Bedwetting in children is very common, but often parents are unsure at what age their child should stop wetting the bed. Consultant Paediatrician Dr Kishor Tewary from BMI The Priory Hospital answers common questions and considers when it’s time to seek professional help.
Bedwetting can present in a number of ways. Some children will pass urine only once in the night, often towards the early morning, while others may wet the bed a number of times throughout the night.
Below I’ve given answers to some of the most common questions on the subject. If you are at all worried about your child’s bedwetting, talk to a professional.
At what age should children stop wetting the bed?
Children usually achieve daytime dryness (continence) by about three years of age. We expect children to be dry both day and night by their fifth birthday.
After age five, if a child is still bedwetting we call it ‘nocturnal enuresis’.
If you hear a medical professional talking about enuresis, they might call it ‘primary’ or ‘secondary’. Primary is when the child has never stopped bedwetting. Secondary is where they had stopped but have started again after some time of being completely dry.
- At what point should parents be concerned and seek medical attention?
If children are not (and have not been) dry by five years of age, parents should actively look for advice, whether this is from your school nursing team or your GP. Evidence suggests that the longer the child continues bedwetting after their seventh birthday, the longer it can take to stop.
Therefore while it’s a very common problem in young children, it should be addressed as soon as possible after turning five so that it doesn’t become chronic or have an effect on a child’s psychological and social development.
What advice would you give to parents whose child keeps bedwetting?
If your child is still bedwetting after the age of five, seek help. Often there are simple measures that can be taken to improve the situation, such as managing their fluid intake, establishing a more consistent bladder habit, or creating a reward system.
Sometimes you and your child might need further support, using an enuresis alarm (more on this below) or medication.
A medical professional will be able to help you find the right solution for you. We’ll create a bespoke plan based on your child’s individual needs and symptoms.
What are the common causes of bedwetting?
Most commonly it is due to delayed maturation of bladder-brain coordination, particularly in children who are heavy sleepers. These children will often wet the bed towards the early morning and sleep through it.1
It can also occur due to lack of surge of a hormone called ‘vasopressin’ at night. Vasopressin diminishes our urine production at night. If a child is lacking this hormone or has low levels, they may continue to produce urine through the night the same way they do in the day.
These children will likely wet multiple times a night and may wake up. Treatment involves an external administration of the hormone by mouth for a few months.
Another cause of bedwetting is an irritable or overactive bladder. If this is the case, most children will have daytime symptoms too, such as having accidents due to the inability to hold urine, or needing to wee frequently. There are medications and exercises that can help with this.2
How is bedwetting treated?
The treatment will depend on the child, but most are simple and non-invasive.
Primary enuresis is normally treated by changing your child’s behaviour through new habits and schedules, which might be encouraged using reward systems such as star charts.
You might also be recommended a bedwetting alarm, also known as an enuresis alarm. This has a sensor that goes off when it gets wet, waking up your child.
If we do find any issues with vasopressin levels or an overactive or irritable bladder, we may prescribe medication.1
What can be done at home to prevent or improve bedwetting?
Good hydration and regular intake of fluids are important, as is making sure your child is going to the toilet regularly. Together these can help regulate bladder function.
Encourage your child to drink 6-8 glasses of water a day and to empty their bladder regularly throughout the daytime. You may be able to get support in this from your school nurse.
I find that many patients try to pre-empt bedwetting by waking their child a few hours after going to bed. This is not recommended and can actually be more disruptive to the child’s sleep.
Instead, stopping drinks a few hours before bed and working on establishing regular toilet habits and good perineal hygiene is a better approach.2
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