“Oh no, not again!” Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don’t despair. Bed-wetting isn’t a sign of toilet training gone bad. It’s often a normal part of development.

What is it?

Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Children who’ve never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.

Generally, bed-wetting before age 6 or 7 isn’t cause for concern. At this age, nighttime bladder control simply may not be established.

If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.

What causes it?

No one knows for sure what causes bed-wetting, but various factors may play a role.

  • A small bladder. Your child’s bladder may not be developed enough to hold urine produced during the night.
  • Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep – especially if your child is a deep sleeper.
  • A hormone imbalance. During childhood, some kids don’t produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production.
  • Stress. Stressful events – such as becoming a big brother or sister, starting a new school or sleeping away from home – may trigger bed-wetting.
  • Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, frequent urination and pain during urination.
  • Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child’s breathing is interrupted during sleep – often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness.
  • Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, unusual thirst, fatigue and weight loss in spite of a good appetite.
  • Chronic constipation. Sometimes children who don’t have regular bowel movements retain urine as well. This can lead to bed-wetting at night.
  • Anatomical defect. Rarely, bed-wetting is related to a defect in the child’s urinary system.

What are the symptoms?

Bed-wetting is characterized by involuntary urination at night.

Most kids are fully toilet trained between ages 2 and 4 — but there’s no target date for developing complete bladder control. At age 3, about 40 percent of children wet the bed. At age 5, bed-wetting remains a problem for up to 20 percent of children.

Are there any natural therapies?

Your health care professional should assess whether the problem is minor and if it is disease-related.

Most children outgrow bed-wetting on their own. Limiting fluids before bedtime and double voiding — urinating at the beginning of the bedtime routine and then again just before falling asleep — may help.

You may want to encourage your child to delay daytime urination as well. If the bladder isn’t completely full, the urge to urinate may fade within a few minutes. With practice, this simple “stretching exercise” may help your child’s bladder hold more urine at night.

If your child is still wetting the bed by age 7 — and is motivated to stop — your child’s doctor may recommend more aggressive treatment.

A moisture alarm may be a handy tool to help ease bedwetting. These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child’s pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — hopefully in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights.

What else can I do?
Children don’t wet the bed to irritate their parents. Be patient as you and your child work through the problem together. Make sure that you:

  • Adopt good habits.
  • Be sensitive to your child’s feelings.
  • Put your child to bed earlier.
  • Plan for easy cleanup.
  • Enlist your child’s help.
  • Celebrate effort.

Did you know?

Bed-wetting can affect anyone, but it’s twice as common in boys. It also tends to run in families. A child with two parents who wet the bed as children has an 80 percent chance of wetting the bed, too.