“My 5-year-old is still wetting the bed. Is this normal? What can we do?” For answers in this Sound Advice column, we reached out to Dr. Christopher Straughn, Mom-Approved pediatrician at Forest Lane Pediatrics & Medical City Children’s Hospital in Dallas.
Straughn: Bedwetting is a common issue for young children, with 15% of otherwise healthy and normal 5-year-olds still wetting the bed. Most kids gradually outgrow this and stay dry at night, but 5% of 10-year-olds and up to 2% of 15-year-olds may still have nighttime accidents.
The most important thing to understand is that staying dry at night is not under the child’s conscious control. Once a child is asleep, they are asleep. The good news is that most children eventually are either able to hold it or wake up and use the restroom at night.
“It’s important to make it very clear to the child that it is not their fault.”
For kids 5 and younger, watch-and-wait is the best approach, with no need to add pressure to the situation. For school-age kids who are not staying dry at night, it is often still within the range of normal, and they may simply be at the unlucky end of the bell curve. If the child is not stressed out or bothered by this, parents do not need to stress either.
That said, bedwetting can turn into a source of anxiety or low self-esteem for some kids. It may become a problem when it limits their ability to socialize with friends, such as at sleepovers or camp. If your child is bothered by it, discuss it with your pediatrician to consider treatment options and to screen for any modifiable factors or underlying medical issues, such as constipation, diabetes, ADHD, neurological issues, or anatomic problems. During this process, it’s important to make it very clear to the child that it is not their fault, nor is it the fault of the parent or caregiver.
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For kids to stay dry at night, several stars have to align. First, the child must have sufficient bladder capacity; some kids simply have a smaller bladder. Next, the brain, kidneys and bladder need to communicate. As the child matures, the brain starts to send a signal to the kidneys to say, “Hey! It’s nighttime! Don’t make so much urine!”
The bladder also needs to do its part during sleep by sending a loud signal back to the brain that says, “Hey! I’m full down here, wake up and go to the bathroom!” If this signaling loop hasn’t kicked in yet, deep sleepers may continue to wet the bed.
Constipation is a common medical factor that can contribute to bedwetting—bulky stool in the colon and rectum presses on the urinary bladder next door, which decreases bladder capacity and alters the sensation in the bladder, so a child is less sensitive to the feeling of fullness in the bladder. Treating constipation can sometimes indirectly treat bedwetting.
Medications can be helpful if there is a short-term goal, such as being able to stay dry for a campout or sleepover. It’s necessary to try out the medicine in advance of the event to determine an effective dose, but it’s generally meant for special occasions and not for use every night.
Bedwetting alarms that detect wetness and (rather loudly) wake up the child can be a long-term treatment option. To be effective, the child must be motivated and should be involved in cleaning up, not as a punishment, but to take a positive and active role in the process.
Finally, if routine measures discussed with your pediatrician aren’t helping, it may be time to visit with a specialist. Although so much about this issue is natural and normal, if bedwetting is causing stress for you or your child, please know that there are plenty of options to help.
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Top illustration: iStock
