Bedwetting is a common but often misunderstood part of childhood. Many parents worry when their child continues to wet the bed past a certain age. When is bedwetting normal? Do children outgrow this? What can I do to help my child? It’s crucial to know what’s typical, why bedwetting happens, management strategies, and when to seek further evaluation.
What is bedwetting?
Bedwetting, also known as nocturnal enuresis, is the involuntary release of urine during sleep in a child who is fully potty-trained during the day and is older than five. After age five, bedwetting becomes less common, but it’s important to note that this condition affects more children than you might think. Approximately 10-15% of 7-year-olds and about 1-2% of 15-year-olds experience nighttime wetting.
Bedwetting tends to be more prevalent in boys, and genetics may also play a role— if one or both of your parents wet the bed after age five, their children have a 40-70% chance of experiencing it, too.
What causes bedwetting?
Bedwetting can be divided into two categories: primary and secondary enuresis.
Primary enuresis occurs when a child has never had full nighttime bladder control. The root cause usually lies in delayed bladder-brain communication. Essentially, the bladder sends signals to the brain too late, resulting in accidents while the child sleeps. This developmental issue often resolves as the child matures. Children who are deep sleepers may also be more prone to bedwetting because they may not wake up in time to go to the bathroom.
Secondary enuresis occurs when a child previously had bladder control at night for at least six months but has started wetting the bed again. Medical conditions, emotional stress, or changes in routine can cause secondary bedwetting. Medical issues such as bladder or kidney disease, neurological conditions, sleep apnea, and constipation can also contribute to this problem. Additionally, stressful events like moving homes, starting a new school, or the arrival of a new sibling may trigger bedwetting.
When should you be concerned?
While bedwetting is often normal and temporary, there are times when it warrants closer attention. If your child is still wetting the bed after age five, talking to their clinician is a good idea. Here’s what to consider:
Is your child having daytime accidents? Bedwetting is usually a nighttime issue, but if accidents occur during the day as well it might indicate a medical problem.
Are there any accompanying symptoms? Be on the lookout for signs such as painful urination, excessive thirst, constipation, abnormal bowel movements, or other behavioral or developmental concerns.
Has there been a significant life change? Emotional stress or trauma may contribute to bedwetting.
Does your child snore? Snoring can indicate sleep apnea, a condition that can sometimes cause bedwetting.
Here are some red flags that warrant a discussion with your child’s doctor:
- Painful urination
- Unusual or excessive thirst
- Pink or bloody urine
- Constipation
- New swelling in the feet or ankles
- New onset of snoring
- Signs of abuse or sudden behavioral issues that are new
Your child’s clinician will evaluate their overall health and possibly recommend tests like urine, blood work, imaging studies, or referrals to specialists. The key is to understand the root cause and manage that if needed. If there are no red flags, it’s likely not medical and needs behavioral modification or time. Luckily, there are many strategies you can try at home to help manage bedwetting and support your child.
Tips for managing bedwetting
Bedwetting can be frustrating and exhausting, but there are steps you can take to manage it effectively and help your child feel more comfortable.
- Avoid the 4 C’s: Caffeine, carbonated drinks, citrus, and chocolate. Caffeine, fizzy drinks, citrus fruits, and chocolate can irritate the bladder and increase urine production, so it’s best to avoid them in the afternoon and evening.
- Encourage regular bathroom breaks. Ensure that your child stays hydrated during the day and uses the bathroom regularly. Before bed, make it a routine for your child to empty their bladder. While some parents wake their child up for a bathroom trip before the parent’s bedtime, this can disrupt sleep, so it’s a matter of personal preference.
- Use positive reinforcement. Encourage your child by framing nighttime underwear or pull-ups positively. Rather than focusing on accidents, say, “Let’s try to keep these dry tonight.” If your child does wet the bed, respond with reassurance: “It’s okay. I know you can stay dry! Let’s clean this up together.”
- Involve your child in the cleanup. Getting your child involved in changing the sheets and cleaning up helps reinforce responsibility without shame. Make it matter-of-fact, rather than punitive, and remind them that it’s a normal part of growing up.
- Consider a bedwetting alarm. For older children (around 6 or older), a bedwetting alarm can be helpful. These alarms detect moisture and sound an alert, helping train the brain to wake up when the bladder is full. While research shows that about 50% of children using alarms become dry at night after several weeks, this method requires consistent parenteral involvement to help the child fully wake up and use the bathroom. Bedwetting alarms can take up to 12 weeks to show improvement, so patience is key.
- Medications for special circumstances. If lifestyle changes and alarms aren’t effective, your child’s clinician may suggest short-term medication like Desmopressin (DDAVP). This medication can help reduce urine production during sleep and is often used for special occasions like sleepovers or camp. However, it’s important to use it cautiously, as it can affect fluid balance in the body.
Specialists: When to seek additional help
If your child continues to struggle with bedwetting and there are concerns about bladder capacity, a referral to a pediatric urologist may be appropriate. Pelvic floor therapy can also be beneficial for children with constipation or daytime urinary issues. Some parents explore chiropractic care or osteopathic manipulation, which may help improve the brain-bladder connection, but it’s essential to consult professionals experienced in pediatric care.
What not to do when addressing bedwetting
The most important rule when managing bedwetting is never to shame or punish your child. Bedwetting is involuntary, and negative reactions can increase anxiety and even prolong the issue. Instead, focus on celebrating your child’s progress and reinforcing their confidence that this phase will eventually pass.
Bedwetting is a common part of childhood development, and most children outgrow it as they get older. While it can be challenging for caregivers and children, remaining patient and positive is important. Remember, if you have concerns or are unsure about your child’s bedwetting, don’t hesitate to reach out to their pediatrician for guidance and reassurance.
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