A child who pees the bed can cause frustration for parents and be a source of embarrassment for the child.
Often, parents feel like this behavior warrants intervention, but really it doesn’t if your child is young. Kids under 6 years of age don’t usually wet the bed on purpose. More often than not, the communication between their brain and their bladder just hasn’t matured yet.
Daytime dryness can happen quickly after potty training is accomplished, but nighttime bladder control can take time and maturity. This is especially true for kids who are deep sleepers.
In this article, we will look at reasons why kids wet the bed, how you as the parent can make things better for your child and some treatment options.
Reasons That a Child Pees the Bed
The medical term for bed wetting is nocturnal enuresis. There are several possible reasons why your child may have nocturnal enuresis.
- Maturity of the brain/bladder connection hasn’t happened yet
- Emotional stress or trauma: in a child who was dry at night before and now wets the bed or one who has never been dry at night, you might consider whether emotional stress or trauma may be contributing to this problem. I see this often in kids of divorced parents who create turmoil in custody situations or cause any other family crisis. Additionally, kids who have other social stressors or kids who have lots of school stress or put undo pressure on themselves to perform in a certain way can express their stress through bed-wetting.
- Health conditions: ADHD, abnormalities in bowel or bladder function, constipation and obstructive sleep apnea can all contribute to bed wetting. If your child was previously dry at night and is now wetting the bed, you can also consider whether or not they may have a UTI. Kids with urinary tract infections usually have daytime accidents, pain with urination or abdominal pain as well. Children who have an overactive bladder may struggle with bedwetting.
- Substances such as caffeine are diuretics and cause the brain to block the release of antidiuretic hormone. This contributes to the need to release urine at night. There are many other reasons for children to avoid caffeinated drinks, but certainly bedwetting is one of them.
- Family history. Often “prolonged” noctural enuresis runs in families. In my evaluations for bedwetting, I always ask about any family members that wet the bed for an extended period of time.
How Parents Can Help Decrease Bed Wetting
Parents can help children to be set up for success by decreasing the chances of bed wetting.
Here are some steps parents can take to address bedwetting and help their child overcome this challenge:
1. Limit fluids before bedtime: Limiting fluid intake before bedtime can help decrease the likelihood of bedwetting. Encourage your child to drink plenty of water during the day and gradually reduce their intake in the two hours before bedtime.
2. Encourage a visit to the bathroom before bedtime: Include a potty stop in your bedtime routine. Children with enuresis benefit from solid nighttime bathroom habits.
3. Positive reinforcement by tracking dry nights: Maintain a chart or diary to track the nights your child is free of nighttime wetting. Only do this if it is confidence boosting for your child. If it makes them feel bad, then try a different strategy to celebrate the times that they have control of their bladder at night.
4. Wake children at specific times: Some parents find success in waking their child during the night to use the bathroom. Set an alarm to wake your child at regular intervals, ensuring they have an opportunity to empty their bladder before any accidents occur. This is a form of bladder training that parents can initiate.
5. Talk to your child’s doctor: If bedwetting persists or if your child is older than six years, consult with your child’s pediatrician. We can help you to figure out what is going on.
6. Plastic cover /protective cover or mattress protector for your child’s bed: prevents your child’s bed from smelling strongly of urine.
How Do You Know if the Cause is a Medical Problem
If a child, who has been completely toilet trained for six months or longer, suddenly begins wetting the bed, it could be an indication of an underlying medical problem.
Several signs associated with this issue need to be considered:
- Changes in bathroom habits such as frequent urination or pain with urination
- Abnormalities in urine production such as a narrow or small stream of urine or dribbling of urine
- Cloudy urine or pink urine
- Behavior changes such as anxiety, depression or moodiness in addition to urinary symptoms
- Loss of bladder control can indicate a problem in your child’s spinal cord. Definitely something that your pediatrician should know about right away.
- Signs of childhood constipation such as infrequent stools, hard stools or abdominal pain
Managing a Child Who Pees the Bed
While this condition can be normal for children, it can also be frustrating. Changing wet bed sheets every morning is no fun for anyone. There are several ways to manage nighttime enuresis in children.
- Support instead of punishment: Do not punish your child for accidents. Find other ways to support your child such as pull ups at night, quick change of sheets and monitoring what your child drinks close to bedtime.
- Honesty and understanding: An embarrassed child is more likely to lie about their bed wetting. Allow for honest dialogue with your child and normalize this condition for them. Depending on their age, teach your child how to change their own sheets so they can be empowered to have some control over the situation.
- No teasing. Instruct siblings and other caregivers/ relatives that we don’t make fun of each other, especially the child that is struggling with getting out of bed at night to use the bathroom.
Bedwetting Alarms
Some parents find that bed-wetting alarms fit well into their family life while others find them to be difficult to use and even annoying. Your child will wear a sensor clipped to their underpants that serves as a moisture alarm. The idea is that it will wake your child before you get to the soggy sheet level of urine in the bed. This can be a successful treatment for many kids, but requires time and patience. It often takes at least 6-8 weeks to notice a difference in nocturnal enuresis when using an alarm.
These bed alarms are not always an effective treatment for kids who are very deep sleepers. They will often sleep through the sound of the alarm and wake up in wet sheets.
Medications to Prevent a Child from Peeing the Bed
There are several kinds of treatment available for bed wetting. These medications include:
- Desmopressin is a synthetic hormone that mimics the effects of vasopressin or antidiurectic hormone. This medication reduces the production of urine. It comes in pill form or as a nasal spray. Common side effects may include nasal congestion, headache, and stomach pain. This is the medication that pediatricians use most often.
- Oxybutynin and tolterodine belong to a class of medications called anticholinergics. They work by relaxing the bladder muscle, reducing the urgency to urinate and increasing bladder capacity. However, these medications may cause dry mouth, constipation, and blurred vision.
- Imipramine is a tricyclic antidepressant that has been found to have an effect on bladder control. Side effects may include drowsiness, constipation, and dry mouth.
- Solifenacin and trospium chloride are antimuscarinic medications that work by blocking the action of a neurotransmitter called acetylcholine, which is responsible for bladder contractions. These medications help relax the bladder muscle, reducing the frequency of nighttime urination. Common side effects include dry mouth, constipation, and blurred vision.
Patience and Time
Thankfully, most kids will overcome their noctural enuresis by the time they reach the age of six years old. The rest will typically be dry by college. So, take heart. Allow for the tincture of time with a good dose of parental patience to allow you to making it through this hurdle.
If you are looking for a pediatrician who has time to thoughtfully listen to you and care for your child, I am she. Visit my website to set up a free meet and greet. We are here to help you and your family with your pediatric care needs.
At 127 Pediatrics, an at-home pediatrician service based in Colleyville, TX, we understand the challenges that come with being a new parent, especially when it comes to a baby’s needs.
© 127 Pediatrics; December 2023
This article is for informational purposes only and should not be construed as medical advice.
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls-only concierge pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.
