No. 18; Updated October 2023
Many parents are concerned when their child continues to wet their bed at night past the age of three years old. Although most children are toilet trained between two and four years, some children are not able to stay dry until a few years later, and for some nighttime dryness occurs in older children. Child and adolescent psychiatrists and pediatricians stress that bedwetting is fairly common and not a disease. Occasional accidents may occur, often when the child is ill. Parents need to be understanding since even toilet trained children may have occasional accidents.
Some facts parents should know about bedwetting:
- About 20 percent of 5-year-old and 10 % of 7-year-olds children wet the bed
- Many more boys than girls wet their beds
- Bedwetting runs in families
- Bedwetting is also known as enuresis
- Usually bedwetting stops by puberty
- Most children who wet the bed do not have emotional problems
Causes of bedwetting include the following:
- A child’s bladder is small and not ready to hold the child’s urine overnight
- A child is a deep sleeper and does not wake up when the bladder is full
- A child is constipated, and this is placing pressure on the bladder
- A child does not empty the bladder completely before going to sleep
Continued bedwetting beyond the age of three or four rarely signals a kidney or bladder problem. The child’s pediatrician or family doctor can help rule out medical causes such as infection. Bedwetting may sometimes be related to a sleep disorder. Sometimes medications a child is taking can change how deeply they sleep and lead to bedwetting. In most cases, the child's bladder control might be slower to develop than other children. Bedwetting may also be the result of the child's tensions and emotions that require attention.
There are emotional reasons for bedwetting. For example, when a young child begins bedwetting after several months or years of dryness during the night, this may reflect new fears or insecurities. Often, this may follow changes or events which make the child feel insecure, such as: moving to a new home, parents’ divorce, losing a family member or loved one, being the victim or bullying or trauma, or the arrival of a new baby or child in the home.
Parents should remember that children rarely wet on purpose, and usually feel ashamed about the incident. Parents need to encourage the child and express confidence that he or she will soon be able to stay dry at night.
Parents may help children who wet the bed by:
- Limiting liquid drinks before bedtime
- Encouraging the child to go to the bathroom before bedtime
- Praising the child on dry mornings
- When starting to have dry nights consider a sticker chart to track the change and praise
- Avoiding punishments
- Waking the child during the night to empty their bladder
- Using “pull-ups” until a number of successive dry nights
Treatment for bedwetting in children usually includes behavioral conditioning devices (pad/buzzer/alarms) and/or medications if behavioral tools like the ones listed above are unsuccessful. In rare cases, the problem of bedwetting continues. Sometimes the child may also show symptoms of emotional problems--such as persistent sadness or irritability, or a change in eating or sleeping habits. In these cases, parents may want to talk with a child and adolescent psychiatrist or mental health provider, who will evaluate physical and emotional problems that may be causing the bedwetting, and will work with the child and parents to resolve these problems. Early supportive intervention will help minimize the potential emotional impact of persistent bedwetting on the child.
For additional information see: