Bed-wetting — also called nighttime incontinence or nocturnal enuresis — is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.
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 normal part of a child's development.
Generally, bed-wetting before age 7 isn't a concern. At this age, your child may still be developing nighttime bladder control.
If bed-wetting continues, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medication may help reduce bed-wetting.
Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.
Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.
Consult your child's doctor if:
No one knows for sure what causes bed-wetting, but various factors may play a role:
Bed-wetting can affect anyone, but it's twice as common in boys as in girls. Several factors have been associated with an increased risk of bed-wetting, including:
Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. However, bed-wetting can create some issues for your child, including:
Depending on the circumstances, your doctor may recommend the following to identify any underlying cause of bed-wetting and help determine treatment:
Most children outgrow bed-wetting on their own. If treatment is needed, it can be based on a discussion of options with your doctor and identifying what will work best for your situation.
If your child isn't especially bothered or embarrassed by an occasional wet night, lifestyle changes — such as avoiding caffeine entirely and limiting fluid intake in the evening — may work well. However, if lifestyle changes aren't successful or if your grade schooler is terrified about wetting the bed, he or she may be helped by additional treatments.
If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment.
Options for treating bed-wetting may include moisture alarms and medication.
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 and wake the child.
If you try a moisture alarm, give it plenty of time. It often takes one to three months to see any type of response and up to 16 weeks to achieve dry nights. Moisture alarms are effective for many children, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does. These devices are not typically covered by insurance.
As a last resort, your child's doctor may prescribe medication for a short period of time to stop bed-wetting. Certain types of medication can:
Slow nighttime urine production. The drug desmopressin (DDAVP) reduces urine production at night. But drinking too much liquid with the medication can cause problems, and desmopressin should be avoided if your child has symptoms such as a fever, diarrhea or nausea. Be sure to carefully follow instructions for using this drug.
Desmopressin is given orally as a tablet and is only for children over 5 years old. According to the Food and Drug Administration, nasal spray formulations of desmopressin (Noctiva, others) are no longer recommended for treatment of bed-wetting due to the risk of serious side effects.
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 medication is stopped, until it resolves on its own at an age that varies from child to child.
Here are changes you can make at home that may help:
Some people may choose to try complementary or alternative medicine approaches to treat bed-wetting. For approaches such as hypnosis, acupuncture, chiropractic therapy and herbal therapy, evidence of effectiveness for bed-wetting is weak and inconclusive or such efforts have proved to be ineffective. In some cases, the studies were too small or not rigorous enough, or both.
Be sure to talk to your child's doctor before starting any complementary or alternative therapy. If you choose a nonconventional approach, ask the doctor if it's safe for your child and make sure it won't interact with any medications your child may take.
Children don't wet the bed to irritate their parents. Try to be patient as you and your child work through the problem together. Effective treatment may include several strategies and may take time to be successful.
With reassurance, support and understanding, your child can look forward to the dry nights ahead.
You're likely to start by seeing your child's pediatrician. However, he or she may refer you to a doctor who specializes in urinary disorders (pediatric urologist or pediatric nephrologist).
Here's some information to help you get ready for your appointment, and know what to expect from your doctor.
Before your appointment, make a list of:
Some basic questions to ask your doctor may include:
Don't hesitate to ask other questions during your appointment.
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask: