How to Help Older Children Overcome Bedwetting

At what age is bedwetting a problem? It’s a common question fielded by pediatricians everywhere.

Bedwetting among older children is common, but can be uncomfortable and embarrassing for children and frustrating for parents. Because it’s rarely talked about among friends and extended family members, both parents and children can feel like there is something wrong with them when bedwetting continues into the elementary years and beyond.

So how can you get an older child to stop wetting the bed?

What parents should know about bedwetting

Jennifer Kirk, MSN, CPNP, a nurse practitioner in the Division of Urology at Children’s Hospital of Philadelphia (CHOP), works with dozens of families every year to help children overcome bedwetting.

Her first piece of advice is to recognize how common bedwetting is, and that most children naturally outgrow it. Experts estimate that 15 to 20 percent of children between the ages of 5 and 7 wet their beds at least occasionally. The numbers drop steadily as children age, down to about 2 percent at age 16. “About 15 percent of children who wet the bed will become dry every year,” says Kirk.

Bedwetting causes

Why do children wet the bed?

• In many cases, bedwetting is a genetic pattern, inherited from a parent, aunt or uncle.
• Most older children who wet the bed are very sound sleepers, so the signals of a full bladder aren’t strong enough to wake them.
• Some children have small bladders or don’t produce enough of a hormone (vasopressin) that reduces urine production during sleep.
• Bedwetting can be triggered by stress and by changes in the family, even positive ones, like a new baby or a different bedtime schedule over vacation.

In some cases, especially when bedwetting is a new occurrence, it can be a sign of another health problem. If your child is older than 7 and has started to wet the bed after many months of being dry, talk to your pediatrician. Your child’s primary care provider will ask if there have been any stressful events or changes in your child’s life, and can screen for health problems such as diabetes, constipation, sleep apnea or a urinary tract infection.

“You should only consider bedwetting a problem if your child does, for example if they feel embarrassed or upset, or if there is a medical cause for concern,” says Kirk. “The motivation to stop bedwetting needs to come from the child.”

How parents can help a child who wets the bed

“The key thing is not to blame or shame your child,” says Kirk. “Instead, focus on positive encouragement and practical steps you can take together.”

What are some of those practical steps to stop bedwetting?

Manage daytime fluid intake and urination

“Focus on what is going on during the day,” says Kirk. “The timing of fluid intake and urination during the day affects what happens at night.”

• Work with your child to make a habit of urinating every two or three hours during the day, even when they don’t feel the need. Have them void twice at bedtime — once an hour before they go to bed and then again right before they go to bed.
• Have your child use a calendar tracker to understand urination patterns over time. CHOP offers two of these trackers on its website, one for children and preteens and one for teens. This can give your child a sense of control over their bedwetting and help them see and feel good about progress.
• Encourage your child to drink plenty of fluids early in the day, rather than waiting until the end of the day to quench their thirst. Children who participate in sports late in the day should hydrate before their practice or game, then try to limit fluid intake during the evening.

Minimize disruption and discomfort at night

Use a waterproof mattress cover and keep a clean set of sheets and sleepwear at hand in case a change is needed.

Consider a bedwetting alarm

Bedwetting alarms have a moisture sensor that triggers a bell or buzzer when the child’s pajamas start to get wet. “The alarm is for the parent, at least at first,” says Kirk. “A child who can sleep through a wet bed will sleep through the alarm.” So you might want to put a baby monitor in the child’s room.

The process takes time, but after three or four months most children (not all) learn to awaken when the alarm sounds and to get up and use the toilet.

“The alarm requires a motivated child and a motivated family to work,” says Kirk. “Timing is important. Pick a time free of stressors and when the family isn’t overcommitted.”

Talk with your child’s primary care provider about medication

Some children are helped by a medication — DDAVP^®, or desmopressin — taken as a pill before bedtime to reduce the amount of urine produced during sleep. DDAVP can be a valuable tool for special events like sleepovers and sleep-away camp when used in addition to fluid and voiding management during the day.