Dry Bed, Dry Eyes: Overcoming Bedwetting

Staying dry through the night is a milestone in the toilet training process. By 5 years of age, most children are able to go through the night without having an accident. But despite being able to use the bathroom normally during the day, many children older than 5 wet their beds regularly, a condition called nocturnal enuresis. Some continue to struggle with bed-wetting into their teen years.

What causes bed-wetting?

Here are some of the reasons why your child may be wetting the bed:

• It can be hereditary. Your child is likely to be a bed-wetter if there is a family history.
• Many children who wet the bed are very heavy sleepers who don’t wake when their bladder is full.
• During sleep, the body produces a hormone called vasopressin that reduces urine production. Usually the body begins producing vasopressin during early childhood. If your child’s body is slow to develop vasopressin, he may make more urine than the bladder can hold, which could lead to bed-wetting.
• Bed-wetting could be a sign of a bladder infection or the onset of juvenile diabetes.
• Your child may have a small bladder that can’t handle the amount of urine produced at night.
• Emotional and social factors play a role. Children who are stressed are more likely to wet the bed.

Tips for helping your child overcome bed-wetting

Wetting the bed can be very upsetting for your child. It can affect your child's self-esteem and cause anxiety — especially if your child is going to a sleepover at a friend’s house. It’s important that you offer lots of love and support; let your child know you are there to help him or her overcome the problem. In addition, try the following:

• Give your child most of his fluids in the morning and afternoon. Encourage him to do most of his drinking in the morning and at school.
• Limit all fluids two hours before bedtime.
• Don’t give your child anything that can irritate the bladder. Caffeine, carbonation (fizzy drinks), citrus juices and sports drinks should be avoided — especially at night.
• Have your child use the toilet twice before bed. If bedtime is at 8 p.m., have her go at 7 p.m. and then again right before bed.
• Give your child plenty of praise for dry nights.
• Offer disposable nighttime underpants (don’t force your child if he doesn’t want to wear them).
• Keep a pad under your child’s fitted sheet to protect the mattress.
• Do not scold or punish your child for wetting the bed. Show understanding and compassion.
• To help exercise the bladder during the day, encourage your child to wait to urinate and try to hold her urine for 5 to 10 minutes longer than usual.
• If the problem does not resolve in a timely manner, call your pediatrician or seek the help of a specialist.

The Division of Urology at CHOP is a leader in treating all types of urological conditions in children, including bedwetting.

Contributed by: Patrick S. Pasquariello, MD