Bed wetting at night is common with young children, however, most children will grow out of it. Treatment programmes are available for a child who has continued bed wetting.
- Wetting the bed at night (nocturnal enuresis) is very common in young children, with slightly more boys than girls affected. Some children also wet their pants during the day.
- Most children will grow out of it.
- Bedwetting is not considered to be a problem until children reach about 7 years of age. Treatment programmes can be started at this time if your child wants to do something about it.
- In some cases, children who start wetting again after a long period of staying dry may be reacting to stress, trauma or illness.
- Consult your family doctor when you first notice bed wetting in your child. You can also contact local continence advisors and school public health nurses.
How common is it?
- Nocturnal enuresis (bedwetting) is the most common form of incontinence in children.
- At five years of age, 15-20%, or one in five children still wet the bed at night.
- This drops to 5% among 10-year-olds.
- Your child is likely to have 2-3 other children in his or her class who also wet the bed.
- Despite treatment, 1- 2% of 15-year-olds will still regularly wet the bed: this may continue into adulthood.
- About 1% of adults may still have occasional problems.
There is no single cause for enuresis in children past the age of expected bladder control. There is a large variation in the way children develop and some children take longer to control their bladder than others.
Some possible causes:
- Family history: Some families have a history of bedwetting. If one parent wet the bed as a child, there is about a 40% chance of their child wetting the bed until a similar age. If both parents wet the bed, there is about an 80% chance of bedwetting in their children.
- Difficulty waking: Children who wet their beds are often thought to be deeper sleepers than other children. However, the problem is more likely to be difficulty in arousal or waking from sleep.
- Urine concentrating hormone: Some children who wet repeatedly at night may have insufficient urine concentrating hormone (ADH) and produce large amounts of weak urine overnight. These children can stay dry if they are able to wake at night to go to the toilet when their bladder is full.
- Overactive bladder: The bladder may be ‘overactive’ – this may lead to wet pants or urgency even in the daytime.
- Small bladder: Children with a small bladder capacity will usually also have problems with daytime wetting.
Can emotional upset cause bedwetting?
Occasionally children wet because of emotional stresses such as parental separation, a new baby, sickness or problems at school. Treatment should include identifying and, if possible, relieving the child's stress.
When should I seek professional help?
Talk to your family doctor if:
- Your child is still wetting the bed at the age of 7 years,
- your child is wetting during the day,
- your child has been dry at night for 6-12 months and then starts to wet the bed again.
The doctor will rule out urinary tract infection and constipation, and want to know about your child’s drinking pattern, how much they wet and when at night. The more information you can provide, the easier it is for the doctor to determine where the problem lies. In some cases the doctor may also recommend referral to a paediatrician.
A continence adviser (a nurse or physiotherapist with expertise in continence management) may be needed to work out a programme suited to your child and family.
If your child attends school you can also contact the public health nurse affiliated with the school (ask at the school office). Public health nurses can help with education, resources, toileting programmes, and support for you and your child.
What do treatment programmes involve?
Most training programmes for children are not successful until the child wants to be dry - when they perceive it as a problem. Be patient and understanding. Reassure your child, especially if they are upset.
- Adequate fluid intake: it is important to ensure your child drinks adequately (at least one litre a day) and regularly. Restricting fluid at night does not stop bedwetting, but avoid caffeinated drinks such as tea, coffee and fizzy drinks before bedtime as these can irritate the bladder.
- Rewards: praise and reward your child for getting up to the toilet. Respond gently if your child wets the bed, even if you feel angry. Don’t punish the child for what s/he can't control.
- Bladder training: this may be helpful if investigations have established the child has a small bladder for their age. The purpose is to increase the amount the bladder can hold by stretching it a little at a time. It involves regular drinking and encouragement to 'hold on' for gradually longer periods during the day, thereby gently stretching the bladder and gradually making it easier to hold on to larger volumes. Regular measurement of urine volumes passed (a bladder diary) will help monitor progress and give the child encouragement.
- Enuresis alarm (bed buzzer): these can be a very effective method of treatment for children who do not respond to simpler measures. A pad in the bed is connected to an alarm which goes off when moisture is detected. This wakes the child and helps him/her to learn how to recognise the sensation of needing to pass urine and to wake when the bladder is full. Body worn and wireless alarms are also available. Families need to be taught how to use it correctly, and in a supportive manner to benefit the child.
- Medication: there are a number of medications that can help your child stay dry, but these do not treat the cause of the bed wetting. A child may become dry, but can revert to wetting when the medication is stopped. There are side effects with some of these drugs, which will be explained by your doctor should this form of treatment be chosen.
- 'Lifting' not advised: it is preferable to avoid “lifting’ the child (routinely carrying the child to the toilet, usually while asleep, to empty their bladder) as this can delay the child achieving dryness independently if they are not properly awake. Lifting can prevent the child learning the sensation of a full bladder and they sometimes become conditioned to pass urine as the parent approaches! If lifting is used as a way of managing wetting, avoid lifting at the same time every night. Once a behavioural management plan is in place, it is recommended that lifting is not continued.
To find alarm providers and more, visit Continence service providers NZ Continence NZ.
Pull ups: can be a useful symptom management tool to reduce stress for both the child and their family but need to be removed before a bedwetting programme is implemented. Pull ups can be useful for school camps and sleepovers and can be placed in the end of the child’s sleeping bag when packing, for them to wriggle into discreetly at bedtime
Mattress protectors: until the child is dry you can protect the mattress with a waterproof cover.