Health Essentials from Cleveland Clinic

You’re frustrated. You’re exhausted. Your child is already in school – and he is 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 him to empty his bladder. Still, no luck.

You are not alone. Parents often worry about bedwetting in their children, a problem defined as “involuntary urination in children 5 years of age or older.” But in reality, approximately 15 percent of children in the United States are still wetting the bed at age 5.

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

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Should I be worried?

Dr. Janjua says bedwetting is not a concern until your child is 5 years old. When your child is older than age 5 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 not yet matured.

Also, keep in mind that about 15 percent 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. Janjua says.

She says the parents are usually upset because it’s an ongoing issue – and everybody needs to get some sleep. She says there are chances that there is a family history of bedwetting as well. To combat bedwetting, 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 him or her to urinate on demand isn’t the answer, either – and will only lead to more sleeplessness and frustration.
• Don’t resort to punishment. Getting angry at your child doesn’t help him learn. The process doesn’t need to involve conflict.

Try a bedwetting alarm if other options fail

If the above strategies don’t help, a bedwetting alarm is often 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, parents should not expect the alarm to wake up the child. Instead, this is a signal that they need to get up to wake their child; get him or her into the bathroom; clean off the bed; and repeat the process.” Dr. Rhee says.

Medications: not usually recommended

Although there are medications, including a synthetic form of a hormone, that can address bedwetting, Dr. Rhee doesn’t prescribe them unless a child is already on the medication.

“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 bedwetting on purpose. Parents will ask, “‘Doesn’t he want to get better?’” Dr. Janjua 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,” she says.

Dr. Rhee says it’s also important to talk to your child to see if there is motivation to change.

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

As the child gets older and has opportunities to go to slumber parties and weekend trips, bedwetting can affect his or her confidence and social life. This will most likely motivate the child to solve the problem and avoid feeling embarrassed.

When bedwetting signals more serious issues

Occasionally, bedwetting 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 is not a first course of evaluation of a child with bedwetting issues.
• Urinary tract infections (UTIs) – A urine sample can detect these infections, which is a typical test doctors will order when bedwetting 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, approximately 20 percent of children have daytime incontinence. But, only 5 percent of teenagers have these symptoms,” Dr. Janjua says.

More information

From Bedwetting to Kidney Stones: Urinary Problems in Children