Soggy sheets and pajamas —
and an embarrassed child — are a familiar scene in many homes. But
don't despair. Bed-wetting isn't a sign of toilet training gone bad.
It's often just a developmental stage.
Bed-wetting is also known as nighttime incontinence or nocturnal
enuresis. Generally, bed-wetting before age 6 or 7 isn't cause for
concern. At this age, nighttime bladder control simply may not be
If bed-wetting continues, treat the problem with patience and
understanding. Bladder training, moisture alarms or medication may help
Bed-wetting is characterized by involuntary urination at night.
Most kids are fully toilet trained by age 4, but there's really no
target date for developing complete bladder control. By age 5,
bed-wetting remains a problem for only about 15 percent of children.
Between 8 and 11 years of age, fewer than 5 percent of youngsters are
When to see a doctor
Most children outgrow bed-wetting on their own — but some need a little
help. In other cases, bed-wetting may indicate an underlying condition
that needs medical attention.
Consult your child's doctor if:
* Your child still wets the bed after age 5 or 6
* Your child starts to wet the bed after a period of being dry at night
* The bed-wetting is accompanied by painful urination, unusual thirst, pink urine or snoring
No one knows for sure what causes bed-wetting, but various factors may play a role.
* A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
* Inability to recognize a full bladder. If the nerves that control
the bladder are slow to mature, a full bladder may not rouse your child
from sleep — especially if your child is a deep sleeper.
* A hormone imbalance. During childhood, some kids don't produce
enough anti-diuretic hormone (ADH) to slow nighttime urine production.
* Stress. Stressful events — such as becoming a big brother or
sister, starting a new school, or sleeping away from home — may trigger
* Urinary tract infection. A urinary tract infection can make it
difficult for your child to control urination. Signs and symptoms may
include bed-wetting, daytime accidents, frequent urination and pain
* Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep
apnea, a condition in which the child's breathing is interrupted during
sleep — often because of inflamed or enlarged tonsils or adenoids. Other
signs and symptoms may include snoring, frequent ear and sinus
infections, sore throat, and daytime drowsiness.
* Diabetes. For a child who's usually dry at night, bed-wetting may
be the first sign of diabetes. Other signs and symptoms may include
passing large amounts of urine at once, increased thirst, fatigue and
weight loss in spite of a good appetite.
* Chronic constipation. A lack of regular bowel movements may lead
to reduced bladder capacity, which can cause bed-wetting at night.
* Anatomical defect. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.
Several factors have been associated with an increased risk of bed-wetting, including:
* Sex. Bed-wetting can affect anyone, but it's more common in boys.
* Family history. If both of a child's parents wet the bed as
children, their child has an 80 percent chance of wetting the bed, too.
* Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.
Although frustrating, bed-wetting without a physical cause doesn't pose
any health risks. The guilt and embarrassment a child feels about
wetting the bed can lead to low self-esteem, however.
Rashes on the bottom and genital area may be an issue as well —
especially if your child sleeps in wet underwear. To prevent a rash,
help your child rinse his or her bottom and genital area every morning.
It also may help to cover the affected area with a petroleum ointment at
Preparing for your appointment
You're likely to start by seeing your family doctor or your child's
pediatrician. However, he or she may refer you to a doctor who
specializes in urinary disorders (pediatric urologist or nephrologist).
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
* Write down any symptoms, including any that may seem unrelated. It
can also be helpful to keep a voiding diary. Write down when your child
goes to the toilet, as well as whether or not he or she felt a sense of
urgency to urinate. Also include your child's total daily fluid intake
and his or her fluid intake after the evening meal, if possible.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, vitamins and supplements that your child is taking.
* Write down questions to ask your child's doctor.
Your time with your child's doctor may be limited, so preparing a list
of questions can help you make the most of your time together. List your
questions from most important to least important in case time runs out.
For bed-wetting, some basic questions to ask your doctor include:
* What's causing my child to wet the bed?
* When might he or she outgrow wetting the bed?
* What treatments are available, and which do you recommend?
* Are there any side effects?
* Are there any alternatives to the primary approach that you're suggesting?
* Are there any fluid or dietary restrictions that my child needs to follow?
* Is there a generic alternative to the medicine you're prescribing?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:
* Is there a family history of bed-wetting?
* Has your child always wet the bed, or did it begin recently?
* How often does your child wet the bed?
* Does the bed-wetting seem to be triggered by certain foods, drinks or activities?
* Is your child dry during the day?
* Is your child facing any major life changes or other stresses?
* Does your child complain of pain or other symptoms when urinating?
* If you're divorced, does your child live in each parent's home and does the bed-wetting occur in both homes?
What you can do in the meantime
Try to be patient and understanding with your child. Bed-wetting is a
source of anxiety and frustration for your child. He or she is not
wetting the bed on purpose. While you're waiting to see the doctor, try
limiting the amount of fluid your child drinks in the evening.
Tests and diagnosis
Your child will need a physical exam. Depending on the circumstances,
urine tests may be done to check for signs of an infection or diabetes.
If the doctor suspects an anatomical abnormality or other problem, your
child may need X-rays or other imaging studies of the kidneys or
Treatments and drugs
Most children outgrow bed-wetting on their own. If there's a family
history of bed-wetting, your child will probably stop bed-wetting around
the age the parent stopped bed-wetting.
Generally, your child will be your doctor's guide to the level of
necessary treatment. If your child isn't especially bothered or
embarrassed by an occasional wet night, less aggressive treatments may
be all that's needed. However, if your grade schooler is terrified about
wetting the bed on a sleepover, he or she may be more motivated to try
These small, battery-operated devices — available without a prescription
at most pharmacies — connect to a moisture-sensitive pad on your
child's pajamas or bedding. When the pad senses wetness, the alarm goes
off. Ideally, the moisture alarm sounds just as your child begins to
urinate — in time to help your child wake, stop the urine stream and get
to the toilet. If your child is a heavy sleeper, another person may
need to listen for the alarm.
If you try a moisture alarm, give it plenty of time. It often takes at
least two weeks to see any type of response and up to 12 weeks to enjoy
dry nights. Moisture alarms are highly effective, carry a low risk of
relapse or side effects, and may provide a better long-term solution
than medication does.
If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:
* Slow nighttime urine production. The drug desmopressin acetate
(DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or
ADH) that forces the body to make less urine at night. The medication is
available as a pill or nasal spray. However, the nasal spray isn't
recommended for the treatment of bed-wetting because this form of the
medication stays active for much longer, which can increase the risk of
serious side effects. Although DDAVP has few side effects, the most
serious is a seizure. This can happen if the medication is accompanied
by too many fluids. For this reason, don't use this medication on nights
when your child has had a lot of fluids. Additionally, don't give your
child this medication if he or she has a headache, has vomited or feels
* Calm the bladder. If your child has a small bladder, an
anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine
(Levsin) may help reduce bladder contractions and increase bladder
capacity. Side effects may include dry mouth and facial flushing.
* Change a child's sleeping and waking pattern. The antidepressant
imipramine (Tofranil) may provide bed-wetting relief by changing a
child's sleeping and waking pattern. The medication may also increase
the amount of time a child can hold urine or reduce the amount of urine
produced. Imipramine has been associated with mood changes and sleep
problems. Caution is essential when using this medication, because an
overdose could be fatal. Because of the serious nature of these side
effects, this medication is generally recommended only when other
treatments have failed.
Sometimes a combination of medications is most effective. There are no
guarantees, however, and medication doesn't cure the problem.
Bed-wetting typically resumes when the medication is stopped.
Lifestyle and home remedies
Here are changes you can make at home that may help:
* Limit fluid intake in the evening. Limit your child's fluid intake
during the evening. Around 8 ounces (about a quarter of a liter) or so
in the evening is generally enough, but check with your doctor to find
out what's right for your child. There's no need to limit your child's
fluid intake, but some experts feel a good rule of thumb is for children
to have 40 percent of their liquids between 7 a.m. and noon, another 40
percent between noon and 5 p.m. and just 20 percent of their daily
fluids after 5 p.m. However, don't limit fluids if your child is
participating in sports practice or games in the evenings.
* Avoid beverages and foods with caffeine in the evening. Caffeine
may increase the need to urinate, so don't give your child drinks, such
as cola, or snacks that have caffeine, such as chocolate, in the
* Encourage double voiding before bed. Double voiding is urinating
at the beginning of the bedtime routine and then again just before
falling asleep. Remind your child that it's OK to use the toilet during
the night if needed. Use small night lights so that your child can
easily find the way between the bedroom and bathroom.
* Encourage regular urination throughout the day. During the day and
evening, suggest that your child urinate once every two hours, or at
least enough to avoid a feeling of urgency.
* Treat constipation. If constipation is a problem for your child,
your doctor may recommend an over-the-counter stool softener.
Many people are interested in trying alternative therapies to treat
bed-wetting, and several therapies, such as hypnosis and acupuncture,
appear to be somewhat effective. However, other therapies currently
don't have evidence to support their use.
* Hypnosis. Small trials of hypnosis coupled with suggestions of
waking up in a dry bed or visiting the toilet in the night found that
this therapy may help some children stay dry throughout the night.
* Acupuncture. This treatment involves the insertion of fine needles
in specific parts of the body. Results of multiple studies have found
that acupuncture is effective for some children.
* Diet. Some people believe that certain foods adversely affect
bladder function and that removing these foods from the diet could help
decrease bed-wetting. Limited research has not involved many subjects,
and more study is needed.
* Chiropractic. The idea behind chiropractic therapy is that if the
spine is out of alignment, normal bodily functions will be affected.
However, convincing evidence is lacking regarding the use of
chiropractic for the treatment of bed-wetting.
* Homeopathy and herbs. Although some people are interested in
homeopathic remedies and herbal products, none of these has been proven
effective in clinical trials. If you decide to try such a product, check
with your child's doctor before giving it to your child, as some of
these products may contain harmful ingredients or may interact with
other medications your child is taking.
Coping and support
Children don't wet the bed to irritate their parents. Because your
child's bed-wetting is involuntary, it's illogical to punish wet nights
or reward dry nights. Try to be patient as you and your child work
through the problem together.
* Be sensitive to your child's feelings. If your child is stressed
or anxious, encourage him or her to express those feelings. When your
child feels calm and secure, bed-wetting may become a thing of the past.
* Plan for easy cleanup. Cover your child's mattress with a plastic
cover. Use thick, absorbent underwear at night to help contain the
urine. Keep extra bedding and pajamas handy.
* Enlist your child's help. Perhaps your child can rinse his or her
wet underwear and pajamas or place these items in a specific container
for washing. Taking responsibility for bed-wetting may help your child
feel more control over the situation.
* Celebrate effort. Don't punish or tease your child for wetting the
bed. Instead, praise your child for following the bedtime routine and
helping clean up after accidents.
With reassurance, support and understanding, your child can look forward to the dry nights ahead.