Bed-wetting at night (nocturnal enuresis) means that a child accidentally passes urine during the night while asleep. Bed-wetting is usually normal for infants and young children. Many children who are going through toilet training stay dry during the day, but continue to wet the bed at night for several more months or even a few more years. Bed-wetting is not even considered as a possible problem until a child reaches school age, around 5 or 6 years old.
Most children who wet the bed have never been dry at night (primary nocturnal enuresis). However, bed-wetting that occurs after a child has been fully dry for several months or years is called secondary nocturnal enuresis and should be discussed with your child's pediatrician.
Primary nocturnal enuresis is very common, particularly in boys, and tends to run in families. At age 5, approximately one of every five children still wets the bed. Most children who wet the bed overcome the problem between 6 and 10 years of age, and all children eventually get over it, even without special treatment.
Bed-wetting happens when a child makes more urine than the bladder can hold but does not wake up to empty the bladder. Experts think this problem is the result of several different developmental, physical, genetic, hormonal and external factors, all working together.
Parents should never punish a child for wetting the bed. It is important for parents to appreciate that a child does not wet the bed on purpose. By 5 or 6 years of age, children want to become more independent and have control over their lives. Wetting the bed can be embarrassing, discouraging, disappointing and damaging to their self-esteem, especially when a child wants to sleep at a friend's house.
Treatment Options: Any Age
For children of any age who wet the bed, try these suggestions to help with nighttime toilet training:
- Encourage drinking during the day. Drinking more fluids results in more urine production, which may help make the bladder larger so that it can hold more urine at night.
- In the last two hours before bedtime, limit the amount of liquids your child drinks. For many children, this means no drinking after the evening meal. Your child should also avoid any drinks that contain caffeine and should limit foods that melt into liquids, such as ice cream, Popsicles and flavored gelatin (Jell-O).
- Always remind your child to go the bathroom before going to bed. When your child doesn't feel the need to go, tell him or her to try anyway.
- Remind your child to get up to go to the bathroom in the middle of the night (if he or she feels the need to urinate).
- Make it easy for your child to find the bathroom at night. Make sure your child can easily and safely climb out of bed (and get back in bed). Put a bright light in the bathroom and in the hallway. If the bathroom is far away or you are staying in an unfamiliar place, put a portable toilet in your child's bedroom.
- Praise your child for dry nights.
- Never punish, shame or blame your child for wet nights. Make sure that brothers and sisters do not tease him either.
- Protect the mattress from urine with a plastic or waterproof mattress cover, or place a large plastic bag under the sheets.
- When accidents happen, involve your child in the cleanup. Younger children can help remove the sheets and put them in the washing machine. Older children can change the bed by themselves. Have a clean set of sheets nearby so your child can quickly change the bed and get back to sleep (without waking you), if he wakes in the middle of the night after wetting.
- Use real cloth underwear rather than diapers, pull-ups or plastic pants. Your child will feel the wetness on the cloth underwear and the urine will soak through to the sheets. Feeling uncomfortable and having to change underwear and sheets usually help motivate children to stay dry. (Pull-ups can be used occasionally, such as when camping or staying overnight at other people's homes.)
Treatment Options: Older Than 6 Years
For children older than 6 years of age, there are several treatment options that your child's doctor may recommend:
- Motivational therapy. A "token and reward" system may help to motivate your child to stop wetting the bed at night. This typically involves using a chart to keep track of your child's progress, with a gold star or favorite sticker for every dry night. When the chart is filled, let your child pick out a small reward. Many doctors encourage the use of three to six months of motivational therapy before trying other treatment options.
- Exercises. A few children who wet the bed at night improve with bladder-training exercises during the day. To help increase the size of the bladder, encourage your child to hold his urine for several minutes after feeling the urge to go to the bathroom during the day. To help strengthen the muscles that control urination, have your child start urinating into the toilet and then stop and restart.
- Behavioral therapy. Enuresis alarms use sounds or vibrations to wake a child who wets his or her bed or underwear. Eventually the child "learns" to avoid setting off the alarm by not wetting the bed. Alarms are typically not used until after age 8, though occasionally may be recommended for younger children.
- Medications. There are several medications that are used in certain circumstances (for example, sleepovers at family or friends' houses) to temporarily control primary nocturnal enuresis. However, these medicines do not actually cure bed-wetting; it usually returns after the child stops taking the medicine.
- Combination therapy. In some children, a combination of medications and behavioral therapy will stop bed-wetting when other treatments have failed.
- Other options. Hypnosis, diet therapy (especially eliminating caffeine) and psychotherapy have also been used to treat some children with bed-wetting.
Remember, bed-wetting is a common problem, but fortunately, one that most children outgrow, usually without medical treatment. Parents should never punish a child for wetting the bed. Call your doctor to discuss treatment options if your child is age 6 years or older and still wetting the bed or if you or your child is concerned about bed-wetting. Call your doctor immediately if your child starts wetting the bed after having been dry at night for some time, especially if he is wetting the bed and also has fever, pain when urinating, or seems to be urinating or drinking more than usual.