condition is unlikely.
When will my child outgrow bedwetting?
Most children eventually outgrow bedwetting as their bodies mature, though the exact age varies quite a bit. Here is a general timeline of when you can expect spontaneous dry nights:
– 20% of 5-year-olds will stop wetting the bed every year.
– 15% of 6-year-olds will stop wetting the bed every year.
– 10% of 7-year-olds will stop wetting the bed every year.
– 5% of 8-year-olds will stop wetting the bed every year.
– After age 10, less than 1% of children will wet the bed regularly.
– Only 1% of teens may continue wetting the bed.
While you can expect steady improvement in bedwetting up until adolescence, don’t despair if your child is still struggling with it at age 7 or older. This is still very normal and they should eventually outgrow it even without treatment. Get support from your pediatrician and use this time to build up your child’s self-esteem despite the challenges of bedwetting.
Coping strategies for child
Bedwetting can be embarrassing and upsetting for children, but parents can minimize the trauma and reassure them through this normal developmental stage:
Emphasize it’s common and temporary
Let your child know that bedwetting is normal and happens to lots of kids. Share facts and statistics that demonstrate how common it is. Give reassurance that their body will eventually learn to stay dry.
Avoid punishment
Punishing or shaming a child for accidentally wetting the bed can be very damaging to their self-esteem. Instead use positive reinforcement like rewards for dry nights. Protect their dignity by keeping bedwetting private.
Suggest nighttime bathroom trips
Help your child prevent nighttime accidents by using the bathroom right before bed. Wake them once or twice during the night to preemptively use the toilet again before their bladder reaches full capacity.
Use nighttime protection
Products like absorbent nighttime underwear, pullups, or mattress covers allow children to stay dry and sleep through an accident with minimal disruption or embarrassment. Protecting sheets and pajamas prevents wetness from announcing the accident in the morning.
Avoid limiting fluids
Restricting water and other fluids is not recommended, as children need to stay hydrated for proper health and growth. Limit only right before bed if waking up to pee helps your child get back to sleep easily.
Be patient and involve child in solutions
Deal with accidents and nighttime changes with patience. Involve your child in preparing for bed and implementing strategies like using a calendar to track dry nights. Let them take ownership of the process as much as possible.
Parenting strategies for bedwetting
As a parent, you play a big role in helping your child eventually overcome bedwetting. Here are some of the most effective strategies:
Use a protective mattress cover
A plastic-backed mattress pad or cover protects the mattress from accidents. It also allows sheets to be changed without disrupting the child’s sleep if wetness wakes them. Choose waterproof mattress covers designed for bedwetting.
Have multiple sheet sets on hand
Keep extra sheet sets handy to quickly remake the bed after an accident at night. Having backups ready means you can get your child quickly back to sleep with minimal disruption to their rest or routine.
Use nighttime pullups or absorbent underwear
Disposable pullups or reusable absorbent underwear provide protection against leaks, preserve dignity, and train kids to eventually recognize a full bladder while sleeping. Slowly transition to less absorbency as control improves.
Use bedwetting alarm systems
Sensitive alarm systems detect moisture and sound immediately to wake your child at the start of an accident, eventually training them to wake first on their own. Alarms take patience but can be very effective.
Try scheduled awakenings
Gently waking your child once or twice a night to preemptively use the bathroom can help prevent wetting. Slowly increase time between bathroom trips as they gain nighttime control.
Limit fluid intake before bedtime
Restricting drinks about an hour before sleep may help reduce accidents, but take care not to deprive your child of needed hydration which is important for health.
Reward and praise dry nights
Positive reinforcement increases motivation and self-esteem. Use rewards like stickers on a calendar, special privileges, or treats to celebrate dry nights and build your child’s confidence.
Seek professional help if needed
Talk to your child’s doctor if bedwetting persists too long past age 7 or if daytime accidents develop too. They can check for underlying issues and help create a customized treatment plan. Be patient and keep trying different tactics.
Medical treatments for bedwetting
If bedwetting becomes excessive or persists too long without improvement, consult your pediatrician. They may recommend these medical treatments for urinary incontinence while sleeping:
Prescription bedwetting medications
Drugs like desmopressin help reduce urine production overnight. Imipramine makes the bladder more able to hold urine. Side effects may include headaches or stomachaches. Medications are stopped once bedwetting resolves.
Bladder stretching
Your child urinates according to a timed schedule to stretch bladder capacity between trips to the toilet. As the bladder expands, the child can go longer between bathroom visits and accidents decrease.
Wake-up training
Alarms are used over 1-3 months to wake the child at the first hint of urination to get them to the bathroom. Eventually the alarms are phased out as the child learns to wake independently.
Hypnosis training
A trained therapist uses hypnosis techniques to improve bladder function, increase nighttime waking, and help the brain gain conscious control over the bladder. Several sessions are usually needed.
Talk to your doctor before trying any prescription treatments, which are usually only recommended after natural tactics have failed. Medicines, bladder training, hypnosis and other intensive therapies may help kids who suffer from severe or long-term bedwetting.
The takeaway on bedwetting
It’s frustrating as a parent when a child struggles with bedwetting past the expected age. However, nighttime incontinence is very common and most children will eventually outgrow it on their own. Try the following tips to help manage this challenging but temporary stage:
– Use nighttime protection to preserve dignity and reduce disruption
– Emphasize to your child that bedwetting is normal and temporary
– Have your child use the toilet before bed and avoid excess fluids before sleep
– Reward dry nights and build self-esteem using calendars, stickers and positive praise
– See your pediatrician if wetting becomes excessive or other symptoms develop
– Consider medical therapies like bedwetting medications if natural tactics don’t resolve the issue
– Be patient – in most cases, your child’s body just needs more time to develop full nighttime bladder control
With the right support, understanding and tactics, bedwetting can be overcome. Stay positive, protect your child’s self confidence, and know that most kids do eventually achieve consistent dry nights.
