Managing Bed-Wetting (Nocturnal Enuresis) in Children

Nighttime bed-wetting during sleep is more common in young children than you might think. Most children outgrow this type of bed-wetting, medically known as nocturnal enuresis, by the time they turn 5 years old, but in some cases it may still continue. Bed-wetting isn’t a medical condition; however, it's one that can be challenging for parents and embarrassing for children. Find out what can cause bed-wetting and how to manage this period in children’s lives.

What Is Bed-Wetting (Nocturnal Enuresis)?

When wetting of the bed happens in children only during sleep, it’s officially called nighttime incontinence or nocturnal enuresis, or more commonly bed-wetting. This involuntary urination happens while your child is asleep.

A familiar morning scene in many households may include wet sheets and pajamas, and an ashamed child. But know that this doesn’t mean your efforts with toilet training have gone down the drain. This is a normal part of your child’s development.

There are a number of ways you can manage these bed-wetting incidences. Your best approach is to practice patience and understanding with your child, and then follow up with solutions, of which we have many.

How Common Is Bed-Wetting in Children?

All children wet the bed and have “accidents” at some point during toilet training. This is a normal, expected part of the learning process. In general, bed-wetting may occur even after your child is toilet trained, which usually takes place between the ages of 2 and 4.

Even after toilet training has been successful, bed-wetting may occur up to two or three times a week. It may gradually become less prevalent and then will eventually disappear, often at around the age of 5. But since every child is different, your child may or may not fall within this age range.

Bed-wetting can continue for some children after this age. Statistically, bed-wetting affects 1 out of 4 children at 5 years old, 1 out of 5 children at 7 years old, and 1 out of 20 children at 10 years old. Bed-wetting is more common in boys than girls. And, bed-wetting is hereditary, usually passed down through the father.

Bed-Wetting (Nocturnal Enuresis) Causes

Bed-wetting isn’t fully understood by medical professionals, but in general it’s believed that it takes time for children to develop bladder control at night. This involves controlling the nervous and muscular systems in order to subconsciously suppress the sensation of a full bladder. So, bed-wetting isn’t something any child can willingly stop.

Here are some reasons your child may be wetting the bed:

• They are a deep sleeper and have trouble awakening when their bladder is full

• Their bladder is small or hasn’t developed sufficiently to hold urine for an entire night

• They may not have yet learned how to hold and empty their bladder (the communication between the brain and bladder may still be developing)

• They produce too much urine at night due to a lack of the antidiuretic hormone, which slows urine production at night

• Constipation may be putting pressure on their bladder, leading to bed-wetting

• Being overly tired

• A medical problem like diabetes mellitus or a urinary tract infection

• Emotional distress caused by an upsetting incident or major life change or stress, such as a new sibling, a move, or divorce

• There’s a family history of bed-wetting

• If your child suffers from sleep apnea, in which their breathing is interrupted during sleep, they may be more likely to wet the bed

• If your child has attention-deficit/hyperactivity disorder (ADHD), they are more likely to wet the bed.

Solutions for Managing Bed-Wetting With Your Child

If and when your child wets the bed, it’s best not to make a big issue out of it. Respond in a calm, low-key manner, and know that your child isn’t wetting the bed on purpose.

Here are 10 tips for managing bed-wetting with your child:

1. Don’t punish or blame them

2. Help them feel less embarrassed or ashamed after the incident by reassuring them that accidents happen. Explain that bed-wetting isn’t their fault, that it happens to all children, and that it will go away in time

3. If bed-wetting runs in the family (for example, if a sibling or a parent has been a frequent bed-wetter), let your child know in order to make the situation feel more relatable

4. Consider putting your child back in training pants or using a plastic cover over their mattress to make cleanup after a bed-wetting incident easier

5. Consider letting your child help change the sheets after a bed-wetting incident; however, if they interpret this as punishment, don’t force it

6. Establish a no-teasing rule with other siblings

7. Pay attention to your child’s urine and bowel movements throughout the day

8. Encourage your child to use the toilet before their bedtime routine and just before falling asleep; and have them avoid drinking a lot of liquid

9. Wake your child up a couple hours after going to sleep and encourage them to use the toilet

10. Reward your child for dry nights with positive reinforcement and offer loving support after wet nights.

Signs That May Indicate It’s More Than Just Bed-Wetting

If your child still has frequent bed-wetting occurrences six months to a year after toilet training, it may be related to a medical condition.

If you notice any of the following signs in your toilet-trained child, consult their healthcare provider:

• Wet underwear, pajamas, and bed sheets even when your child uses the toilet on a regular basis

• A change in urination frequency or the amount of urine produced

• Straining, pain, or burning sensations during urination

• A narrow/small stream of urine or dribbling after urination

• Pink or cloudy urine, blood stains in their underwear or pajamas

• A red rash in the genital area

• Hiding wet underwear

• Urinating after coughing, running, or lifting

• Wetting during the day and at night

• A sudden change in mood or personality

• Poor control over bowel movements

• Problems with walking, such as an off-balance gait, which may indicate neurological problems.

Seeing Your Child’s Healthcare Provider About Bed-Wetting

If your child older than 5 years old is still experiencing bed-wetting episodes even after trying the different methods mentioned above, consult their healthcare provider for guidance. The provider may ask you questions about the bed-wetting incidents to determine if the bed-wetting is related to stress, a family history of bed-wetting, drinking too much fluid or eating salty food, or if there’s anything unusual about your child’s urine.

Medical Tests for Bed-Wetting (Nocturnal Enuresis)

In some cases, your child’s healthcare provider may want to run tests to see if there’s an underlying cause for the bed-wetting.

If the provider suspects a urinary tract infection, the provider may order tests to check your child’s urine. The provider may prescribe antibiotics.

To rule out an abnormality in your child’s bladder or kidneys, the provider may order X-rays of your child’s bladder and/or ultrasound of their kidneys.

Treatment for Bed-Wetting (Nocturnal Enuresis)

In some cases, the healthcare provider may recommend simple home treatment for your child, such as discouraging them from drinking liquid two hours before bedtime. If constipation is an issue, the provider may recommend treatment for that.

Bed-Wetting Alarm

There’s another option that may help your child if they’re still wetting the bed after one to three months of no success: a bed-wetting alarm. Your child’s provider may recommend using this device, which includes a moisture-sensing pad that goes on either the bedding or your child’s pajamas.

The bed-wetting alarm works by awakening your child as soon as it senses wetness. However, the device isn’t foolproof; many children sleep right through the alarm. You, as the parent, may need to step in and wake up your child when you hear the alarm.

When used according to the provider’s instructions, the bed-wetting alarm may help condition your child to wake up when they need to use the toilet. It works for more than half of the children using it, but it may take at least four months of use to reach success.

Medications

Oral medications prescribed by the healthcare provider are also a possibility for older children; these work in about half to two-thirds of children who use them. Side effects are rare, but relapse rates are high. However, these medications may come in handy when used occasionally for specific situations, such as sleepovers and summer camp.

The Bottom Line

Bed-wetting has happened to just about everyone—even you when you were a child! It isn’t uncommon for children between 2 and 4 years old to experience bed-wetting during daytime and nighttime toilet training. Most children outgrow bed-wetting around the age of 5, but for some bed-wetting may continue.

There are many reasons why your child may be wetting the bed, some of them having to do with a developing bladder, an inability to hold urine at night, or an overproduction of urine in the evening. Sometimes a medical condition could be the cause. Children who have sleep apnea or ADHD are more likely to wet the bed. Bed-wetting can also be hereditary.

If your child does wet the bed, instead of punishing them, reassure them that it was just an accident, and that it has happened to everyone. To make future incidents less messy, you might consider putting your child in training pants and/or using a mattress cover. Before putting your child to bed, encourage them to use the toilet, and see that they drink less liquid in the evening.

If you’re concerned about your child’s bed-wetting, consult their healthcare provider for guidance. Tests may indicate that the bed-wetting is due to a medical condition. The provider may also decide to prescribe medicine to help, or recommend the use of a bed-wetting alarm to help condition your child to hold their urine. Rest assured that sooner or later every child will outgrow bed-wetting.

_{How we wrote this article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}