Bedwetting: Understanding and Managing Nighttime Accidents

If your child wets the bed, you're not alone—and neither is your child. Bedwetting is incredibly common, affecting millions of children well into school age. Understanding why it happens and how to help can make this phase easier for everyone involved.

How Common Is Bedwetting?

More common than most people realize: AAP

By age:

• Age 4: About 30% wet the bed
• Age 5: About 20% wet the bed
• Age 6: About 15% wet the bed
• Age 7: About 10% wet the bed
• Age 10: About 5% wet the bed
• Age 15: About 1-2% wet the bed

Key facts:

• Boys are more likely to wet the bed than girls
• It often runs in families
• Most children outgrow it without treatment
• It's almost never a behavior problem or sign of emotional issues

Why Bedwetting Happens

Bedwetting (nocturnal enuresis) is usually not a choice or a sign of laziness. It's developmental: AAP

Common causes:

### Developmental immaturity

• The brain-bladder connection isn't fully developed yet
• Some children sleep very deeply and don't wake to the bladder signal
• Bladder capacity may be smaller than average
• The body may not yet produce enough ADH (antidiuretic hormone) at night

### Genetics
If one parent wet the bed as a child: ~40% chance child will too
If both parents wet the bed: ~70% chance child will too

### Constipation

• A full bowel presses on the bladder
• Often an overlooked cause
• Treating constipation often helps bedwetting

### Medical causes (less common)

• Urinary tract infection
• Diabetes
• Sleep apnea
• Anatomical issues
• Rarely, neurological conditions

What bedwetting is NOT:

• A behavior problem
• Laziness
• Defiance
• Poor parenting
• A sign of emotional problems (in most cases)

Primary vs. Secondary Bedwetting

This distinction matters: AAP

Primary bedwetting:

• Child has never been consistently dry at night
• Most common type
• Usually developmental
• Generally resolves with time

Secondary bedwetting:

• Child was dry for 6+ months, then started wetting again
• Can indicate stress, medical issue, or life changes
• Worth investigating the cause
• Talk to your pediatrician

Triggers for secondary bedwetting:

• New sibling
• Starting school
• Family stress or changes
• Moving
• Constipation
• Urinary tract infection
• Sleep apnea
• Rarely, abuse or trauma

When to See the Doctor

Make an appointment if: AAP

• Bedwetting is still frequent at age 7+
• Your child was dry and started wetting again
• Daytime wetting accompanies nighttime wetting
• You see signs of infection (pain, fever, frequent urination)
• Your child snores loudly or seems to stop breathing during sleep
• Your child is very constipated
• Bedwetting is affecting your child's self-esteem significantly
• You want guidance on management strategies

What the doctor may do:

• Physical examination
• Urine test to rule out infection or diabetes
• Assessment for constipation
• Sleep evaluation if sleep apnea is suspected
• Discussion of treatment options

What Actually Helps

### Start Here: The Basics

Fluid management:

• Encourage drinking during the day
• Limit fluids 1-2 hours before bed (but don't restrict excessively)
• Avoid caffeine (soda, chocolate) in the evening
• Have child urinate right before bed

Address constipation:

• Regular bowel movements make a significant difference
• High-fiber diet, adequate fluids, possibly stool softeners
• Talk to your pediatrician about constipation management

Bedroom setup:

• Waterproof mattress protector
• Keep a clean set of sheets and pajamas handy
• Nightlight so child can find bathroom
• Consider pull-ups if desired (this doesn't slow down dryness)

### Bedwetting Alarms

The most effective long-term treatment: AAP

How they work:

• Sensor clips to underwear or lies on pad
• Alarm sounds at first drop of wetness
• Child wakes and finishes in bathroom
• Over time, brain learns to wake to bladder signal

Effectiveness:

• Success rate: 50-70%
• Takes 2-3 months of consistent use
• Lower relapse rate than medication
• Requires motivated child and parent commitment

Tips for success:

• Child needs to be invested in trying
• Parent may need to help wake child at first
• Stick with it for at least 3 months
• Celebrate progress, even small steps

### Medications

Options for short-term use or when alarms haven't worked: AAP

Desmopressin (DDAVP):

• Reduces urine production at night
• Often effective same night
• Used for sleepovers, camp, or longer-term
• Bedwetting usually returns when stopped
• Generally safe with supervision

Other medications:

• Oxybutynin (for small bladder capacity)
• Imipramine (rarely used due to side effects)

Discuss with your pediatrician whether medication is appropriate.

### What DOESN'T Help

Avoid:

• Punishment or shaming (causes emotional harm, doesn't help)
• Waking child multiple times at night (disrupts sleep, limited effectiveness)
• Extreme fluid restriction (can cause dehydration)
• Making the child feel bad about something they can't control

Protecting Your Child's Self-Esteem

Bedwetting can be emotionally hard for children: AAP

Do:

• Reassure your child this isn't their fault
• Tell them many kids have this happen
• Keep it private (don't discuss in front of siblings or friends)
• Praise dry nights without making wet nights feel like failure
• Let them know you're on their team
• Share that a parent had this if applicable (helps normalize)

Don't:

• Punish or express disappointment
• Let siblings tease
• Make it a big deal
• Compare to other children
• Show frustration (even though it's exhausting)

For sleepovers:

• Pull-ups or disposable underwear under pajamas
• Send child with a plastic bag for wet items
• Practice getting up at night at home
• Consider medication for special occasions
• Many kids manage sleepovers successfully with planning

When Kids Are Motivated to Stop

Involve your child if they're ready: AAP

Child involvement:

• Let them track dry nights (sticker chart)
• Have them help change sheets (not as punishment, as partnership)
• Let them choose underwear/pull-ups
• Teach them to use the alarm
• Celebrate progress together

Not ready to work on it:

• That's okay—they may outgrow it
• Don't force involvement
• Protect their self-esteem
• Revisit in a few months

The Timeline: When Will It Stop?

The encouraging truth:

• Almost all children stop wetting the bed eventually
• About 15% of bedwetters become dry each year without treatment
• By teen years, it's very rare
• Even if it takes time, it will end

Factors that predict earlier resolution:

• Girls tend to stop earlier than boys
• Smaller bladder capacity may take longer
• Strong family history may mean longer timeline
• Children motivated to work on it may progress faster

The Bottom Line

Bedwetting is normal, common, and almost always resolves with time. It's not your child's fault, and it's not your fault. While it's inconvenient, it's not harmful.

Focus on protecting your child's self-esteem, managing the practical aspects, and being patient. If it persists or causes distress, talk to your pediatrician about treatment options like alarms or medication.

Clara is here if you need help managing bedwetting or want to talk through your options.