Bed-wetting (also called “nocturnal enuresis”) is not a “behavior problem” – rather it is a physical problem. There are many possible reasons for nighttime accidents, including:
- Small bladder. If a child’s bladder isn’t fully developed, it may not be big enough to hold all the urine produced during the night.
- Genetic factors. Parents who were bed-wetters themselves have a higher chance of having children who are bed-wetters. When nocturnal enuresis is genetically inherited, the problem can persist for longer than usual. For instance, it can be a family tendency that the kids still wet their beds past 7 or 8 years of age. Indeed, in some cases bed-wetting can continue right through adolescence (and even into adulthood). Medical treatments can usually provide significant relief.
- Poor signals. The child fails to awaken when the bladder is full because the brain is not registering the “full” signal.
- Slow or delayed nervous system development.
Bed-wetting may also be an indication of another medical problem, including sleep apnea, diabetes, urinary tract infection, problems with the urinary system, or constipation. If wet nights are consistent, talking to a doctor about the problem is recommended. Bed-wetting can also result from emotional stress such as occurs when parents are fighting frequently, someone in the family is ill, there are significant changes in the child’s life, he or she is being bullied or abused, a new baby is born into the family, or when any other form of stress is present in the child’s life.
Distinguishing between Normal and Not Normal Bed-Wetting
Bed-wetting is common in households with young children. At which age can parents expect bed-wetting to stop? How can parents tell if their child is going through a normal developmental phase or if their child has some sort of problem that requires professional attention?
Bed-wetting is common and normal for children under the age of 5. However, by the age of 6, bed-wetting should be a rare occurrence. If it is still happening twice per month in this age group, it can be considered a medical problem that should be attended to. Although the doctor may find that everything is perfectly normal and simply prescribe “patience,” it is important to rule out possible medical issues at this stage.
In addition, if a child starts wetting his bed after long periods of dry nights, or if he experiences pink or painful urination, unusual thirst, or snoring, he should be seen by a doctor.
Bed-wetting in young children usually stops on it’s own so it’s best not to start any treatment until the child is six or seven years-old (although it is sometimes started earlier if the bed-wetting is damaging the child’s self-esteem and/or relationship with family/friends). Helpful treatments and techniques may include:
- Bed-wetting alarms – these sound a loud tone when they sense moisture and can help by conditioning the child to wake up at the sensation of a full bladder
- Decreasing the consumption of liquids before bedtime
- Praising the child when he has a dry night
- Avoiding punishments, reprimands and other signs of disapproval
- Waking the child at night to empty his bladder
- Encouraging the child to go to the bathroom before bedtime
- Diapers, pull-ups or absorbent underwear can be helpful in managing bed-wetting (and is especially helpful in avoiding embarrassment at sleepovers or similar activities)
Some medications such as anti-diuretic hormone nasal spray or tricyclic anti-depressants may also help. If the bed-wetting is occurring due to emotional stress, consulting a child or adolescent psychiatrist or psychologist can be helpful.