When parents won’t tell my front office staff why they need an appointment, it’s often code for “My kid is wetting the bed.” They find the issue embarrassing, and that’s understandable—but it’s also problematic. You see, the silence surrounding bedwetting has led to all sorts of misinformation that can keep kids from getting treatment or a more accurate diagnosis. It’s time for us to pull back the covers on five pervasive rumors once and for all.
It breaks my heart that some children think they’re the only one who has this problem. In reality, 20 percent of 5-year-olds pee in their sleep, and with each successive year, only 15 percent of that group stop. Ten percent of kids in any given elementary school wet the bed, as do 3 percent of tweens and teens in any given middle school. And if you really want to destigmatize bedwetting for your kid, think back on your own childhood. Around 50 percent of boys and girls who wet the bed have a mom or a dad who did too. Many parents are embarrassed to share their history even though hearing about it could comfort a frustrated child.
Doctors view bedwetting as a normal part of development until around age 7, and most say age 6 (sometimes 5) is the earliest they’ll consider treatment. Time provides a cure for almost everyone, but it’s impossible to say when it will happen for any one child. That’s why you should wait until your kid wants to work on the problem to treat it. Rest assured, less than 1 percent of adults wet the bed.
On the contrary, children who wet the bed usually feel shame about the habit and would be willing to do anything to make it stop. And yes, this rule holds true even if your child only has accidents now and then. “Many kids don’t wet the bed every single night,” says Howard Bennett, M.D., author of Max Archer, Kid Detective: The Case of the Wet Bed. If you wake up to yet another soaked comforter and accidentally let out an exasperated sigh, be sure to follow it up with a hug, because your child is just as upset as you are. Never discipline her for bedwetting. And keep in mind that punishments can be subtle: For example, buying a new sleeping bag or comforter for a sibling—and not for the child who wets the bed—sends a hurtful message.
Kids with this issue often have a smaller—not weaker—bladder than their peers, but the real issue is how readily a child rouses from sleep. Children who stay dry at night wake up more easily as the night wears on, whereas for bedwetters, it becomes increasingly difficult as the hours tick by. To help your child learn to get up and pee in the middle of the night on his own, some experts suggest waking him partway through the night or placing a moisture sensor in his underwear so an alarm rings or vibrates at the first drop of urine. Both strategies are worth a try, but neither guarantees a dry night.
Soaking the sheets can be a symptom of a number of health conditions, including urinary tract infections and diseases of the kidneys and endocrine system (like diabetes) that increase urine output. Once you bring up the problem with your pediatrician, she’ll likely collect a urine sample to screen for these conditions.
Some wetting problems stem from physical issues close to the bladder, like labial adhesions (a film of scar tissue that can close the opening of the vagina), or vesicoureteral reflux (an abnormal flow of urine from the bladder back up through the ureters—the tubes that connect the kidneys to the bladder). In rare cases, the ureters can even connect to the vagina rather than to the bladder, causing constant leaking.
It’s also possible your child has a medical problem that has almost nothing to do with her urinary tract. Sleep apnea—when a child’s breathing periodically pauses or becomes shallow during sleep, often because she has enlarged tonsils or adenoids—can cause bedwetting and should be considered in every child’s medical evaluation.
Constipation also frequently leads to urinary issues: If a mass of stool grows large enough, it can push on the back of the bladder, instigating bladder spasms. These may cause a child to experience day- or nighttime wetting. What’s more, the nerves that control the bladder and the rectum are intertwined, so holding in stool can affect a child’s bladder control. Fortunately, identifying and treating constipation by making certain dietary changes (for example, eating more fruit, vegetables, and whole grains, and less meat, cheese, and fast food), using stool softeners, or even going to physical therapy can help resolve bedwetting.
Until your child is at least 6 years old, the only thing you should do is reassure him that it’s perfectly normal, you’re not angry with him, and that he’s going to outgrow this. After that, you can talk to your pediatrician to rule out other medical problems, and start to consider adjustments to your routine, including cutting off any caffeine after 4 p.m., limiting fluids to 2 ounces after 6 or 7 p.m., making sure your child pees right before bed, waking him during the night to pee, or having him wear a bedwetting alarm. In the meantime, keep your chin up and your worry in check. Oh, and buy a waterproof mattress pad (and these pee-proof pajamas).