My child is still wetting the bed at night – when should I worry?

Bedwetting is common and involuntary. Night-time dryness is not a behavioural milestone, it is linked to physiological change where our bodies begin to release a hormone that slows down urine production.

What you need to know

Bedwetting is common and involuntary. Night-time dryness is not a behavioural milestone, it is linked to physiological change where our bodies begin to release a hormone that slows down urine production.  Almost a third of four-year-olds wet the bed. By the time they are six, only one in 10 children wet the bed, and one in 20 by age 10. Bedwetting can sometimes continue into adolescence. 

There are some factors that can increase the likelihood of bedwetting:

  • Genetics – children of parents who took a long time to stay dry at night, are likely to do the same
  • Constipation – large amounts of stool may push against the bladder, preventing it from expanding all the way
  • Being a boy – boys are twice as likely as girls to wet the bed
  • Being a deep sleeper – the brain is not signalling to wake up when the bladder is full
  • Small bladder – a child with a small bladder will not be able to hold urine throughout a whole night
  • Overactive kidneys – too much urine is produced during the night
  • Stress and anxiety or changes in circumstance – sometimes can trigger or increase bedwetting 
  • Urinary tract infection – keep an eye out for pain and fever or a need to urinate frequently during the day
  • Sleep apnoea – increases the production of the “atrial natriuretic peptide” (ANP) hormone which causes the kidneys to produce extra urine during sleep
  • ADHD – children with ADHD are more likely to wet the bed than other children
  • Underlying medical causes – diabetes or kidney issues. These are rare, but something to consider if you have an older child who hasn’t responded to treatment. 

Tips and strategies

Your child may be embarrassed by bedwetting, so it’s important not to blame or shame them. 

For most children, the problem will resolve itself over time. If your child is over seven, you could consider using a bedwetting alarm. Bedwetting alarms wake the child when moisture is detected. The alarm gradually teaches a child to wake when it’s time to urinate. Keep in mind that an alarm may not be suitable for children with sensory issues and can cause more harm than good. Medication can help treat bedwetting in some specific cases – your GP can discuss this with you.

These are some simple strategies that you can implement at home to support your child:

  1. Increase fluid intake during the day, and stop drinking a few hours before bedtime. 
  2. Avoid sugary or caffeinated drinks at night – they can increase production of urine
  3. Ensure your child goes to the toilet as part of their bedtime routine 
  4. Use a nightlight to make access to the toilet as easy as possible 
  5. Ensure your child is getting enough sleep – children who are over tired are more likely to wet the bed
  6. Use a plastic mattress cover to protect the bed
  7. Make the bed with a mattress protector and sheet, then another mattress protector and sheet, so you can quickly and easily remove the wet layer
  8. Trial a week with no pull-ups – sometimes removing this safety net can help a child become dry

References

https://doctorsaustralia.com.au/au/topic/general-report/bedwetting
https://health.ucdavis.edu/children/patients_family_resources/bedwetting-solutions.html
https://pubmed.ncbi.nlm.nih.gov/18250221/
https://www.urologyhealth.org/urologic-conditions/bed-wetting-(enuresis)
https://www.medicalnewstoday.com/articles/bedwetting

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