Thursday, February 11, 2016

What to do about bedwetting

If your child is still wetting the bed, you're not alone. Up to 7 million kids still wet their beds after age 6. Here are some tips on dealing with this common problem.

What to do about bedwetting

Up to 7 million kids still wet their beds after age 6. Plenty just need a little longer to develop the internal alarms and hold-it systems that keep urine in until a child wakes up and stumbles into the bathroom.  (AP Photo/Messenger-Inquirer/John Dunham)
Up to 7 million kids still wet their beds after age 6. Plenty just need a little longer to develop the internal alarms and hold-it systems that keep urine in until a child wakes up and stumbles into the bathroom. (AP Photo/Messenger-Inquirer/John Dunham)

by Gary A. Emmett, M.D

 If your child is still wetting the bed, you’re not alone. Up to 7 million kids still wet their beds after age 6. Plenty just need a little longer to develop the internal alarms and hold-it systems that keep urine in until a child wakes up and stumbles into the bathroom.  It may – or may not – be comforting to know that by age 15, just 1 to 2 kids in 100 are still having problems with wet beds.

Kids who wet the bed fall into two categories.


  1. Children who have never (yet) been consistently dry at night.  These children almost always have histories of parents who wet their beds and they are remarkably deep sleepers who are simply hard to wake up.  Bladder pressure doesn’t rouse them – they just sleep right through their wetting themselves and their bed.  They wet their beds because they do not respond to high bladder pressure that wakes up most people.   This group usually stops nighttime wetting at the same age their parents stopped it. Most bed-wetters fall into this group.
  2. Children who were dry at night and now are not. This group was completely dry and then starting wetting their beds. This is very different, and much rarer, issue.  A few of them have bladder infections or kidney problems and this can be diagnosed quickly with a urine sample for analysis.  Many of this small group can get all better just with a course of antibiotics.  Another reason for losing the ability to be dry at night is, unfortunately, severe emotional distress such as child abuse (physical, sexual and/or emotional), bullying at school or post-traumatic stress disorder. If that describes your child, have a serious conversation with your doctor about the steps you should take to find the cause, and help your child heal.
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Back to group #1. Here’s what you should know:


Q: How common is bedwetting in children who are daytime toilet-trained?

A: Over 20 percent below age 5 and even 5 percent in the teenage years (just no one talks about it)

Q: At what age are most children able to control their bladder?

A. Most girls potty train for daytime dryness by age 30 months and for night dryness by age 5. Boys can also potty train for day dryness by 30 months of age, but may need til age 6 to stay dry overnight.

Q:  Could something be wrong with my child’s bladder?

A: In children who have never been consistently dry at night and are perfectly trained during day, urinary tract disease is unheard-of as the cause of bed-wetting. (Of course, if your child has other signs of bladder problems such as pain, fever, an unusual urine odor, nausea, vomiting or just looking unwell with a fever and no known cause, contact your doctor.)

See your doctor if your child has never been dry – day or night – by age 4.  

Q:  What are your top tips for helping children who wet the bed?

A: For all children:

  • No liquids after dinner
  • Awaken child before the parent goes to sleep and make him or her go to the bathroom and then back to sleep
  • Teach child to hold urine in during the day for slightly longer periods of time

For children who are dry during day, wet at night and 6 years old or over:

  • The 3 above and the “Carrot and the Stick”

CARROT: Get a “star chart” (a calendar and gold stars), and if the child goes a week without bedwetting let him or her do a big kid thing like ride his bike to the end of the block (but the child has to want to do this big child thing). (Don’t reward with toys or food.) Continue to extend the dry period needed for a reward over time UNTIL DRY ALL THE TIME.

STICK: The child is responsible to strip the bed and take the sheets to the washer/dryer or gets to sleep in wet sheets.

Q: How can I help my child keep their bed dry?

Try the ideas above. And consider buying a bedwetting alarm that will awaken the child when his/her underwear start to get damp (it will also probably awaken the parents – many types available on line, for example,

Q: How soon does bedwetting resolve itself?

A: If you do nothing, 10 percent of nocturnal enuresis (the medical term for bed wetting) goes away every year. If you do everything I recommended above, 30 percent goes away every year. There is no easy solution. 

Q: Does bedwetting emotionally affect my child?

A: In a young child, it may only be an issue if he or she goes to sleep-away camp or to a friend or relative’s house for a sleepover. But after age 10, emotional reactions may be more severe.

Q:  How can I help my child cope with wetting the bed?

A: Reassure him/her it is normal. If you or your spouse experienced the same challenge, tell your child about it.  

Gary A. Emmett, M.D., F.A.A.P., has been a primary care pediatrician in South Philadelphia and Center City since 1979.  He is currently an attending pediatrician at Nemours Pediatrics, Philadelphia and Director of Hospital Pediatrics at Thomas Jefferson University Hospital

Does your child wet the bed – or did she or he? What did you do about it? What helped most?

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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