What your pediatrician wants you to know about bedwetting

Learn how common it is, what causes it, and how to treat it.

Michael Esan, MD, a pediatrician at the Fairview clinics in Princeton and Elk River, has advice for parents concerned about their child’s bedwetting.

How common is bedwetting?

Bedwetting is the most common childhood urologic complaint. Five to seven million children under the age of 5 years old wet the bed. After age 5, 15 percent of kids still aren’t dry at night.

 
Just like a developmental milestone such as walking, there’s a range when children will be dry. For example, most children will walk between 9 months and 15 months of age. Most children will be dry at night by 5 years old. But for some kids, just like delayed walking, they could have delayed dryness. 

What causes it?

Some children just need extra time to develop control of their bladder. When you need to go to the bathroom, your bladder sends signals to your brain to wake up, because it’s full. For children who wet the bed at night, there’s often a delay in being able to process this information. They fail to recognize the sensation of a full bladder. 

Genetics also plays a role in bedwetting. It tends to run in families. Many children who wet the bed have a parent who also wet the bed. If one parent has a history of bedwetting, there’s up to a 40 percent chance that the child will also have bedwetting. If both parents have a history of bedwetting, then there’s up to a 70 percent chance of the child bedwetting.

A small number of bedwetting cases are due to medical problems, such as having a urinary tract infection, constipation, or small bladder capacity. This is found in only about 5 percent of children. 

We’re able to identify any significant medical problems through a detailed clinical history. When you and your child come into the clinic for bedwetting issues, we generally are able to rule out medical problems by simply asking questions. Most diagnoses don’t require extensive testing.

Many people think that bedwetting can be caused by stress. However, studies have shown that there are no major physiological differences between children that wet the bed and children that don’t. 

We do know that older children who wet the bed often have poor self-esteem and experience significant family stress. They may have been shamed by their parents, and as they age they experience social isolation because they can’t go to their friends’ houses for sleepovers or other events. So we know that bedwetting causes stress, but it has not been confirmed that stress causes bedwetting. 

This just means that your child has to get to the level of maturity where they want to do something about their bedwetting. They might not be bothered by it at all, and often they don’t feel guilty about it until they start missing out on things or are constantly getting scolded. 

How to treat it

Methods for tackling bedwetting depend on the age of the child and how motivated both the parent and the child are to do something about it. 

Limiting your child’s fluid intake before bed can help reduce their urine production at night and is something we recommend starting at 5 years if your child is not fully dry at night. Try to keep the consumption of liquids to a minimum one to two hours before bed. Restrict fluids that cause your child to produce more urine at night – especially dairy products and juices – and encourage your child to go to the bathroom before bedtime.

Other treatments involve a significant time investment. Both the child and parent need to follow through, as it may take several months to achieve desired results. 

If your child is under the age of 8, motivational therapy is the first thing we try. This treatment uses praise, encouragement, and rewards to help your child gain control over their bedwetting. It’s about encouraging your child to take steps that bring more dry nights. We recommend setting up a chart in the child’s room and keeping track of each dry night, giving positive reinforcement or a small prize for each night the child is dry, and involving them in cleaning up so the child feels empowered to do something.

Another option is dry-bed training. This involves the parent waking up the child several times throughout the night to go potty. As the days go on, you wake up the child less frequently with hope that the child will stay dry longer.

Once the child reaches 8 years old or after these other options have been tried and no progress has been made, we may introduce the bedwetting alarm. This involves a moisture monitor that detects urine and alerts the child to wake up and go potty. This goes on for at least three weeks and is the most effective treatment.

For older children – those hitting pre-adolescence or teenage years – we have to be more aggressive, because at that point, we know it’s a real issue.  Medication is something we try only after other treatments haven’t worked. You give the child the medication one to two hours before bed. The medicine works similar to a natural body hormone, reducing urine production at night so that the child doesn’t have a full bladder. 

Medication does work well in the short-term but has a high relapse rate. When the child stops the medication, they may start wetting the bed again. 

What not to do

If your child is experiencing bedwetting, it’s important not to shame them. Let your child know it’s not their fault. Children should never be punished for wetting the bed. They need support and compassion.

The best way to address bedwetting is to understand why it happens and develop a plan to manage it. 

Our pediatricians are here for you. It all starts with having a conversation with your doctor. After we obtain a detailed history, we can start to talk about different treatment options. 

Make an appointment with one of our pediatricians today. 

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