Why is My Kid Wetting the Bed?

By age seven, about 10% of children still wet the bed. If you’re concerned about your child’s bedwetting (called nocturnal enuresis) — and it’s creating nighttime anxiety and preventing them from enjoying sleepovers — it’s important to figure out the cause. Then you can address it together and help your child wake up dry and happy.

Is your child’s bedwetting a medical or behavioral issue?

“If your child has never had good bladder control (a condition called primary enuresis), the first thing to do is get a medical evaluation to determine whether there is a medical cause,” says Alan Delamater, Ph.D., a clinical pediatric psychologist with the University of Miami Health System. “There may not be any medical issues. But, before beginning behavioral treatment, that must be determined.”

If your child’s nocturnal enuresis continues past age seven, speak with your primary care physician, says Andrea Assantes, M.D., a pediatrician with UHealth.

“Urinary elimination (both daytime and nighttime) should be discussed at all wellness checks so you can gain an understanding of what’s considered normal for your growing child.” 

When a child has no nighttime accidents for six months or longer, then suddenly starts wetting the bed again, “this is called secondary enuresis and can be a sign of a greater issue,” she says. “And it should be evaluated by your primary doctor.”

Your pediatrician can determine if your child has any of the following medical causes of wetting the bed:

•  urinary tract infection
• bladder/kidney disease
• genetics (runs in the family)
• small bladder
• neurological disease 
• seizures
• diabetes
• sleep apnea
• constipation
• hormonal changes or insufficiencies 

Once you’ve effectively treated or ruled out an underlying medical problem, yet your child’s bedwetting continues, a pediatric psychologist can help determine and address the cause. 

The following behavioral and emotional issues can trigger sudden or persistent bedwetting:

• poor development of brain-bladder connection
• doesn’t recognize full-bladder sensations
• drinking too much before bedtime
• not emptying bladder before bedtime
• deep sleeper
• stress, anxiety
• trauma

When a child has primary nocturnal enuresis and is unable to consistently wake up dry by age seven, it’s likely that they never developed the brain-body connection needed to control their bladder and recognize when they need to use the bathroom, says Dr. Delamater.

He says secondary nocturnal enuresis (a sudden return to wetting the bed) “is usually associated with some stressor (such as changes at home, school, friendships, or loss of loved ones). Kids who have experienced trauma (like a car accident, violence, or abuse) and have developed PTSD may regress in their developmental skills.”

How to encourage more dry mornings

Pediatric psychologists and pediatricians agree that it’s essential for parents to respond thoughtfully, skillfully, and patiently to their child’s bedwetting — regardless of the cause.

“Kids may often experience stress and anxiety as a consequence of their bedwetting, related to how their parents respond to it (e.g., scolding and shaming their child),” Dr. Delamater says. This added stress can only worsen the bedwetting and possibly make the child feel shame and embarrassment.

To help establish the brain-bladder connection for children with primary enuresis without a medical issue, he says, “the key is to engage and motivate the child and help the parents and the child have a different view of the issue.”

This positive-reinforcement approach is highly successful:

Never scold or punish your child for wetting the bed.

When they tell you that they’re wetting the bed again, or you discover soiled bedding or pajamas, “talk to them about what is going on and be sensitive to their feelings,” Dr. Assantes says. “Have them help with changing the sheets.”

On mornings when they wake up to a dry bed, offer encouragement and praise. 

“Keep track of dry nights and provide tangible, meaningful rewards to the child after reaching goals (e.g., five dry nights, then later seven dry nights in a row),” says Dr. Delamater. 

“With this approach, almost all kids will fairly quickly begin to attain nighttime control. They will eventually outgrow this problem without treatment, but dry-bed training will hasten their developmental success and has an excellent ‘cure’ rate.”

To help children with secondary enuresis, first, address their acute emotional issues. Then this incentive program can reinforce motivation for dry nights.

It’s also helpful to reduce the child’s fluid intake after dinner, establish a consistent bedtime, and have them empty their bladder on the toilet as part of their bedtime routine.

Have you tried a bedwetting alarm?

“Sometimes a urine sensor and alarm (a strip that can be inserted into underwear or a pad the child sleeps on) can be used as part of the overall dry-bed training,” Dr. Delamater says.

With this tool, moisture triggers a vibrating or auditory alarm to wake the child, so they can get up to use the toilet. Eventually, the child’s brain associates the alarm notification with their need to urinate.

Dr. Assantes says a bedwetting alarm is appropriate only for older children who are developmentally ready to actively participate in their bladder-control treatment plan. 

“Success averages above 50%,” she says. Dr. Delamater says the quality of the research on this training approach is low. Parents need to actively participate because they may need to use the alarm for many weeks.

Is medication appropriate?

Medications like DDAVP and desmopressin may help temporarily resolve problematic bedwetting, but the condition will return when the child stops taking the drugs.

“I have prescribed DDAVP for short-term periods like a sleepover or camp. If longer durations of control are being considered, I enlist the help of my nephrology colleagues,” Dr. Assantes says. “Both of these medications can have side effects, and it’s important to talk to your doctor regarding the pros and cons for your child,” in addition to non-pharmaceutical treatment options.

Dana Kantrowitz is a contributor for UHealth’s news service.

Tags: amounts of urine, behavioral health, children who wet the bed, Dr. Alan Delamater, pediatric care in Miami, sleep patterns