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Bed-wetting (nocturnal enuresis)

Boy sleeping in bed at night Boy sleeping in bed at night  

What is bed-wetting?

Bed-wetting, also known as nocturnal enuresis, is urination (peeing) at night that your child cannot control. It is a very different condition from diurnal enuresis (daytime wetting).

How common is bed-wetting?

Bed-wetting is common in young children. It is found in about 20 per cent of five-year-olds but falls to about 2 per cent of fifteen-year-olds.

Very few children have dry nights before they are three years old. Most children start to stay dry at night between ages three and eight. Until your child achieves this milestone, they will benefit from your patience and understanding.​

Unintentional and unconscious urination at night is a normal stage in your child’s development. Most children will be toilet trained for the daytime long before they are able to be toilet trained for night time. Do not look at bed-wetting as failed toilet training. Each child matures and develops good bladder control at a different pace.

Causes of bed-wetting

In most cases, bed-wetting occurs because your child is simply a deep sleeper and does not wake up when their bladder is full.

Often, the tendency to wet the bed can run in families. If you were a bed-wetter, your child is more likely to do the same.

In very rare cases, bed-wetting can be caused by type 1 diabetes or a congenital (from birth) defect of the urinary tract. However, these conditions also cause daytime symptoms too. If your child does not experience daytime wetting, you can rest assured that they are likely to be completely healthy.

Some children can start to wet the bed when they had previously been dry at night as a response to changes in their lives. These changes may include moving to a new home, the birth of a brother or sister or new child-care arrangements. If your child has suddenly started to wet the bed after an extended dry period, talk to them about what is bothering them and try to help them cope with the change.

When to see a doctor about bed-wetting

Your child should see a doctor if there is a sudden onset of bed-wetting following a six-month, completely dry period. Although some cases of sudden bed-wetting are caused by life changes, a doctor should also check your child for any underlying medical condition or illness.

Your child may also need to see a doctor if:

  • enuresis occurs during the day and night after the age of six
  • the bed-wetting bothers your child and prevents them from going to sleepover parties or staying overnight at camp.

Your child’s doctor will advise you about treatment options.

How bed-wetting is treated

If your child is experiencing bed-wetting, your child’s doctor may prescribe a hormone called desmopressin (DDAVP). However, this is only for temporary use for sleepovers or overnight camp.

If your child’s doctor finds a physical cause for daytime wetting, such as a urinary tract infection, they may prescribe medication such as antibiotics​.

How to help your child with bed-wetting

Most children stop wetting the bed without treatment. Until that happens, the following tips can be helpful.

What to do

  • Reassure your child that wetting is not their fault and that it will get better in time.
  • Encourage or gently remind your child to go to the toilet before bedtime.
  • Ask your child to go to the bathroom at the beginning of the bedtime routine and then again just before going to bed. An overall bladder retraining​ routine may also help.
  • Remind your child to get up at night and use the toilet.
  • Make sure there is a clear path from your child's bedroom to the toilet.
  • Use a plastic cover on your child’s mattress.
  • Include your child in any morning cleaning routines in a way that does not punish or humiliate them.

What to avoid

  • Do not encourage your child or offer positive reinforcement for dry nights. This approach is no longer recommended because it can indirectly cause a child to feel shame for any wet nights.
  • Do not ‘lift’ your child at night (wake them to urinate), as it is often more trouble than it is worth.
  • Although it can be easy to feel frustrated if you find yourself constantly washing your child’s sheets, do not punish or humiliate your child for their bed-wetting.
  • Do not let other family members make jokes or tease your child about their condition.

Key points

  • Bed-wetting is common in young children.
  • Every child develops bladder control at a different pace.
  • Speak to a doctor if your child suddenly wets the bed after an extended dry period or has difficulty controlling their bladder during the day and night after six years of age.
  • Help your child by reassuring them and offering gentle reminders about bathroom routine.
  • Punishing or humiliating a child will not help them develop better bladder control.
Elizabeth Berger​, BA, MD, FRCPC, FAAP, MHPE​