Many children continue wetting the bed at night for years after finishing toilet training. Although this can be upsetting, it is not usually a sign of a serious problem and is considered normal up to at least age five. Even at age seven, 5 to 10% of children in the United States still wet the bed. Without any treatment at all, 15% of these children will stop wetting each year, although a small number may continue to do so as adults.
Bedwetting happens more frequently in children whose parent or parents wet the bed, and it is more common in boys than girls.
About Bedwetting, “Nocturnal Enuresis”
A child who has not stayed dry at night for six months after successful toilet training has what is called primary enuresis. A child who starts to wet the bed after being dry has secondary enuresis, which is frequently associated with other problems.
When bedwetting occurs along with other symptoms, there may be a physical condition that needs attention, such as:
- Abnormalities or infections of the urinary tract
- Neurologic conditions and/or developmental abnormalities
If you are concerned because your child is five years of age or older and wetting the bed, take him to the doctor to make sure nothing else is wrong and to get help managing the bedwetting. Medical issues need to be treated first.
The doctor should thoroughly examine your child and check the urine. He will want to know how much wetting the bed is upsetting your child and your family. He may refer you to a specialist if he suspects a more serious underlying problem and not just bedwetting.
It is very important to understand that wetting the bed is not your child’s fault. You should not get angry at him or punish him. Simple bedwetting may happen because a full bladder does not wake your child up enough to get to the toilet, he makes a lot of urine at night, and/or his bladder holds a relatively small amount of urine.
Assuming there are no other problems, your child can be treated after age 5 if needed. If you can wait until he is older, your child will be able to help more with his own treatment. Medications are usually not started until age 7.
There are two main types of treatments for bedwetting:
- Behavioral therapy, including a bed alarm
- Medication, usually desmopressin
A family can begin behavioral therapy at any time. Easy actions include restricting evening fluid intake or carrying a sleeping child to the toilet and waking him to urinate. More effective interventions include:
- Dry bed therapy. Your child helps you change his wet bedclothes.
- Scheduled times for urination, including waking your child or having him wake to a clock or phone alarm to go to the bathroom.
- Using a bed alarm to alert your child to.
The Bed Wetness Alarm
The bed alarm is the most effective type of behavioral therapy. Pads are placed on your child’s clothes or bed with sensors that detect wetness, and an alarm will go off to wake your child. The goal is for him to hear the alarm, stop urinating, turn it off, go to the bathroom to finish urinating, then reset the alarm and return to bed.
Parents and child need to cooperate for this to work. They must commit to a three-month trial period. Parents may have to wake up a child who sleeps through the alarm or does not complete all the tasks alone. This can disrupt everyone’s sleep.
Over time, the intervals between alarms should increase, and the number of alarms decrease. Wet spots on the bed should get smaller, and eventually, the bed should be dry.
Children frequently relapse after stopping alarm therapy. It can be used again, as needed.
Medication for Bedwetting
The current medication of choice for bedwetting is desmopressin. This drug mimics a hormone which decreases the amount of urine produced. Desmopressin works quickly and does not disrupt sleep. Your child’s doctor will start with a low dose, increasing it if necessary. The doctor should explain everything you need to do, including limiting your child’s evening fluid intake.
The medication should be stopped for a week, every three months to see if your child is dry. Relapse is common, and medication can be used again. Desmopressin can also be used along with alarm therapy.
Desmopressin may be the best choice for a child seven-years-of-age or older who desires rapid improvement, or when the child or family does not want the work of an alarm system. It can be taken just for sleepovers or camping if fear of wetting the bed is making your child avoid these activities.
Currently, other medications can be used. These have more side effects and may be best for children who have other physical issues.
As noted, most children stop wetting the bed even with no treatment, so that “tincture of time” may be the best therapy for some children and their parents.