Bed-wetting affects over five millions children in the US.

Bed-wetting is a common pediatric concern affecting over five million children in the US.  Medically it is called nocturnal enuresis, which refers to nighttime involuntary urination in children over the age of six.  Most children achieve nighttime bladder control by age six years; however, about 6% of girls and 9% of boys continue to wet the bed at age 7.  Many of these children gain nighttime bladder control by age 10 but some go on to experience bed-wetting for several more years.

Children older than age 6 who have never achieved nighttime bladder control are said to have primary nocturnal enuresis.  Your health care provider should be alerted to the presence of bed-wetting to determine if there is a medical problem that needs to be addressed and assist the parent and child in choosing appropriate intervention strategies.

Some children achieve nighttime control by age 3 to 4 but then suddenly begin wetting the bed again.  These children are said to have secondary enuresis.  There are many causes of secondary enuresis including psycho-social factors, physical factors, diabetes, child abuse, or change in sleep patterns.  Secondary enuresis should be quickly brought to the attention of the child’s health care provider.

What Causes Bed-wetting?
There are a variety of factors that cause or contribute to bed-wetting.  They include:

  • Genetics (bed-wetting tends to run in families)
  • Gender (bed-wetting is more common in boys than girls)
  • Sleep or arousal disturbances (very deep sleeper)
  • Small bladder (the child’s bladder may not be developed enough)
  • Inability to recognize the feeling of a full bladder (developmental)
  • Hormonal factors (too little of the hormone antidiuretic hormone which slows nighttime urine production)
  • Stress (first exposure to school, new baby brother, parental divorce, etc.)
  • Urinary tract infections
  • Abnormality of the spine or nervous system (infrequent)

How can your child’s nurse practitioner or physician help?
The primary care provider will ask you and your child several questions about factors that may be related to bed-wetting such as a family history of enuresis, current and past bladder control, sleep patterns, physical and social symptoms, and family situational factors.  These questions will help the provider determine if and how much more how much investigation needs to be completed.  A physical examination will help to determine if a physical abnormality is present or if there are other factors that need attention.  A urinalysis will be probably be obtained to assess for infection and diabetes.  Referral to a urologist or other specialist is infrequently needed.

When is Bed-wetting a Problem?
Parents and children may answer this question differently.  For parents, caring for wet children and wet sheets, often several days a week and in the middle of the night, can be frustrating.  Bed-wetting is not so much a problem as an inconvenience.  Children are sometimes not bothered by bed-wetting unless they feel pressure or teasing from parents, siblings, or friends.  Children often voice concerns about bed-wetting at the age when it may affect sleepovers with friends, visiting grandparents, or attendance at summer camp.  Older children know that most of their friends do not have bed-wetting problems and self-esteem can be affected. Keeping an open an honest line of communication with your child is the first and best way to protect their emotional health.  Be sensitive and be discreet.  No child should have to hear a discussion about his/her bed-wetting at a social event such as a family gathering.  If you deal with the issue in a matter of fact way, your child will likely do the same.