Wetting the bed at night causes kids and parents a lot of stress. It is a really common problem, one that I see every week. Parents will kill themselves, setting alarms at night to help their kids get up and pee, buying all sorts of fancy devices, and trying all sorts of medicines to help “cure” it. The truth is, sometimes it just takes time. There are 2 major classifications of nighttime bed wetting (the medical term is nocturnal enuresis): primary and secondary. Someone with primary nocturnal enuresis has always wet the bed (since being a baby) and has never been night-trained. Secondary nocturnal enuresis refers to someone who has been trained/dry for at least 6 months, then starts night wetting again. Kids with secondary nocturnal enuresis should be evaluated for a possible medical problem.

How common bedwetting?

Fear not, you’re not alone. Most kids don’t night train right off. If often takes a while of being day trained before a kid can hold it at night. The AAP (American Academy of Pediatrics) says 20% of 5 year-olds, 10% of 7 year-olds, 5% of 10 year-olds, and 1% of 15 year-olds have nocturnal enuresis.

Bedwetting causes

There are many potential causes of bedwetting:

  1. Hormones: ADH (or antidiuretic hormone) is supposed to make it so your body doesn’t make as much urine at night. If you don’t make enough hormone, you’ll make too much urine.
  2. Genetics: There is a strong family link to bedwetting. Parents are always reluctant to want to admit to being bedwetters themselves, but it helps explain when kids have trouble with bedwetting. Be more patient if there is a family history of bedwetting.
  3. Bladder problems: If the bladder is tiny or has spasms, there can be problems holding urine.
  4. Deep sleepers: Some people sleep so deep that they just don’t seem to wake when the body senses a need to pee.
  5. Stress: Major life stressors can cause a kid to pee at night. (This usually falls into the category of secondary enuresis though).

Evaluation and Treatment

Depending on the cause, the evaluation may involve questions, a physical exam, and urine analysis. Treatment entirely depends on the cause of the bedwetting, but is often nothing more than reassurance and waiting for time to resolve it. On occasion, your doctor may recommend medications to use for times when wetting the bed may be particularly stressful socially (e.g., a sleepover, boy scout camp). It is worth knowing that nocturnal enuresis has a 15% natural resolution rate per year (e.g., of a 100 kids that wet the bed, 15 of them will stop on their own each year).

Practical bedwetting solutions

I am a practical person at heart. If I tell you that your 5 year-old may wet the bed for the next decade (because dad was a bedwetter), you don’t have to go crazy washing sheets for the next 3,650 nights. Put a Pullup (Huggies) or an UnderJam (Pampers) on your kid at night. I usually tell kids, no underwear until they have been dry for a month. Make the kids handle the pee problem themselves (over age of 5): take off the wet pull up, throw it away, use a wet washcloth to clean the skin or shower (no one wants to smell like pee), and put on clean underwear. Make it a very matter-of-fact situation that just gets quietly addressed. Make sure a kid is never made fun of or teased for it, but empower him/her to handle it independently. Hang in there, this too shall pass.

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