Bed-Wetting: What Is Normal and When to Worry

Once your child is ready for night training, to curb bed-wetting, make sure to have a good routine in place. This should include a consistent bedtime. After bath and stories, have your child get out of bed and go to the bathroom

MILLIONS OF CHILDREN struggle with bed-wetting. As a pediatrician, I understand the stress and frustration that bed-wetting can have on families. For some kids, wetting the bed can be embarrassing and upsetting; they get anxious about sleepovers and special events away from home. On the other hand, some kids don’t care they wet, but their parents don’t like the mess, the daily cleanup process or the continued expense of diapers. Either way, families often come to my office to find solutions.

The first thing I tell families is that it’s normal for a child to wet the bed well into elementary school. Trying to train a child to be dry at night when they are too young can cause more frustration, shame and anxiety. For some perspective, about 20 percent of a kindergarten class is still routinely wetting the bed, 7 percent of kids in elementary school wet the bed at least once per week, and 1 in every 100 teens still wets the bed. Letting your child know that there are lots of other kids who also wet the bed can diffuse worry and calm fears. For most kids, bed-wetting is cured with time.

Despite the common suggestions to limit fluids before bed or to drag your sleeping child to the bathroom before you go to bed, these “tricks” avoid dirty laundry without working on the real cause of night wetting. Wetting is caused by an immature brain-bladder connection, which is required to cue your body to wake up and pee. This immature connection is often complicated by the fact that kids’ bladders are physically too small to hold the amount of pee their body makes at night, setting them up to leak while sleeping. We also know that bed-wetting is genetic. Often a bed-wetting child has a parent, aunt, uncle or sibling who wet the bed. Bed-wetting can also be caused by stress or change. A new baby, a move or another transition in the family may be enough to see some night accidents.

Before I encourage my families to work on night training, I confirm that three things are true. First, your child should be at least 8 years old, even better if she has had a few dry nights in the past or if the volume of the wetting accidents is starting to decline. Second, your child needs to care about the wetting. If he doesn’t care that he wets at night, he will have no motivation for success. Finally, there shouldn’t be any signs of medical reasons for the night wetting. Specifically, the child has never had consecutive months of dryness, pain during or after peeing, snoring or increased hunger or thirst. Kids with these symptoms may need lab testing or a specialist referral before working on night dryness.

Once your child is ready to train, put a good nighttime routine in place. This should include a consistent bedtime. After bath and stories, have your child get out of bed and go to the bathroom. Make sure the path to the bathroom is free of clutter and well lit. Secondly, carefully monitor your child’s pooping habits. Constipation is sneaky and can sabotage success. A big poop can place pressure on the bladder, limiting the ability for it to fill adequately. This effectively makes the bladder smaller and more likely to overflow at night. Also, talk about the process. Having your child say, “I have to pee, I have to get up” may sound silly. Verbalizing the plan, however, is a significant first step in triggering the brain-bladder connection that you want to encourage.

The most effective means for training the brain-bladder connection involves using a bed-wetting alarm. These inexpensive devices, which rely on a moisture sensor, are placed in the bed or worn in the underwear to alert your child of wetness. As soon as your child leaks urine, the alarm will go off (vibration or sound). That is the trigger to get out of bed to go to the bathroom. For kids who are deep sleepers, this may take additional effort from a parent to assist them in waking when the alarm goes off. Use of this technique is often the quickest route to long-term success, achieving dry nights in the majority of kids over age 7 within 12 weeks.

The bottom line is that the most common cure for bed-wetting is time. As kids get older, the brain-bladder connection naturally matures. As each year passes, more and more kids will have dry nights without any interventions at all. If you have worries about your child’s health or your child is expressing concern about wet nights, please talk with your child’s doctor, who I’m sure would be happy to help.

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