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4/30/21blog post

why is my child wetting the bed?

Bedwetting can be a very frustrating and sometimes embarrassing problem to deal with and can potentially lead to negative impacts on self-esteem and quality of life. While there are several explanations as to why your child might be having this issue, it is typically due to a maturational delay in the development of bladder control at night. Christopher Brown, MD, pediatric urologist at Dayton Children’s sat down with us to talk about bedwetting, why it happens and what you can do to help your child.

Who wets the bed and why does it happen?
By the age of 5, approximately 85% of children will be dry through the night, leaving approximately 15% of children that will continue to wet the bed. In any consecutive year after the age of 5, about 15% of children still wetting the bed will gain the ability to stay dry through the night. In younger children, bedwetting is more common in boys, however, it is seen with similar frequency in both boys and girls in adolescence.  By the time a child is a teenager, there is a less than 1% chance that they will still have issues with bedwetting. While not always popular, simply waiting for your child to develop nighttime bladder control on their own is always an option.

What causes bedwetting?
There are multiple factors that can contribute to children being affected by bedwetting. As children develop, they gain control of their bladder and bowels in a stepwise fashion: first, with nighttime bowel control, followed by daytime bowel control, then daytime urinary control and finally nighttime urinary control. The most common reason for children wetting the bed longer than expected or desired is simply a delay in this maturational process. However, there can be additional functional or anatomic issues leading to bedwetting, including:

  • Overproduction of urine at night that exceeds the capacity of the bladder
  • Impairment of the normal sleep arousal response – these children are frequently described as “deep sleepers”
  • Bladder overactivity
  • Small functional bladder capacity
  • Constipation (when the rectum is full of stool it can irritate the bladder and the surrounding nerves leading to impaired bladder filling and bladder instability)

What can be done at home about this?
It is important to help your child realize that this is not their fault, and they should not be punished for continued bedwetting, as this is commonly counterproductive. Successes should be rewarded. Any treatments considered do not have much chance of success if your child is not motivated to become dry at night. On your own, families can try:

  • Limiting excessive fluid or food intake in the evening prior to bed
  • Voiding immediately before going to sleep
  • Encouraging your child to get an adequate amount of sleep for his/her age
  • Avoiding constipation
  • Practicing a low-calcium, low-sodium diet in the afternoon and evening meals
  • Waking your child up and taking them to the bathroom before parents go to bed

When should my child see a specialist about bedwetting versus going to our pediatrician?
Your pediatrician is a great place to start with any concerns you may have with bedwetting. Many pediatricians are comfortable and familiar with this issue. When considering an active treatment for bedwetting, the treatments that have shown the best results include alarm therapy (a small device clipped to the underwear and worn through the night that will wake the child when he/she starts to wet) and a medication called Desmopressin or DDAVP, which helps to limit the production of urine through the night. You should consider seeing a specialist if your child has any known anatomic or functional bladder abnormalities, if the bedwetting is particularly severe or resistant to the previously mentioned treatments, or in older patients with new-onset bedwetting. 

To make an appointment with a Dayton Children's pediatric urologist visit childrensdayton.org/schedule-urology-appointment

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Christopher Brown, MD

urology
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