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.
Children don't wet the
bed on purpose. Most likely, a child wets the bed for one or more reasons, such
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.
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
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
Learning about bed-wetting:
Living with bed-wetting:
Health Tools help you make wise health decisions or take action to improve your health.
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:
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.
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.
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
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
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
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
wet the bed.
Call your doctor if:
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 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,
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.
Any child beyond age 6 or 7 who
wet the bed may need to be evaluated by a doctor. The
evaluation should include 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.
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:
Treatment for bed-wetting may include:
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.
For more information, see:
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.
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
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.
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
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
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.
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:
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.
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.
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.
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:
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.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
UrologyHealth.org is a website written by urologists
for patients. Visitors can find specific topics by using the "search"
The website provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology A–Z page to find materials about urologic problems.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
The National Kidney Foundation works to prevent kidney
and urinary tract diseases and help people affected by these conditions. Its
website has a lot of information about adult and child conditions. The site
has interactive tools, donor information, recipes for kidney disease patients,
and message boards for many kidney topics. Free materials, such as brochures
and newsletters, are available.
Other Works ConsultedForeman 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.Glazener CMA, et al. (2004). Complex behavioural and educational interventions for
nocturnal enuresis in children. Cochrane Database of Systematic Reviews (1).Graham KM, Levy JB (2009). Enuresis. Pediatrics in Review, 30(5): 165–173.Huang T, et al. (2011). Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews (12).Medical Specialty Society, American Academy of Child and Adolescent Psychiatry (2004). Practice parameter for the assessment and treatment of children and adolescents with enuresis. Journal of the American Academy of Child and Adolescent Psychiatry, 43(12): 1540–1550.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.
October 24, 2012
Susan C. Kim, MD - Pediatrics & Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
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