The first time a child stays dry all night is cause for celebration in most homes. It’s a step toward being fully potty-trained, no longer dependent on diapers or training pants.
That doesn’t mean, of course, that the child will then have perfect control.
“It’s normal for children to have bed-wetting accidents, even until age 6 or 7,” says UNC Health family medicine physician Sarah Ruff, MD.
About 20 percent of children wet the bed at age 5, and up to 10 percent still do by age 7. Nighttime bed-wetting is more common in boys than girls.
There are two types of bed-wetting: primary enuresis, in which the child has never had bladder control at night, and secondary enuresis, when the child has had bladder control at night for at least six months, then starts wetting the bed. Secondary enuresis should be evaluated by a doctor, Dr. Ruff says, but primary enuresis is much more common and may not need treatment.
Primary enuresis usually occurs because it takes a while for the connection between the bladder and the brain to develop, especially if the child sleeps deeply, she says. Often, there is a family history of bed-wetting, and children are likely to stop about the same age their relatives did. Other significant contributors to bed-wetting include constipation, bladder overactivity, sleep apnea and low levels of an anti-diuretic hormone that signals the kidneys to make less urine at night.
Normal though it may be, parents and kids usually want to get past bed-wetting. Fear of wetting the bed could keep kids from all kinds of fun, like sleepovers, camping and traveling. And wet sheets and mattresses disturb sleep for everyone.
Tips for Overcoming Bed-Wetting
Dr. Ruff offers suggestions for parents who want to help their children stop wetting the bed.
- Let them know that other children wet the bed, too, and that kids outgrow it. Stress over wetting the bed will only worsen the problem.
- Invest in a good mattress pad to make cleaning up easier. Being prepared also reduces stress on both parents and children.
- Limit liquids after dinnertime. “You want your child to stay hydrated,” Dr. Ruff says, “but try to hydrate earlier in the day.”
- Avoid caffeine, which can irritate the bladder.
- Always have your child go to the bathroom before bed, even if they say they don’t need to. “Some parents also wake their child up before the parents go to bed and get them to pee again,” Dr. Ruff says. She doesn’t recommend doing this for very long, however, because it could delay the child’s learning to wake up when they need to pee.
- Put a portable potty beside the child’s bed. “If they start to pee and wake themselves up, they may not be able to make it down the hall to the bathroom,” she says. A potty close by could be a temporary solution.
- Get the child to help change the sheets. “This is not punishment,” Dr. Ruff says. “But it seems to help to have them involved in the process. It makes them more aware of what happens when they wet the bed.”
- Set a mutual goal for successful potty training. “There should be an expectation that the child is going to eventually wake up when they need to pee,” she says. “Allowing your child to rely on pull-up diapers with no expectation that they will be dry could impede the normal development of pathways that make a child wake up.”
- Consider a bed-wetting alarm for children age 8 or older. The alarm goes off when it senses wetness in the child’s underwear, awakening the child so they can get to the bathroom.
- Ask your pediatrician about biofeedback, which has been shown to be effective at increasing bladder capacity in children by helping them retrain their pelvic floor muscles to allow them to completely void their bladder when they go to the bathroom.
Things to Avoid if Your Child Wets the Bed
Don’t punish or shame your child for wetting the bed, Dr. Ruff says.
“Shame does not help a child learn,” she says. “You want to try to help them get through this. Stress adds to the problem.”
Don’t reward them if they stay dry, either, she says.
“Rewarding them makes it seem like they have a choice of whether or not to wake up,” she says. “Rewards might help potty training during the day, but I don’t recommend it for nighttime.”
Bed-Wetting Can Be a Sign of a Bigger Problem
If your child has had bladder control at night for six months or more, then starts wetting the bed—secondary enuresis—it’s time to talk to your pediatrician. New bed-wetting can have emotional or medical causes.
“There are multiple emotional or life-changing events, such as a new school, that can trigger new nighttime wetting,” says UNC pediatric urologist Richard Sutherland, MD. “If bed-wetting had ended, then starts again at age 7 or older, then that’s a new problem and definitely should be discussed with a pediatrician.”
Frequent urination is often the first sign of type 1 diabetes in children and could also indicate a urinary tract infection, which should be treated promptly, Dr. Ruff says. “Or there could be something scaring them at night.”
Parents don’t have to figure this out on their own, Dr. Sutherland says. “Your pediatrician will consider the complexity of the patient’s symptoms. Cases that may be more difficult to treat or need a higher level of care will be referred to a urologist.”
If you are concerned about your child’s bed-wetting, or if they have been dry for six months or longer and start wetting the bed again, call your doctor or find one near you.