Bedwetting (also called nighttime or nocturnal enuresis) is a common problem in children. When children find that they have a full bladder, they will learn to control urination during the day. Once this happens, they will learn to consciously control and coordinate their bladder. This usually happens at the age of four. Nighttime bladder control generally takes longer and is expected to be between 5 and 7 years old.
Nocturnal enuresis (bedwetting) is a disruptive condition that affects around 15% to 20% of five-year-olds and up to 2% of adults (Caldwell et al., 2013).
Toilet training can be a tough endeavor for parents, so it’s a big relief when it’s over with. By the age of five, children will generally be able to manage to stay dry during the day but may still have an incident of bedwetting every now and then. While that’s normal at this age, parents should monitor this closely as bedwetting can become a concern if it continues past the age of seven.
The Whys of Wetting
Bedwetting in children can be caused by a number of factors, including:
- Genetic reasons
- The child struggles to wake up from sleep
- Slower than average development of the central nervous system—this can reduce the child’s ability to get to the toilet before their bladder empties
- Hormonal factors
- Urinary tract infections
- Abnormalities in the urethral valves or ureter
- Abnormalities in the spinal cord
- Stress or worry
Treatment and Care
Behavioral interventions to treat bedwetting are defined as interventions that require children to adopt behaviors or actions that promote dryness at night, and include strategies to reward those behaviors. Behavioral interventions are further divided into: (a) Simple behavioral intervention behaviors or actions, which can be achieved by the child without much effort; (b) Complex behavioral interventions require greater efforts on the part of children and parents to achieve multiple behavioral interventions. Including bedwetting alert therapy (Caldwell et al., 2013).
Motivational Therapy is a simple behavior intervention that is a good first option for younger children and involves keeping a record of progress, with bigger rewards for longer periods of dryness. You and your child should agree about the reward in advance and might progress from a sticker on a calendar for each dry night to a favorite book for seven consecutive dry nights (Drutz et al., 2021).
Bedwetting alarms are the most effective method for controlling bedwetting as found in a data analysis of sixteen randomized trials of simple behavioral interventions for treating bedwetting involving 1643 children (Caldwell et al., 2013). They are typically reserved for children older than six years of age. You may consider trying alarm therapy after three to six months of other behavioral training techniques, before treatment with medication.
Alarms work by using a sensor that detects the first drops of urine in the underwear (Glazener et al., 2003). When the sensor is activated, it sends a signal to an alarm device, which is intended to wake the child with a sound, light, or vibration. The alarm helps to train the child to wake up or stop urinating before the alarm goes off.
Several complementary and alternative therapies have been tried in children with nocturnal enuresis, including acupuncture, chiropractic maneuvers, and hypnosis. However, there is not enough data from scientific studies to know if these therapies are effective (Huang et al., 2011).
Takeaways For Parents
Bedwetting can be extremely frustrating and embarrassing for children who are determined to prove their ‘big boy’ or ‘big girl’ status. For parents, there are a few things that you can do to help your child cope.
Patience and support – While constantly washing sheets can be frustrating, it’s extremely important to reassure your child that this is a normal part of growing up and that it happens to lots of people.
Tease-free zone – Ensure that, within your household, there is no teasing or joking about the bedwetting, especially if there are older children in the house. While teasing may be normal, it can be upsetting for a child who is unable to control his or her bladder during the night (Drutz et al., 2021). Similarly, you should always avoid talking about the bedwetting outside of the home, especially in a situation where other children may be present.
Sharing responsibility – While it’s important that your child understands that bed wetting is not necessarily ‘bad’ or ‘wrong’, it’s also important to encourage responsibility. For this reason, it’s a good idea to have your child help you to wash and change his or her sheets in order to reinforce the idea of shared responsibility.
How to prevent bedwetting
In many cases, you can help your child to have dry nights by:
- Making sure that he or she goes to the toilet before bed each night
- Making sure that your child has clear, unobstructed access to a toilet during the night
- Using a night light – sometimes the issue is that a child may be afraid of getting up alone in the dark
- Using a reward system such as a sticker chart to reinforce your child’s pride in staying dry
- Monitoring your child’s bladder and bowel movements – this can often be helpful in identifying physical issues that could be causing the bed wetting
- Using absorbent pants in severe cases, although this shouldn’t be considered as a long-term solution
While these tips can help to prevent some bed-wetting, if the problem persists, you should always seek professional help to identify the root of the problem.
Bedwetting can be persistent, but it’s rare. In most cases, by the time your child is six or seven, they’ll start having dry and peaceful nights. The next stage of his or her development should be free of bedwetting.
Caldwell, P. H. Y., Nankivell, G., & Sureshkumar, P. (2013). Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd003637.pub3
American Family Physician. (1999, March 1). Why does my child wet the bed? American Family Physician. https://www.aafp.org/afp/1999/0301/p1219.html.
Drutz, J. E., & Tu, N. D. (2021, April 27). Patient education: Bedwetting in children (Beyond the Basics)Jan. Uptodate. https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics?search=bedwetting&topicRef=15347&source=related_link.
Glazener, C. M. A., Evans, J. H. C., & Peto, R. E. (2003). Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd002911
Huang, T., Shu, X., Huang, Y. S., & Cheuk, D. K. L. (2011). Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005230.pub2