Physical or emotional problems do not usually cause bedwetting in younger children, but they may be the reason why a pre-teen or teenager wets the bed.
Causes of bedwetting in older children, pre-teens, and teenagers include:
- Genetics: If both parents were bedwetters, a child has a higher chance of becoming a bedwetter
- Dreams: Dreams such as sitting on the toilet urinating may accompany actual urinating while still in bed
- Medical causes, as listed below
- Psychological causes: Includes traumatic experiences such as living in an angry environment, parental divorce, sexual abuse, or any life change that causes emotional stress for the child
What Is Bedwetting?
Bedwetting is a normal problem in children. Children usually learn to control their bladder during the daytime by four years of age, but nighttime bladder control is not expected until a child is between five and seven years old.
About 16 percent of children wet the bed by five years of age and by the time a child is 15 years old, only one to two percent continue to wet the bed. Boys are two times more likely than girls to wet the bed.
What Causes Bedwetting?
Bedwetting is a normal occurrence and is completely involuntary in young children. Some causes of bedwetting include:
- Time: The child's bladder needs more time to mature and some children need more time to develop bladder control
- Bladder size: The child's bladder holds a smaller-than-normal amount of urine
- Genetics: Bedwetting often runs in families
- Sleep patterns: Both children who are deep sleepers and children who are easily disturbed by noise during sleep may wet the bed
- Stress: Life changes such as moving or a new sibling can trigger bedwetting
- Medical causes:
What Are Symptoms of Bedwetting?
Symptoms of bedwetting are characterized by:
- Not being dry overnight
- Wetting the bed two to three times a week over three months or more
- Wetting the bed again after six months of dry nights
How Is Bedwetting Diagnosed?
For most children, parents take their child to the doctor to diagnose the cause of bedwetting when the problem interferes with a child’s ability to socialize with friends or when parents want to make sure the issue is not due to an underlying medical problem.
The doctor will ask about the history of the child’s bedwetting, and will need to know information such as:
- Family history of bedwetting
- Frequency of bedwetting episodes
- Problems with daytime accidents
- Periods of dryness
- If the child snores
- The impact of the problem on the child and family
- Any treatments that have been tried
- Any family issues that may cause instability
The doctor may ask for a 24-hour diary of how much the child drinks, the number of times the child urinates, and how much urine is passed.
Urinalysis may be indicated to help diagnose an underlying cause of bedwetting.
What Is the Treatment for Bedwetting?
Bedwetting often goes away on its own. Treatment for bedwetting can often take time and it is important for parents to remember that bedwetting is involuntary and punishment will not work.
- Behavior therapy
- Motivational therapy involves keeping a record of progress, with bigger rewards for longer periods of dryness
- Have the child help pick out a reward in advance such as a sticker for one dry night and a book for an entire week without wetting the bed
- This is a good method to try first with younger children
- Bedwetting alarms
- These are the most effective method to treat bedwetting
- Not usually a first-line treatment because of cost and the need for the child and parent to be highly motivated
- Usually used after three to six months of behavioral training, but before medications are tried
- Mainly used for children older than six years
- Bedwetting alarms have a sensor that detects the first drops of urine in the underwear and when the sensor is activated, it wakes the child with an alarm
- This helps train the child to wake up and stop urinating before the alarm is activated
- The child should be in charge of the alarm
- Desmopressin (DDAVP) decreases urine production
- Usually, motivational therapy and/or bedwetting alarms are tried for three to six months before medication is used
- Desmopressin may be used along with behavioral therapies
- Relapse rates are very high when children stop taking desmopressin so gradual tapering of the dose is recommended rather than suddenly stopping the drug
How Do You Prevent Bedwetting?
Measures that can be taken to help prevent bedwetting include:
- Encouraging the child to urinate regularly during the day and just before going to bed (a total of four to seven times)
- Avoid beverages with sugar and caffeine, especially in the evening
- Try to have the child drink most of their fluids in the morning and afternoon
- First, keep a diary of the amount of fluids a child drinks in a 24-hour period
- Based on this amount, create a schedule to spread fluid intake throughout the day
- A common recommendation is 40% of fluids in the morning, 40% in the afternoon, and the remaining 20% in the evening
- Only continue this method if it helps keep the child dry
- Remind children to empty their bladders right before bed, and to get up and use the toilet if they feel the need to urinate
- Use nightlights in the bathroom and the hallway to help the child locate the toilet easily at night, or place a portable potty in the child’s room if the toilet is too far away
- Stop using diapers, training pants, or pull-up pants at home since these can discourage a child from wanting to get out of bed (only use them on select occasions, such as overnight visits with others)
- Use a waterproof mattress protector
- If the child does wake in the night and has already wet the bed, encourage them to use the toilet again before getting into dry bed clothes
- Have the child help with morning bed clean-up if they are old enough, and make sure the child bathes daily so there is no urine odor on the skin
- Never tease a child or allow siblings to tease a child who has wet the bed — remember it is involuntary