Wetting the bed isn’t talked about too often but, for the sake of parents and kids alike, we need to open up the discussion on bed wetting so you can learn how and when to help your sleeping angels keep dry and happy.
Bed wet: A river runs through it
It can be hard to know what is “normal” when it comes to bed wetting. For babies, it’s a part of life, so thankfully we have nappies. For older children, there are different stages of development when it comes to urination and some children need a bit more encouragement than others. But generally speaking, bedwetting in children is surprisingly common. About 10% of 10-year-olds still have visits from the pee fairy at night, as do 3% of 15 year olds.
However, usually from about 3–7 years of age, children will start becoming dry on their own and by age five, 80% have developed sufficiently to sleep through the night and not wet the bed. Often girls will reach this level of maturity a little earlier than boys. Many children will get the hang of it after potty training, but for others, it may take a few more years.
When should they stop wetting the bed?
Learning not to wet the bed is a process, like learning to walk – it requires the nervous system and neurological pathways to reach a certain level of maturity before it can evolve. In adults and older children with fully developed nervous systems, urination is a voluntary process; it can be turned on and off like a tap. However, until a child reaches two to five years of age, their nervous system is underdeveloped and peeing is controlled by an involuntary mechanism. Even if they want to, young children can’t turn off the tap.
Older children generally develop the ability to turn off, but that may not be enough to stop bed wetting. Some kids are just very heavy sleepers, and don’t respond to the signal from the bladder telling them they “gotta go”. Like the parts of the nervous system which control urination, the parts which control waking from sleep are beyond a child’s control. Children don’t choose whether they are a heavy or light sleeper anymore than they choose whether or not they wet the bed. It’s important to understand that it’s not the child’s fault if they don’t wake up.
|Understand that your child cannot help wetting the bed. It is not something they do on purpose, nor something they can control|
|Understand that children who are heavy sleepers cannot control whether or not they wake up. It is not their fault if they are unable to wake to go to the toilet|
Dam builders: How to stop kids wetting the bed
Ever done something by accident and been made to feel really bad about it? Everyone has at some point, so we all know it’s a great way to make someone feel guilty. This is why it’s important to not make a big deal about a little pee. Not only will this make your li’l trooper feel worse, it will also put more pressure on them – which never helps. Kids who wet the bed are often teased by their friends, which can be humiliating and reduce their self-esteem. They may be reluctant to go to sleep over parties or on school trips, and even family holidays can be distressing for children worried about wetting the bed.
If children feel their bed-wetting problem is creating tension in their family, this will only make their problems with self-esteem worse and cause them distress. Research has shown that bed wetting is the third biggest cause of distress in children; only their parents getting a divorce or fighting causes kids greater distress.
Bed wetting in children is also a significant source of stress for parents, not because they can’t deal with a little mopping up in the middle of the night or extra washing the next day (although these are a significant burden for parents), but because they worry about how bed wetting will affect their child emotionally.
|Develop strategies for coping with bed wetting that show your child it’s no big deal|
|Take time to remind your child that they are fantastic and bed wetting is not their fault|
No time like the right time for bed wetting solutions
If your child wets the bed, you’re probably at least a little concerned about how to manage their problem. Unfortunately, kids don’t come with instruction booklets, so sometimes it’s hard for you to know when to bring out the big guns, like going to your GP. You really have to gauge how your child is developing in this area. If you feel they are struggling and not developing consistently, then follow your gut.
It’s important not to make it a big deal and never to punish your child for wetting the bed. Remember that bed wetting is something they can’t control and punishment won’t change that. But it’s important not to ignore bed wetting either. There are many simple ways you can help your child without turning the problem into a big deal or source of humiliation.
You may casually remind them to “wee before bed” and “no big drinks before sleeping”. Children may not fully comprehend the relationship between drink and wee and these measures will help them understand. And it’s amazing how often these simple tips are forgotten. Ever had a pint before bed? Undoubtedly you needed to go to the loo in no time at all. There are also some great products out there that weren’t around even a generation ago. For instance, pull-up nappies for toddlers and older kids won’t stop your child wetting the bed, but are a great way to minimise the mess. This way, while your child is still learning, the clean-up is not such a challenge, in the middle of the night when your eyes are only half open.
|Your child is NEVER punished for wetting the bed because it is not their fault|
|Your child is reminded not to drink too much before bedtime|
|Your child is reminded to go to the toilet before sleeping|
|Pull-ups are used to minimise the mess and make the midnight clean-up easier|
When is the right time to act on children wetting the bed?
If your child is still struggling by about 6 years of age, it’s a good time to check them out to ensure it’s just normal bed wetting rather than something more serious. For example, if your child is amongst the 4% of Australian bed wetters who are also troubled by wetting their pants in the day, there might be something more serious going on down there. Other problems like dribbling after urination or feeling pain in the genitals when they’re trying to pee are also signs you should have a chat with the family doctor about your child’s bed-wetting.
Your child’s pattern of daytime urination can also give you signs that their bed-wetting may be something that needs further consultation with your doctor. Children who need to pee often, hesitate or strain to pee, or have an intermittent or weak stream of urine, should be taken to see their doctor. If your child previously kept dry at night and has only recently stated wetting the bed, a visit to the doctor is also essential to rule out illness, emotional stress and health conditions like diabetes which are all possibilities in previously dry kids who start wetting the bed.
If you answer yes to any of the following, a trip to the doctor is in order
|Your child is six years or older|
|Your child wets their pants in the day|
|Your child has other problems urinating in the day which may include:|
Be prepared for the third degree. The doctor will want to know all the gory details like how often, how much and at what time, as well as all about your family life, how your child is getting on at school and any other health problems they might have. They may even want to take a urine sample for examination or check out your child’s kidneys using ultrasound. It’s not being nosy- any one of your answers to these seemingly personal questions might provide the clues you doctor needs to determine if it’s just one of those painful parts of growing up or a sign of another problem.
Pom poms for pee pee: How to stop your child wetting the bed
Regardless of the source of the problem, your doctor can give you advice about how to stop your child wetting the bed. While tablets are also available to treat bed wetting, they are considered a last resort and are only effective in treating bed wetting caused by a condition called nocturnal polyuria – where the brain doesn’t produce enough of the hormone that stops you from peeing, anti-diuretic hormone. The properly functioning brain increases its production of anti-diuretic hormone at night, to give the bladder a bit of extra help not to pee. For kids with nocturnal polyuria, tablets can help them stop wetting by stimulating the brain to make more of this hormone.
But usually all it takes to help your child is a little patience, education and encouragement, so grab your pom poms and think of yourself as a cheerleader for the cause. Start by reminding yourself and your child that bed-wetting is common. If you haven’t already, it might also be a good idea to talk to them about what they think causes their bed-wetting problems. It will get you talking, and that’s a good thing.
It’s also important to sort out any urination problems which occur in the day, before you start trying to tackle the problems which present at night. Make sure your child is peeing regularly throughout the day, drinking the right amount of fluid and eating all the right healthy foods. Avoid beverages containing caffeine as these affect the way the kidney processes urine and can make the problem worse.
|Remind yourself and your child that bed wetting is common|
|Talk to your child about what they think causes bed wetting|
|Make sure your child urinates regularly throughout the day|
|Ensure your child is getting the right amount of fluid, and does not drink beverages containing caffeine|
|Make sure your child is eating a healthy diet|
You can use star charts and reward your little man or lady when they take action to prevent bed wetting, like remembering to go to the toilet or avoiding drinks before bed. But it’s usually not a good idea to reward staying dry, as this is something your child can’t control. It’s important not to imply they are “bad” if they wet the bed. Be careful not to tell them that they’re good when they don’t wet the bed as that might inadvertently send this message.
|If you choose to use a reward system like a star chart, make sure you and your child have agreed upon controllable behaviours like peeing before bed for rewards|
|Do not reward dry nights as your child cannot control whether or not they wet the bed|
With good eating and drinking patterns and support and encouragement from their parents, most kids outgrow bed-wetting without any other treatment. However, some do not and continue to wet the bed as teenagers and adults. If bed wetting problems persist, your child may need more than encouragement.
Bring out the bed wetting alarm
Another behavioural technique can involve bed wetting alarm systems that can be hired from local hospitals or bed wetting services. A monitor attached to the sheet or your child’s undies detects wetness and raises a little alarm to wake you and your child. This helps your sleeping cub associate needing to wee with waking up … rather than sleeping through a rainstorm. However, if you choose to try an alarm, bear in mind you’ll need to wake up and ensure your child goes to the toilet every time the alarm goes off, and then re-attach it before your child goes back to sleep. If you’re finding bed wetting stressful to cope with already, the alarm system might not be the best option.
For a little more help, there are specialist clinics for bed wetting and your doctor can provide a referral!
|Try a bed wetting alarm to help your child stay dry|
|As a last resort, discuss medicines that might help your child stay dry with your doctor|
It needs to be stressed that bed wetting isn’t a “problem” – it’s a process of growing up. Getting stressed about it will only make things worse. Working through this process with your child is a part of parenting, which to some degree you just have to learn about as you go along. Never be scared to ask your GP for advice; they answer these questions every day! Before you know it, bed wetting will be all over – and it will be time for the teen years.
The “teen phase”, however, has no known cure.
- NICE clinical guideline 111: Nocturnal enuresis: The management of bed wetting in children and young people [online]. London: National Institute for Health and Clinical Excellence; October 2010 [cited 15 November 2011]. Available from: URL link
- Caldwell PH, Edgar D, Hodson E, Craig JC. Bedwetting and toileting problems in children. Med J Aust. 2005;182(4):190-5. (Abstract | Full text)
- Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176(1):314-24. (Abstract | Full text)
- Bottomley G. Treating nocturnal enuresis in children in primary care. Practitioner. 2011;255(1741):23-6. (Abstract)
- Fillingham S, Douglas J. Urological Nursing (3rd edition). Edinburgh: Baillière Tindall; 2004. (Book)
- Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453-66. (Abstract | Full text)
- Schulpen TW. The burden of nocturnal enuresis. Acta Paediatr. 1997;86(9):981-4. (Abstract)
- Van Tijen NM, Messer AP, Namdar Z. Perceived stress of nocturnal enuresis in childhood. Br J Urol. 1998;81(Suppl 3):98-9. (Full text)
- Nørgaard JP, Djurhuus JC, Watanabe H, et al. Experience and current status of research into the pathophysiology of nocturnal enuresis. Br J Urol. 1997;79(6):825-35. (Abstract | Full text)
- Kuehhas FE, Djakovic N, Hohenfellner M. Infantile enuresis: Current state-of-the-art therapy and future trends. Rev Urol. 2011;13(1):1-5. (Abstract | Full text)
- Bower WF, Moore KH, Shepherd RB, Adams RD. The epidemiology of childhood enuresis in Australia. Br J Urol. 1996;78(4):602-6. (Abstract)
- Nevéus T. Nocturnal enuresis: Theoretic background and practical guidelines. Pediatr Nephrol. 2011;26(8):1207-14. (Abstract | Full text)
- Neveus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: A standardization document from the International Children’s Continence Society. J Urol. 2010;183(2):441-7. (Abstract | Full text)
- Dr Joe Kosterich, Virtual Medical Centre. Bed Wetting . Available from: URL Link