Bed-Wetting in Children

Condition Basics

What is bed-wetting?

Bed-wetting is accidental urination during sleep. Children learn bladder control at different ages. Children younger than 4 often wet their beds or clothes because they can't yet control their bladders. But by age 5 or 6, most children can stay dry through the night.

In some cases, the child has been wetting the bed all along. But bed-wetting can also start after a child has been dry at night for a long time.

What causes it?

Children don't wet the bed on purpose. Most likely, a child wets the bed for one or more reasons, such as having a small or overactive bladder, constipation, having too little of a certain hormone, or having emotional or social problems. An infection may also cause bed-wetting.

What are the symptoms?

There are often no other symptoms besides wetting the bed. If a child cries or has pain when urinating or has strong urges to urinate, bed-wetting may be a symptom of another medical condition. Call the doctor if your child has any of these symptoms.

How is it diagnosed?

Any child older than age 5 or 6 who keeps wetting the bed may need to be checked by a doctor. A medical history and physical exam are used to diagnose bed-wetting. A urinalysis may also be done.

How is bed-wetting treated?

Treatment usually isn't needed for bed-wetting in children ages 7 and younger. Most children this age will learn to control their bladder without treatment. But treatment may help children older than 7 who wet the bed. Treatments include a praise and reward system, a moisture alarm, and medicine.

What can you do to help your child?

Help your child understand that bladder control will get easier as your child gets older.

Here are some other tips that may help your child:

• Give your child most of the day's fluids in the morning and afternoon.
• Have your child avoid sugary drinks and caffeine, such as from chocolate or colas.
• Have your child use the toilet before going to bed.
• Let your child help solve the problem, if your child is older than 4. Your child can help decide which treatments to try.
• Encourage your child by praising successes.

Cause

Children don't wet the bed on purpose. Most likely, a child wets the bed for one or more reasons, such as:

Delayed development.

Children whose nervous system is still forming may not be able to know when their bladder is full.

A small or overactive bladder.

Some children may have a bladder that gets full quickly.

Constipation.

Pressure on the bladder from constipation can make it hard for the bladder to hold urine.

Deep sleeping.

Many children who wet the bed sleep so deeply that they don't wake up to use the bathroom.

Too little antidiuretic hormone.

This hormone level normally rises at night to tell the kidneys to release less water.

Family history.

Children are more likely to wet the bed if a parent wet the bed as a child.

Emotional or social factors.

Children may be more likely to wet the bed if they have some stress.

Children who wet the bed after having had dry nights for 6 or more months may have a medical problem, like a bladder infection.

Symptoms

There are often no other symptoms besides wetting the bed.

A child may have other symptoms too, such as crying or complaining of pain when urinating, sudden strong urges to urinate, or increased thirst. In that case, bed-wetting may be a symptom of some other medical condition. Call the doctor if your child has any of these symptoms.

What Happens

Children may wet the bed several times during the night, and they may not wake up after wetting.

Children grow and develop at different rates, and bladder control is achieved at an individual pace. Bed-wetting that continues past the age that most children have nighttime bladder control will usually stop over time without treatment.

When to Call a Doctor

Call your doctor now or seek immediate medical care if:

• Your child has symptoms of a urinary infection. For example:
  • Your child has blood or pus in his or her urine.
  • Your child has back pain just below the rib cage. This is called flank pain.
  • Your child has a fever, chills, or body aches.
  • It hurts your child to urinate.
  • Your child has groin or belly pain.
• Your child is older than 4 years and is wetting the bed and leaking stool at night.

Watch closely for changes in your child's health, and be sure to contact your doctor if:

• The treatments you are trying have not helped after 3 months, and the bed-wetting is causing your child problems at school or with family and friends.
• Your child does not get better as expected.

Exams and Tests

Any child older than age 5 or 6 who keeps wetting the bed may need to be checked by a doctor. The checkup should include a urinalysis.

A medical history and a physical exam are also part of a medical evaluation of bed-wetting. If you are having your child assessed for bed-wetting, keep a diary for a week or two before your visit. Write down when wettings occur and how much urine is released.

In some cases, a urine culture may be done to find out if your child has a bladder or kidney infection.

If a child has uncontrollable wetting both at night and in the day, other tests may be needed.

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Treatment Overview

Most children gain bladder control over time without any treatment. Bed-wetting that continues past the age that most children have nighttime bladder control—typically at 5 or 6 years of age—also will usually stop over time without treatment. If not, home treatment may be all that's needed to help a child stop wetting the bed.

If home treatment doesn't work, if the child and parents need help, or if the bed-wetting may be caused by a medical problem, medical treatment may be helpful. With treatment, your child may wet the bed less often or may wake up to use the toilet more often.

Treatment for bed-wetting is based on the:

Child's age.

Some treatments work better than others for children of a specific age group.

Child's and parents' attitudes about the bed-wetting.

If gaining bladder control is seen as a normal process, it's usually easier for the child to stop wetting the bed.

Home situation.

If the child shares a bedroom with other children, certain techniques to arouse the child, such as some moisture alarms, may not be practical.

Treatment may help if bed-wetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with peers.

Treatment options

Treatment for bed-wetting usually isn't a cure. The goal is to reduce the number of times the child wets the bed and to manage the wetting until it goes away on its own. Treatment may include:

Motivational therapy.

With this method, parents encourage and reinforce a child's sense of control over bed-wetting.

Moisture alarms.

These alarms detect wetness in the child's underpants during sleep. They sound an alarm to wake the child.

Desmopressin and tricyclic antidepressants.

These medicines increase the amount of urine that the bladder can hold or decrease the amount of urine released by the kidneys.

Other Treatment

You may hear of other ways to help children who wet the bed. But not all of these treatments have good evidence that they help. Talk to your doctor before you spend time and money on these other treatments. Ask about the risks and benefits. Examples include:

• Acupuncture .
• Bladder-stretching exercises that teach the child to hold urine for longer periods of time.
• Dry-bed training, which consists of following a strict schedule for waking the child up at night until he or she learns to wake up alone when needed.
• Hypnosis.
• Waking your child and taking him or her to the toilet a few times each night, or having your older child wake himself or herself a few times each night to use the toilet.

It's not a good idea to have your child wear diapers or pull-ups at night on a regular basis. Using diapers can get in the way of proven treatments (such as motivational therapy and moisture alarms) that require a child to get up at night.

Counseling (psychotherapy) may be helpful for the child who has secondary enuresis or for bed-wetting that is caused by emotional stress. Psychotherapy involves talking with a trained counselor. The counselor helps the child identify and deal with the stress that may be causing the bed-wettings. The goal is to reduce or help manage the stress or to prevent stress from occurring.

Some children who finish a treatment and have dry nights for a while will start to wet the bed again. Repeating treatment, especially with a moisture alarm, usually helps bring back dry nights.

Treatment may be helpful if bed-wetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with peers.

Treatment by age

The best solution may be a combination of treatments. Below are some suggestions for treatment options according to the age of your child.

Ages 5 to 8.

Help your child understand that wetting the bed is a normal part of growing up. Encouragement and praise may be all that is needed to help your child wake up before wetting. Praise and reward your child for the steps he or she takes to have dry nights. And have your child take an active role in cleaning up after wetting.

Ages 8 to 11.

If your child still wets the bed, a moisture alarm may help. Also, a medicine such as desmopressin can be helpful for occasional overnight events such as camp or sleepovers.

Ages 12 and older.

There can be major emotional effects if a child still wets the bed at this age, so treatment can be more aggressive. If consistent use of moisture alarms doesn't work, the doctor may suggest medicine, counseling, or both.

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Self-Care

Most children gain bladder control over time without any treatment. A child should first be allowed to overcome bed-wetting on his or her own. But there are things you can do to help manage your child's bed-wetting.

• Monitor your child's consumption of liquids.

  As a rule of thumb, children should be encouraged to consume 40% of their total daily liquids in the morning, 40% in the afternoon, and 20% in the evening. Talk with the doctor about how much fluid your child needs.

• Have your child avoid sugary drinks and caffeine.

  Foods such as chocolate and beverages such as colas and tea may contain caffeine.

• Have your child use the toilet before going to bed.
• Remind your child to get up during the night to go to the bathroom.

  It may help to keep a night-light near or potty chair beside the bed.

• Let your child help solve the problem, if he or she is older than 4.
• Praise and reward your child for taking steps to have more dry nights.

  Involve your child in planning the reward system. You may want to use a calendar and put stars or stickers on the days that your child does not wet the bed. You know your child. If you think a reward system will help your child, then try it. If you think it may make your child feel worse, then do not use a reward system.

• Encourage your child to take responsibility for changing clothes and linens after a bed-wetting accident.

  For example, use washable sleeping bags as bedding so your child can easily replace one that is wet with one that is dry.

• Add 0.5 cup (125 mL) of vinegar to the wash water to get rid of the urine odor in clothing and bed linens.

If your child wets the bed, don't blame yourself or the other parent. Don't punish, blame, or embarrass your child. Your child is neither consciously nor unconsciously choosing to wet the bed. Give your child understanding, encouragement, love, and positive support.

• Be patient about changing the bed linens. Don't act offended by the smell of urine.
• Do not wake the child up at different times during the night to go to the bathroom unless it is part of a systematic treatment that the child has agreed to.
• Do not make the child feel bad. Shaming or punishing the child may make the problem worse.
• If you think your child may be feeling emotional stress, talk with a health professional about whether counseling may be helpful.

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Medicines

Medicines that either increase the amount of urine that the bladder can hold (bladder capacity) or decrease the amount of urine released by the kidneys may be used to treat bed-wetting. These prescription medicines may be used to control bed-wetting for a little while. They don't completely stop it.

• Medicines work well to control accidental wetting for short periods of time, such as when children are on overnight trips or at camp.
• Your doctor may suggest them for bed-wetting that is related to a stressful event, such as divorce or the birth of a sibling.
• Sometimes medicines are used along with other treatments or for children who have not been able to control bed-wetting with other treatments. Medicines can help to encourage and motivate a child who is having trouble with other treatments by letting the child feel what it is like to have dry nights.