Topic Overview
What is bed-wetting?
Bed-wetting is urination
during sleep. Children learn
bladder control at different ages. Children younger
than 4 often wet their beds or clothes, because they can't yet control their
bladder. But by age 5 or 6 most children can stay dry through the night.
Bed-wetting is defined as a child age 5 or older wetting the bed at least
1 or 2 times a week over at least 3 months. In some cases, the child has been
wetting the bed all along. But bed-wetting can also start after a child has
been dry at night for a long time.
Wetting the bed can be
upsetting, especially for an older child. Your child may feel bad and be
embarrassed. You can help by being loving and supportive. Try not to get upset
or punish your child for wetting the bed.
What causes bed-wetting?
Children don't wet the
bed on purpose. Most likely, a child wets the bed for one or more reasons, such
as:
- Delayed growth. Children whose
nervous system is still forming may not be able to
know when their bladder is full.
- A small bladder. Some children may
have a bladder that gets full quickly.
- Too little antidiuretic
hormone. The body makes this hormone, which rises at night to tell the kidneys
to release less water. Some children may not have enough of this
hormone.
- Deep sleeping. Many children who wet the bed sleep so
deeply that they don't wake up to use the bathroom. They probably will wet the
bed less often as they get older and their sleep pattern
changes.
- Emotional or social factors. Children may be more likely
to wet the bed if they have some
stress. For example, a child may have a new brother or
sister.
Children who wet the bed after having had dry nights for
6 or more months may have a medical problem, such as a bladder infection. Or
stress may be causing them to wet the bed.
How is it treated?
Treatment usually is not needed
for bed-wetting in children ages 7 and younger. Most children who are this age
will learn to control their bladders over time without treatment.
But if your child older than 7 wets the bed at
least 2 times a week for at least 3 months, treatment may help your child wet the bed less
often or help him or her wake up to use the toilet more often. You and your child may also decide to try treatment if bed-wetting
seems to be affecting how your child is doing with schoolwork or getting along with his or her peers. Treatment may involve a praise and reward system (motivational therapy), a moisture alarm, or medicine.
One or more of these methods may be used.
If bed-wetting is caused by a
treatable medical problem, such as a bladder infection, the doctor will treat
that problem.
What can you do to help your child?
Help your
child understand that controlling his or her bladder will get easier as your
child gets older.
Here are some other tips that may help your
child:
- Give your child most of his or her fluids in
the morning and afternoon.
- Have your child avoid caffeine, such as from chocolate or colas.
- Have your child use the toilet before he or
she goes to bed.
- Let your child help solve the problem, if your
child is older than 4. He or she can help decide which treatments to
try.
- Encourage your child by praising successes.
Frequently Asked Questions
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Cause
Almost all children who
wet the bed do not do so intentionally. Most likely,
several things are involved when a child older than age 5 continues to
wet the bed. Possible causes of
primary nocturnal enuresis include:
- Delayed development. Children with a
less mature nervous system may not be as able to sense when the bladder is
full.
- Small bladder capacity. Having a
smaller-than-normal bladder may make some children more prone to wet the
bed.
- Too little antidiuretic hormone (ADH). Levels of
antidiuretic hormone (ADH), a brain chemical that
signals the kidneys to release less water, normally rise at night. Some
children who wet their beds may not produce more ADH at night.
- Sound sleeping. Many parents note that their child
who wets the bed is a deep sleeper. These children usually wet the bed less
often as their sleep patterns mature.
- Psychological and social factors. Bed-wetting does
not appear to be a direct result of emotional problems. In fact, bed-wetting
may be the cause of some emotional problems for children. But children
living in stressful home situations or in institutions may be more likely to
wet the bed.
Some of these things may be inherited. A child is at
increased risk for wetting the bed if one or both parents has a history of
bed-wetting as a child.
Most cases of primary nocturnal enuresis
are not caused by any medical condition. But
secondary nocturnal enuresis, which is bed-wetting
that occurs after a period of staying dry, is more likely to be related to a
medical condition. Examples of physical causes include a kidney or bladder
infection (urinary tract infection) or birth defects that affect
the urinary tract. Emotional
stress, such as may result from the birth of a brother
or sister, can also be something that triggers bed-wetting.
Symptoms
Bed-wetting is
not a disease, so it has no symptoms. For a child who has never had nighttime
bladder control for more than 3 months, overcoming this problem is usually a
matter of normal development.
If a child has other
symptoms, such as crying or complaining of pain when urinating, sudden strong
urges to urinate, or increased thirst, bed-wetting may be a symptom of some
other medical condition. Call the doctor if your child has any of these symptoms.
What Happens
Bed-wetting is common in young children. Children grow
and develop at different rates, and bladder control is achieved at an
individual pace. Usually, daytime bladder control occurs before nighttime
control.
Children may wet the bed several times during the night,
and they may not wake up after wetting.
Primary nocturnal enuresis-bed-wetting that continues past the age that most children have
nighttime bladder control-will usually stop over time without treatment. If a
medical condition is causing the bed-wetting, treating
the condition may stop the wetting.
Treatment often does not
completely stop bed-wetting, but it may reduce how often it occurs. Although
bed-wetting may return when treatment is stopped, repeating or combining
treatments may have longer-lasting results.
Sometimes bed-wetting is related to emotional stress.
Bed-wetting usually stops when the stress is relieved or managed.
The emotional responses to bed-wetting can
impact the relationship with your child. If you or your child is having
difficulty with handling bed-wetting, you may wish to find out about treatment
options.
Some children who wet
the bed also experience
accidental daytime wetting. When wetting occurs during
both the day and night, usually the things related to the daytime wetting are
explored first.
What Increases Your Risk
Children who develop at a slower rate than other children
during the first 3 years of life have an increased likelihood of wetting the bed. Boys tend to develop more slowly, so they are more likely than girls to
wet the bed.
A child may inherit the
tendency to
wet the bed.
When To Call a Doctor
Call your doctor if:
- Your child has signs of a
bladder or kidney infection or other symptoms, such as
back pain, abdominal (belly) pain, or fever. Signs of a bladder or kidney infection
include:
- Cloudy or pink urine or bloodstains on
underclothes.
- Urinating more often than usual.
- Crying
or complaining when urinating.
- Your child age 4 or older is
wetting the bed and is leaking stool. The child may
have stool blocking the
intestines, caused by having constipation over a
period of time.
- Your child wets the bed more frequently while you
are using home treatment for bed-wetting.
- Your daughter older than
5 or your son older than 6 has never had bladder control for more than 3 months
in a row after trying home treatment, and it is causing problems at school or
in the child's relationships with family and friends.
- Your child
who has had bladder control for at least 3 months has begun to wet the bed, and
this has happened more than a few times.
If your child wets the bed but has no other symptoms,
and you have tried home treatment without success, the doctor can recommend
other methods of treatment.
Watchful waiting
Watchful waiting is appropriate if
bed-wetting is not affecting how your child is doing with schoolwork or getting along with his or her peers or family. Most children develop complete bladder control even
without treatment. Home treatment may be all that is needed to help the child
learn bladder control.
Watchful waiting may not be appropriate if
bed-wetting starts after a child has had bladder control for a period of time.
Look for possible
stresses that might be causing the bed-wetting.
Bed-wetting may stop when your child's stress is relieved or managed. If it
does not, your child should see a doctor. For more information,
see:
- Bed Wetting: Should My Child See a Doctor?
Who to see
The
following health professionals can evaluate and treat bed-wetting:
The following specialist(s) may be required if your child
has medical or emotional conditions:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Any child beyond age 6 or 7 who
continues to
wet the bed may need to be evaluated by a doctor. The
evaluation should include a
urinalysis.
A
medical history and a
physical exam are also part of a medical evaluation of
bed-wetting. If you are having your child evaluated for bed-wetting, keep a diary for a week
or two before your visit. Write down when wettings occur and how
much urine is released.
In some cases, further testing may be
needed. Tests may include:
If a child has uncontrollable wetting both at night and in
the day, other tests may need to be done.
- Bed Wetting: Should My Child See a Doctor?
Treatment Overview
Most children gain
bladder control over time without any treatment.
Bed-wetting that continues past the age that most
children have nighttime bladder control-typically at 5 or 6 years of age-also
will usually stop over time without treatment. If not, home treatment may be
all that is needed to help a child stop wetting the bed. For more information, see the Home Treatment section of this topic.
If home treatment is unsuccessful, if the child and parents
need assistance, or if the bed-wetting may be caused by a
medical condition, medical treatment may be helpful.
Medical treatment may help your child wet the bed less often or help him or her wake up to use the toilet more often.
Treatment for bed-wetting is based on the:
- Child's age. Some treatments work better than
others for children of a specific age group.
- Child's and parents' attitudes about the bed-wetting. If gaining bladder control is seen as a normal process, it is
usually easier for the child to stop bed-wetting.
- Home situation. If the child shares a bedroom with
other children, certain techniques to arouse the child, such as some moisture alarms, may not be
practical.
Treatment for bed-wetting may include:
- Motivational therapy. This method involves parents
encouraging and reinforcing a child's sense of control over
bed-wetting.
- Moisture alarms, which detect wetness
in the child's underpants during sleep and sound an alarm to wake the
child.
- Desmopressin and
tricyclic antidepressants. These medicines increase the amount of urine that the bladder can hold or decrease the
amount of urine released by the kidneys.
Treatment may be helpful if
bed-wetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with his or her peers.
The best solution may be a combination of
treatments. Below are some suggestions for treatment options according to the
age of your child.
- Ages 5 to 8: Help your child understand that
wetting the bed is a normal part of growing up. Encouragement and praise may be
all that is needed to help your child wake up before wetting. Praise and reward your child for the steps he or she takes to have dry nights. And have your child take an active role in
cleaning up after wetting.
- Ages 8 to 11: If your child still wets
the bed, a moisture alarm may be a successful treatment option. Also, a medicine such as desmopressin can be helpful for occasional overnight events such as camp or sleepovers.
- Ages 12
and older: There can be significant emotional effects if bed-wetting persists
at this age, so treatment can be more aggressive. If consistent use of moisture
alarms does not work, the doctor may suggest medicine and/or counseling.
For more information, see:
- Bed-Wetting: Should I Do Something About My Child's Bed-Wetting?
What about treatment for daytime wetting?
Accidental daytime wetting may be a normal part of a child's development, or it may
point to a medical condition. Talk to your child's doctor if your child has daytime wetting.
What to think about
Treatment for bed-wetting is usually not a cure. The
goal is to reduce the number of times the child wets the bed and to manage the
wetting until it goes away on its own.
Some children who finish a treatment and have dry nights for a while will start to wet the bed again. Repeating treatment, especially with a moisture alarm, usually helps bring back dry nights.
Counseling (psychotherapy) may be helpful for the child
who has
secondary enuresis or for bed-wetting that is caused
by emotional stress. Psychotherapy involves talking with a trained counselor.
The counselor helps the child identify and deal with the emotional stress that
may be causing him or her to have accidental wettings. The goal is to reduce or
help manage the stress or to prevent stress from occurring.
Prevention
Learning to use the toilet is a natural
process that occurs when children are old enough to control their
bladder muscles and to know when they are about to
wet. It is normal for young children to have accidental
bed-wettings while they are learning to control their
bladders.
If you are teaching your child to use the toilet, be
patient. Some children are slower than others in gaining complete bladder
control. Stay positive and encouraging, and learn about the normal development
of bladder control. For more information, see the topic
Toilet Training.
You can help
prevent or reduce bed-wetting by limiting your child's fluid intake in the
evenings. Do not give any drinks containing caffeine, such as cola or tea.
Also, remind your child at bedtime that he or she should get up at night to use
the bathroom if needed.
Home Treatment
Most children gain
bladder control over time without any treatment. A
child should first be allowed to overcome
bed-wetting on his or her own. But home treatment may
help a child to wet the bed less frequently.
You can help manage
your child's bed-wetting:
- Monitor your child's consumption of liquids. As
a rule of thumb, children should be encouraged to consume 40% of their total
daily liquids in the morning, 40% in the afternoon, and 20% in the evening.
Talk with the doctor about how much fluid your child needs.
- Have your child avoid caffeine. Caffeine is a
diuretic, which means that it promotes the excretion
of urine. Foods such as chocolate and beverages such as colas and tea may contain caffeine.
- Have your child use the toilet before going to
bed.
- Remind your child to get up during the night to go to the
bathroom. It may help to keep a night-light near or potty chair beside the
bed.
- Let your child help solve the problem, if he or she is older
than 4.
- Praise and reward your child for taking steps to have more dry nights. Involve your
child in planning the reward system. You may want to use a calendar and put
stars or stickers on the days that your child does not wet the
bed. You know your child. If you think a reward system will help your child, then try it. If you think it may make your child feel worse, then do not use a reward system.
- Encourage your child to take responsibility for changing
clothes and linens after a bed-wetting accident. For example, use washable
sleeping bags as bedding so your child can easily replace one that is wet with
one that is dry.
- Add
0.5 cup (125 mL) of vinegar to
the wash water to get rid of the urine odor in clothing and bed linens.
If your child wets the bed, don't blame yourself or the other parent. Don't punish, blame, or embarrass your child. Your child is neither
consciously nor unconsciously choosing to wet the bed. Give your child
understanding, encouragement, love, and positive support.
- Be patient about changing the bed linens. Don't
act offended by the smell of urine.
- Do not wake the child up at
different times during the night to go to the bathroom unless it is part of a
systematic treatment that the child has agreed to.
- Do not make the
child feel bad. Shaming or punishing the child may make the problem
worse.
- If you think your child may be feeling emotional
stress, talk with a health professional about whether
counseling may be helpful.
Medications
Medicines that either increase the amount
of urine that the
bladder can hold (bladder capacity) or decrease the
amount of urine released by the kidneys may be used to treat
bed-wetting. These prescription medicines may be used to control bed-wetting for a little while. They don't completely stop it.
- Medicines work well to control accidental
wetting for short periods of time, such as when children are on overnight trips
or at camp.
- Your doctor may suggest them for bed-wetting that is related to a stressful event, such as divorce or the birth of a sibling.
- Sometimes medicines are used along with other
treatments or for children who have not been able to control bed-wetting with
other treatments. Medicines can help to encourage and motivate a child who is
having trouble with other treatments by letting the child feel what it is like
to have dry nights.
Medicine choices
- Desmopressin for Bed-Wetting (DDAVP)
- Tricyclic Antidepressants (TCAs) for Bed-Wetting (such as desipramine or imipramine)
In a few cases, when a small bladder capacity or
overactive bladder is thought to be the cause of bed-wetting,
oxybutynin (such as Ditropan or Oxytrol) may be used to treat
bed-wetting, especially when the child also has
daytime accidental wettings.
Other Treatment
You may hear of other ways to help children who wet the bed. But not all of these treatments have good evidence that they help. Talk to your doctor before you spend time and money on these other treatments. Ask about the risks and benefits. Examples include:
- Acupuncture.
- Bladder-stretching exercises that teach the child to hold urine for longer
periods of time.
- Dry-bed training, which
consists of following a strict schedule for waking the child up at night until
he or she learns to wake up alone when needed.
- Hypnosis.
- Waking your child and taking him or her to the toilet a few times each night, or having your older child wake himself or herself a few times each night to use the toilet.
It's not a good idea to have your child wear diapers or pull-ups at night on a regular basis. Using diapers can get in the way of proven treatments (such as motivational therapy and moisture alarms) that require a child to get up at night.
Other Places To Get Help
Organizations
HealthyChildren.org (U.S.)
www.healthychildren.org
Urology Care Foundation (U.S.)
www.urologyhealth.org
References
Other Works Consulted
- Huang T, et al. (2011). Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews (12).
- Foreman JW (2011). Kidney or urinary tract disorders. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 1691-1696. New York: McGraw-Hill.
- Graham KM, Levy JB (2009). Enuresis. Pediatrics in Review, 30(5): 165-173.
- Mikkelsen EJ (2007). Elimination disorders: Enuresis and encopresis. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 655-669. Philadelphia: Lippincott Williams and Wilkins.
- Sadock BJ, Sadock VA (2007). Elimination disorders. In Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1244-1249. Philadelphia: Lippincott Williams and Wilkins.
- Tanagho EA (2008). Disorders of the bladder, prostate, and seminal vesicles. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 574-588. New York: McGraw-Hill.
Credits
ByHealthwise Staff
Primary Medical ReviewerSusan C. Kim, MD - Pediatrics
John Pope, MD - Pediatrics
Specialist Medical ReviewerMartin J. Gabica, MD - Family Medicine