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Nocturnal enuresis, or bed wetting at night, is a common problem for children. Most of the time, children will be dry during the day by 4 years of age. Children are not expected to be dry at night until they are between 5 and 7 years old. Some children will continue to wet the bed after this age range and that can be normal as well.
This condition is more common in boys than girls and it also runs in families. In fact, children whose parents wet the bed later into childhood are more likely to do the same. The good news is, the majority of children will outgrow this behavior as they get older.
Even though wetting the bed is a common problem, it can cause self-esteem issues and be embarrassing, especially if your child wets the bed when friends are around.
Enuresis is a typical developmental issue for children. In my Sleep Center clinic, parents usually ask me about this as their child keeps wetting the bed, especially as their child gets older. In some instances, enuresis can be associated with sleep apnea. It can also occur more if your child is overly tired.
Why do children wet the bed?
We do not fully understand why children wet the bed at night. We believe it has to do with the central nervous system developing over time. An important thing to remember is your child is not doing this on purpose. So, punishing your child for wetting the bed does not help correct the behavior, and it can often make it worse.
That being said, there are things you can do to make it easier when your child does wet the bed at night:
- Have your child try to use the bathroom after they wet the bed. This will reduce the chance of another accident later in the night.
- Make the clean-up easier. Keep clean pajamas and sheets close to the bed at night in case of an accident. Another method is to layer the bed. Make the bed with a waterproof sheet over the mattress, followed by regular sheets, then place another waterproof sheet on top of the regular sheets, followed again by another set of regular sheets. This way, if your child wets the bed, you can just take off the wet sheets and get your child back to bed without having to completely remake the bed at night.
- Allow your child to help clean up in the morning by helping with the laundry.
In treating bed wetting, there are several options. Some families just need to hear that it is often normal for children to wet the bed until they are older and it will resolve with time. For children between the ages of 5 and 7 who do not wet the bed every night, motivational strategies can be helpful.
I recommend using a sticker chart with rewards set for specific behaviors they can control, such as remembering to use the bathroom before going to bed. Keeping a calendar to mark dry nights can also be helpful to track progress. I recommend using this method for 3-6 months.
Also minimize, but do not completely restrict, drinking after 5 p.m. Avoid drinks that are high in sugar or caffeine (such as soft drinks) as they can make wetting the bed more frequent.
These can also be effective in helping children stop wetting the bed at night. Enuresis alarms work best in children 7 years of age and older. It’s important to note, children have to want to stop wetting the bed on their own for the alarms to work. These alarms shake and make an audible noise when they get wet. They can be placed under the child as a pad or in the underwear, depending on the type of alarm.
At the beginning of the night, your child should place the alarm themselves and test it. It’s important for them to practice what they will do when the alarm goes off if/when they wet the bed. This should involve them turning the alarm off and using the restroom. They should then help change the bed and their pajamas. Your child should wipe down the alarm with a wet cloth followed by a dry one, then reset it before going back to bed.
These alarms work through behavioral conditioning and are likely the best intervention in getting children to stop wetting the bed. Use of the alarms usually work in 3-4 months. After your child is dry for 14 days, you can stop using the alarm. However, the alarms are not for every child and about 1 out of 3 children and families will stop using the alarms at night.
Finally, medications can be used to help treat bed wetting. Desmopressin can be used to help your child’s body not make as much urine overnight. This is usually a short term solution if a child is spending the night at a friend’s house or going off to camp. Once the medication is stopped, the body will again start making more urine and the bed wetting can return. Usually, the child will take a pill by mouth about one hour before bed. In order to get desmopressin, you will need to talk with your doctor.
When should I be concerned?
Wetting the bed can be cause for concern. You should bring it to the attention of your child’s doctor if your child does any of the following: goes to the bathroom more than usual, drinks more than usual, says it hurts when they urinate, is losing weight, starts wetting the bed again after being dry for six months, or has swelling of their feet or ankles.
Remember, wetting the bed is a common problem for children. Often it will go away with time after the central nervous system matures. Wetting the bed is not your child’s fault or your own and punishments will only make the problem worse. There are things you can do to help your child stop wetting the bed. You can always discuss this problem with your pediatrician to see what method would work best for you and your child.