Overcoming Bedwetting

Dear Mr. Dad: My seven-year-old is a happy, well-adjusted, intelligent boy, but he still wets the bed almost every night. How unusual is this? Should we have him tested to see if there’s a medical problem, or is there something we can do to help him overcome this on his own?

A: Sporadic or continuous bedwetting is far more common than most parents realize, even long after daytime toilet training is completed. A quarter of five-year-olds still wet the bed. By age seven, it’s down to 20 percent, and by age ten it’s about five percent. That number keeps dropping into the early teens, and fewer than one percent of middle schoolers are still wetting the bed.

Bedwetting (also known as “nocturnal enuresis”) can result from any number of causes—medical, behavioral, environmental—and most are nothing to worry about, and it almost always goes away on its own.

Let’s start with some of the basics: Did you or your wife have the same problem when you were young? Recent research has found that the tendency to urinate at night often has a genetic component. You’ve developed the ability to wake up when you feel bladder pressure, while a child still sleeps through the sensation. Letting your child know that bedwetting often runs in families—especially if you had the problem yourself—can help your son to feel less ashamed of something that really isn’t his fault.

Testing is rarely necessary unless your child was dry for six months or more and then began wetting the bed again. This is called secondary nocturnal enuresis and may (or may not) indicate a medical condition.

Before even considering medical intervention, make sure you’ve tried the obvious. Limit your child’s liquid intake after dinner and require a trip to the bathroom immediately before going to bed. Avoid anything with caffeine in it, which acts as a diuretic. Sometimes these simple solutions do the trick.

If not, there are several treatments available. Your child can sometimes develop greater bladder control by waiting a little longer to urinate during the day. Knowing he really can hold it in if he has to can be a big confidence booster. There are also a variety of alarms that vibrate when they sense moisture, waking the child and building a conditioned response to the full bladder. Talk to your pediatrician to see if one or more of these approaches is appropriate to your child’s situation and age. Again, remember that even without any interventions, your child is almost certain to grow out of it before long.

In the meantime, it’s important to help your child deal with the embarrassment he surely feels. Bedwetting can take a toll on a child’s self-esteem, hurt his performance at school, and can make it hard to develop and maintain friendships (sleepovers, camping trips, and other overnight activities are out).

It’s never appropriate or helpful to punish your child for wetting the bed. Younger kids can wear pull-ups at night, but for older bedwetters this can be a source of shame, so it’s better to use a waterproof mattress pad and cover. Some experts suggest having the child help change the sheets each time, but only as a normal part of his or her responsibilities. It should never be viewed or presented as a “you made this mess, now you clean it up” kind of punishment.

Finally, if you’re still concerned, you might want to pick up a copy of “The Potty Trainer,” by Dr. Preston Smith. You can also listen to a podcast of an interview I did with Dr. Smith at my website, www.mrdad.com/radio.