Why Do Some Children Wet Their Bed?
Some children over the age of 5 cannot control their bladder when they are asleep and leak urine (pee). Often, bedwetting (sometimes called “nocturnal enuresis”) stops on its own. It may be a sign of a medical problem, although that usually is not the case.
There are two kinds of bedwetting: primary and secondary. Primary bedwetting is wetting the bed most nights since birth. Secondary bedwetting is when a child starts to wet the bed at least six months after they have learned to control their bladder at night.
How Common Is Bedwetting?
It is normal for children under the age of 5 or 6 to wet the bed sometimes. In fact, about 20% of 5-year-old children wet the bed. Older children are also affected: 3% of 10-year-olds and up to 1% of 18-year-olds wet the bed. Bedwetting tends to be more common in males.
Every year, about 15% of children will outgrow the problem. Treatment may help speed up the process, helping children overcome bedwetting sooner.
What Causes Bedwetting?
Children do not wet the bed out of laziness or because they do not care. They simply do not have control of their bladder when they are asleep.
Many children with bedwetting have an overactive bladder and it may not hold a normal amount of urine for their age. This means that their bladder may have muscle spasms that cause an urge to empty the bladder more often than usual.
Bedwetting runs in families. Many children who wet the bed have a parent or family member who did as well.
Other possible causes of nighttime urine accidents include:
- A urinary tract infection
- Diabetes
- Emotional problems and stress
- Abnormalities in the nervous system or the organs, muscles and nerves involved with urination
- Diet
- Side effects of certain medicines
- Constipation
What Steps Can I Take to Help My Child Stop Wetting the Bed?
The most important thing you can do is be patient and understanding. Make sure your child knows that bedwetting is a temporary problem, and it is not their fault!
If your child wets the bed, these simple steps may help:
- Encourage your child to drink beverages during the early part of the day, and not after dinner.
- Avoid dairy-based foods and salty snacks two to three hours before bedtime.
- Encourage your child to take their time to empty their bladder completely before bed.
- Wake your child up before you go to bed (about two to three hours after your child's bedtime) and take them to the bathroom to urinate.
- Bedwetting is more likely to occur when your child is overtired. If your child is not well rested in the morning, an earlier bedtime may be worth a try.
If these steps do not work and your child wants to stop wetting the bed, consider making an appointment with your pediatrician.
What Are the Signs That We Might Need a Doctor’s Help?
Occasional bedwetting is common, and typically does not have a negative impact on children. If your child is wetting the bed often, it can cause embarrassment and shame. Your child may avoid social activities such as slumber parties.
The good news is that treatment is available for children who are motivated to stop wetting the bed. Children who overcome bedwetting often have a much brighter outlook on life than they did before. They develop a greater sense of self-confidence and flourish in other areas of their lives.
Children younger than 7 usually lack the desire and maturity to focus on a bedwetting program. But if your child is at least 6 years old, still wets the bed and wants to do something about it, it may be time to seek help.
The first person to call is your child’s pediatrician. They will provide a complete physical and run some simple tests to rule out problems such as diabetes or a urinary tract infection. If these tests are normal, the doctor may refer you to a pediatric urology practice, where doctors and nurse practitioners specialize in treating children who have problems with their urinary system.
Are There Additional Tests That a Pediatric Urology Provider Might Order?
The most important and valuable test that a pediatric urology provider uses to diagnose bedwetting is something families do at home: keep a “voiding diary.” A voiding diary is a log that parents use to record what their child drinks and when they empty their bladder over the course of two to three days.
The pediatric urology provider may also order a post-void residual assessment (PVR). This simple ultrasound test can show how much urine is left in the bladder after the child urinates.
These tests help the doctor narrow down the cause of bedwetting and develop a treatment plan.
What Treatment Is Available?
Treatment for bedwetting begins with changing behaviors, such as limiting beverages before bed and avoiding certain foods (see “What steps can I take to help my child stop wetting the bed?” above). Sometimes the doctor also may prescribe medicines, a bedwetting alarm, or both.
The doctor may prescribe medicine that allows the child to have dry nights on special occasions, such as when going to sleepovers and camps. This medicine provides a man-made version of the hormone ADH, which our body uses to slow down the amount of urine made during the night.
Bedwetting alarms use a special moisture sensor that attaches to your child's underwear. The sensor triggers a bell or buzzer the moment your child begins to urinate at night. This will wake the child so they can get to the toilet and empty their bladder. Soon, your child won’t need the alarm—they will get up on their own to use the bathroom or hold their urine until morning. Bedwetting alarms can take up to three months to work, but they often are effective.
The Healthy Bladder Clinic at Cincinnati Children’s provides comprehensive treatment for children with bedwetting issues. If your community does not have such a specialty clinic, an appointment with a pediatric urologist or a nephrologist (physician who specializes in treating kidney disorders) may be helpful.
Can Bedwetting Be a Sign of an Underlying Medical Problem?
Very rarely, bedwetting is a sign of an “acute” problem that requires immediate treatment, such as a urinary tract infection or undiagnosed Type 1 diabetes. Contact your child’s pediatrician if your child:
- Suddenly starts wetting the bed after being consistently dry for at least six months
- Begins to wet their pants during the day
- Snores at night
- Complains of a burning sensation or pain when urinating
- Has to urinate often
- Is drinking or eating much more than usual
- Has swelling of the feet or ankles
