Your child may wet the bed every now and then. While it's usually not a big deal, it can be frustrating for both you and your kid. Here's some more information about the types of bedwetting, why it happens, and when to see a doctor.
What Is Bedwetting?
Bedwetting, or nocturnal enuresis, happens when someone accidentally pees while sleeping. It's common in kids, even if they've been toilet trained. Your child will likely stop wetting the bed around 4 to 6 years old.
While bedwetting can be a symptom of an underlying disease, most children who wet the bed have no underlying disease that explains their bedwetting. An underlying condition is found in only about 1% of children who routinely wet the bed.
That does not mean that a child who wets the bed can control it or is doing it on purpose. They are not lazy, willful, or behaving badly. Bedwetting is most often a developmental issue. Most kids simply outgrow it and never need treatment.
It's not a serious condition, but it can cause your child to feel embarrassed or upset. In some cases, they may even avoid activities, like sleepovers, out of fear that they'll wet the bed.
Types of Bedwetting
There are 2 types of bedwetting:
Primary bedwetting. Primary means bedwetting that has been going on since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time.
Secondary bedwetting. Secondary bedwetting is bedwetting that starts after the child has been dry at night for a significant period of time, at least 6 months.
Causes of Bedwetting
Primary bedwetting causes
The cause is likely due to one or a combination of the following:
- The child cannot yet hold urine for the entire night.
- The child does not wake up when their bladder is full.
- The child makes a large amount of urine during the evening and night hours.
- The child has poor daytime toilet habits. Many children habitually ignore the urge to pee and put off peeing as long as they possibly can. Parents usually are familiar with the leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back pee.
Secondary bedwetting causes
Secondary bedwetting can be a sign of an underlying medical or emotional problem. A child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting. Common causes of secondary bedwetting include the following:
- Urinary tract infection. The resulting bladder irritation can cause pain or irritation with peeing, a stronger urge to pee (urgency), and frequent peeing (frequency). Urinary tract infections in children may indicate another problem, such as an anatomical abnormality.
- Diabetes. People with diabetes have a high level of sugar in their blood. The body makes more urine to try to get rid of the sugar. Having to pee often is a common symptom of diabetes.
- Structural or anatomical abnormality. An abnormality in the organs, muscles, or nerves involved in peeing can cause incontinence or other urinary problems that could show up as bedwetting.
- Sleep apnea. When your child’s breathing is disrupted, their brain works harder to take in oxygen than it does on other functions, like bladder control. Sleep apnea in children is often caused by enlarged tonsils and adenoids blocking their airway. In that case, removing their tonsils and adenoids can improve their breathing and end the bedwetting.
- Neurological problems. Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls peeing.
- Emotional problems. A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting. Children who are being physically or sexually abused sometimes begin bedwetting.
ADHD and Bedwetting
Bedwetting is quite common in children who have attention deficit hyperactivity disorder (ADHD). Kids with ADHD are three times as likely to have trouble with bedwetting than those who don't.
Experts aren't sure why ADHD is linked to bedwetting. But some people think it's because both things are related to a delay in the development of someone's central nervous system.
Children with ADHD also have a harder time paying attention to bodily cues. This means that they might not wake up at all or not wake up enough at night to notice they have to pee.
A review found that a few things might put your child at risk of bedwetting if they have ADHD. These include:
- Being assigned male at birth
- A low birth weight
- Having parents with a lower educational level
- Having a family history of bedwetting
- Having sepsis as a newborn
- Being delivered via cesarean section or C-section
Autism and Bedwetting
If your child has autism spectrum disorder (ASD), they might also be more likely to wet the bed. But experts still need to do more research to discover why ASD is linked to bedwetting.
One case study looked at how a 12-year-old girl with autism would react to bedwetting treatment. She wore a urine alarm at night and was rewarded for morning dryness.
Experts found that this form of treatment lowered the number of bedwetting events within 2 weeks. By 3 weeks of treatment, bedwetting stopped.
Is Bedwetting Inherited?
Bedwetting does tend to run in families. Many children who wet the bed have a parent who did too. Most of these children stop bedwetting on their own at about the same age their parent did.
How Common Is Bedwetting in Children?
About 40% of 3-year-olds wet the bed. Experts don't fully understand why one child continues to wet the bed and another doesn't. It could be a matter of development. Sometimes a child's bladder is simply not developed enough to store pee for an entire night. Sometimes a child has not yet mastered the ability to know when the bladder is full, wake themselves up, and get to the bathroom.
What's "Normal" When It Comes to Bedwetting?
The range is very wide regarding bedwetting. Typically, a child becomes toilet trained between ages 2 and 4. But some won't be able to stay dry through the night until they are older. By age 5 or 6, 85% of children can stay dry, but some children still wet the bed from time to time until age 10 or 12.
Sometimes a child who has been dry at night will begin to wet the bed again. This may be triggered by family stress or school problems. As a child's systems mature, they are less likely to wet at night. By the teen years or much earlier, almost all kids who wet their bed have outgrown the problem, with only 1% or less still having issues.
Most children of school age who wet the bed at night have what doctors call "primary enuresis." They have never had nighttime control of their bladder. Family history plays a role, too, in incontinence in children. If you wet the bed as a child, don't be surprised if your child does, too.
How Does Bedwetting Affect a Person’s Mental Health?
It's normal to feel embarrassed about bedwetting, but know that it's common. If you're an older child or an adult, your bedwetting may be a sign that your body isn't working as it should be. While it might be hard to bring bedwetting up to your doctor, they may be able to help you. Whether you're wetting the bed or your child is, a doctor can help you figure out the next steps.
When Should We Talk to the Pediatrician About Bedwetting?
If your child has been dry and then starts to wet the bed, tell your pediatrician right away. Your child's doctor can check them to be sure the problem isn't stress related or due to an underlying medical condition. That likelihood is small. Only 1% of all bedwetting problems are thought to be caused by diabetes, infections, abnormalities of the bladder or kidney, or another medical condition. If your child has any symptoms that are not common, such as burning while peeing or passing bloody urine, talk to the doctor right away.
Managing bedwetting at home
There are steps you can take at home to help your child stop wetting the bed. Some ways include to:
Avoid blaming them. If you feel angry or frustrated because you have a wet bed to clean up yet again, don’t direct your feelings toward your child. They likely feel bad about it, and they didn’t do it on purpose. So don’t blame.
Make sure your child knows that bedwetting isn’t their fault and they aren’t alone. Let them know that millions of children, and teenagers too, regularly wet their beds. Tell your child if you did it too when you were growing up. You can help them see that it’s a problem that they will outgrow.
Keep your other children from teasing them. If you have other children, let them know not to tease about bedwetting. You can make this a rule in your house.
Help them try to use the bathroom before bedtime and during the night. Have your child use the bathroom when they start to get ready for bed, then once again the minute before they get into bed. This helps to empty their bladder.
If you’re still awake an hour or two after your child’s bedtime, think about waking them for a quick bathroom visit (or if your child is older, they might be able to set this habit for themselves). It won’t stop bedwetting, but it can reduce the amount of pee that might end up in the bed.
If your child is afraid of the dark, put night lights in the hallway and the bathroom so they won’t hesitate to get up and go when the urge wakes them.
Use an alarm. Some kids wet the bed because their bodies don’t yet tell them to wake up when their bladders are full. Bedwetting alarms wake children at the first sign that they’re letting go of pee and train the body to notice what it feels like when the bladder is full. The child wears special underwear with sensors that beep loudly when a small amount of urine leaks out. The beeping wakes them, and then they can go to the bathroom.
In the first few weeks of use, however, it is usually a parent who is awakened by the alarm and then wakes the child to use the bathroom. If the alarm is used nightly and the wake-up routine is continued, your child will likely begin to wake up to the alarm within 4 to 6 weeks. Within 12 weeks, your child will likely be getting up on their own to go to the bathroom or hold their pee until morning.
These alarms are among the most effective and safest bed-wetting treatments. Studies show alarm therapy is often successful with children over age 7.
Drink less water before bedtime. Some kids who worry that they’ll wet the bed don’t drink enough during the day. By evening, they’re so thirsty, they drink a lot.
Help your child to drink more during the day, and let them have only one drink with dinner.
Stay away from drinks with caffeine, including cola and iced tea. Caffeine makes the body speed up the pee-making process. Fizzy drinks can also cause problems, so be sure to have your child avoid soda.
Use covers that protect their bed. Use a zip-up waterproof mattress cover so pee won’t reach the mattress. There are also waterproof pads to go between the sheets and blanket. After a wet night, you’ll only have to wash the pad, not the bed sheets.
Medical treatment for bedwetting
In some cases, you may need medication to help with bedwetting. There are different types that can help, including:
Drugs that change how much pee is made at night. A medication called desmopressin (DDAVP) will lower the amount of pee your body makes at night. It's a tablet taken by mouth that's only for children 6 and older. Avoid drinking too much liquid with these drugs though, because it can lead to issues like headaches and dizziness. Make sure you don't use this drug if your child has a fever, nausea, or diarrhea.
Medicines that calm the bladder. Anticholinergic drugs, like oxybutynin (Ditropan XL), can help with having fewer bladder contractions and allow the bladder to hold more pee. This type of drug can be helpful for people who also have daytime wetting. But it's usually only used when different treatments haven't worked.
There are more drugs that can help based on the reasons for bedwetting. In some cases, you'll have to use multiple medicines. Just know that once you stop the medication, bedwetting will start again. Medications may not help everyone because they don't cure the problem.
Beware of devices or other treatments that promise a quick "cure" for bedwetting. There really is no such thing. Stopping bedwetting for most children takes patience, motivation, and time.
How Can I Help My Child During Bedwetting Treatment?
Let your child know that bedwetting in children is common. It's nothing to be ashamed of and almost all children outgrow it with time. Make sure siblings understand this as well. Don't let them tease the bedwetter.
When to Call the Doctor
Parents should consider treatment if their child is still wetting the bed between ages 6 and 7, according to the National Enuresis Society -- or sooner if the child seems troubled by bedwetting. In addition, no matter the age, if you notice other symptoms, such as if your child has the urge to pee more often or has a burning sensation when they pee, see a doctor right away.