Health Essentials from Cleveland Clinic

You’re frustrated. You’re exhausted. Your child is already in school – and they’re still wetting the bed at night. You’ve tried limiting liquids after dinner. You’ve woken your child up in the middle of the night and asked them to go the bathroom. Still, no luck.

You aren’t alone. Parents often worry about bed-wetting in their children, a problem defined as “involuntary urination in children 5 years of age or older.” But in reality, about 15% of children in the U.S. are still wetting the bed at age 5.

To help parents deal with this challenge, we turned to Charles Kwon, MD, a pediatric nephrologist and Audrey Rhee, MD, a pediatric urologist.

Should I be worried?

Dr. Kwon says bed-wetting isn’t a concern until your child is 7 years old.

When your child is older than age 7 and still wetting the bed, you might want to talk with your child’s primary care physician or a pediatric nephrologist or urologist. The underlying issue is usually a bladder that’s not yet matured.

Also, keep in mind that about 15% of children age 5 or older actually stop wetting the bed each year.

“When I meet a child who is wetting the bed, it’s twice as likely to be a boy. He usually presents with no other medical problems,” Dr. Kwon says.

Dr. Kwon says the parents are usually upset because it’s an ongoing issue – and everybody needs to get some sleep. There are chances too that there’s a family history of bed-wetting as well. To combat bed-wetting, doctors suggest:

• Shift times for drinking. Increase fluid intake earlier in the day and reduce it later in the day.
• Schedule bathroom breaks. Get your child on a regular urination schedule (every two to three hours) and right before bedtime.
• Be encouraging. Make your child feel good about progress by consistently rewarding successes.
• Eliminate bladder irritants. At night, start by eliminating caffeine (such as chocolate milk and cocoa). And if this doesn’t work, cut citrus juices, artificial flavorings, dyes (especially red) and sweeteners. Many parents don’t realize these can all irritate a child’s bladder.
• Avoid thirst overload. If schools allow, give your child a water bottle so they can drink steadily all day. This avoids excessive thirst after school.
• Consider if constipation is a factor. Because the rectum is right behind the bladder, difficulties with constipation can present themselves as a bladder problem, especially at night. This affects about one-third of children who wet the bed, though children are unlikely to identify or share information about constipation.
• Don’t wake children up to urinate. Randomly waking up a child at night and asking them to urinate on demand isn’t the answer, either. It will only lead to more sleeplessness and frustration.
• An earlier bedtime. Often children are deep sleepers because they’re simply not getting enough sleep.
• Cut back on screen time, especially before bedtime. Improving sleep hygiene can help their minds slow down so they can sleep better.
• Don’t resort to punishment. Getting angry at your child doesn’t help them learn. The process doesn’t need to involve conflict.

Medications: not usually recommended

Although there are medications (including a synthetic form of a hormone) that can address bed-wetting, Dr. Rhee doesn’t prescribe them unless a child was already put on the medication by another provider.

“There are side effects,” she says. “Plus it’s a temporary fix, a Band-Aid remedy, when what we want is an overall solution.”

Does my child want to learn?

Families often wonder if a child is bed-wetting on purpose. Parents will ask, “‘Don’t they want to get better?’” Dr. Kwon often tells parents that it’s typically not their fault nor is it their child’s fault. “I tell them not to get too stressed, because this issue often resolves on its own,” he says.

Dr. Rhee adds it’s also important to talk to your child to see if there is motivation to change. If they are motivated to change, a bed-wetting alarm can be the solution. 

You can clip the alarm to the child’s underwear or place it on the pad on the bed. Once the device detects any moisture, the alarm goes off.  But if the child isn’t independently motivated, the alarm may have no benefit for the child and may just further frustrate the family.

“If they’re still sneaking drinks late at night and eating what they shouldn’t, then it doesn’t make sense to invest in an expensive bed-wetting alarm. So, I directly ask a child if bed-wetting bothers them, to find out if it’s the parents’ frustration that brought the child to the appointment or their own,” Dr. Rhee says.

As the child gets older and has opportunities to go to slumber parties and weekend trips, bed-wetting can affect their confidence and social life. This will most likely motivate the child to solve the problem and avoid feeling embarrassed.

When bed-wetting signals more serious issues

Occasionally, bed-wetting is a sign of something more significant, including:

• Sleep apnea – If a child snores a lot or otherwise shows signs of sleep apnea, Dr. Rhee will investigate further. Otherwise, this isn’t a first course of evaluation of a child with bed-wetting issues.
• Urinary tract infections (UTIs) – A urine sample can detect these infections, which is a typical test doctors will order when bed-wetting is an issue.
• Diabetes – A urine sample can also detect diabetes in children.

If a child also has daytime incontinence, age is something to consider. Generally children will outgrow the issue. “In preschool, about 20% of children have daytime incontinence. But, only 5% of teenagers have these symptoms,” Dr. Kwon says.