Do not worry about bedwetting if your child is 6 years old or younger, just be patient.
Help your child not to feel bad about bedwetting. Smelly bedrooms and lots of sheets to change and wash are annoying, but try to keep a calm, matter-of-fact attitude and not to fuss about it. It is important not to make your child feel guilty about something he or she cannot control. Bedwetting is a great worry to children. They often feel that they are being babyish or dirty. To punish a child for a wet bed will not help and is not fair.
Explain bedwetting to your child. Explain how common it is, and that there will certainly be other children of the same age in his or her class with the same problem. Explain that he or she will grow out of it in time, and that you are finding out ways to make this happen faster. If you used to bed-wet, tell your child about it.
How to explain bedwetting to your child. The US National Kidney Foundation suggests you explain bedwetting in the following way. Tell your child it is the kidneys’ job to make urine, which goes down tubes into the bladder. The bladder is like a water balloon that holds the urine. There is a muscle gate that holds the urine in. When the bladder is full, it sends a message to the brain and the brain tells the gate to open. Tell your child that, in order to be the boss of his or her urine at night, all the parts need to work together.
- The kidneys must make just the right amount of urine.
- The bladder must hold it and tell the brain when it is full.
- Then the brain must either tell the gate to stay closed until morning or tell the child to wake up to use the toilet.
Deal with practical problems. Think up ways of dealing with practical problems. Obtain waterproof mattress covers, for example.
Sleepovers can be a problem; children who bed-wet are understandably fearful of sleeping at other children’s houses. To deal with this difficulty, buy your child some pyjamas and a washable (polyester) sleeping bag for sleepovers. Ideally, look for a child-sized bag (easier to wash) with a waterproof exterior. Tell your child to put his or her day clothes close by at night. Then, in the morning, it is simple to kick off the wet pyjama bottoms into the damp sleeping bag, quickly get dressed without anyone noticing the problem, and roll up the sleeping bag with the pyjamas inside ready for washing at home.
Consider using absorbent pads or underpants. They are designed to be worn under baggy pyjamas or a nightdress, and do not look like nappies (diapers) but look like underwear. In the USA, these are called ‘pull-up’. They obviously will not solve the problem but are useful for holidays or if you are becoming very stressed by wet beds or if your child wants to have a sleepover with friends. Disposable types are available from pharmacies and retail stores.
Make access to the lavatory easy. Make it easy for your child to get to the lavatory (bathroom). Pyjama bottoms should be easy to get off. Provide a plug-in night-light to guide your child to the bedroom door. Leave a landing or hallway light on – your child may be afraid of the dark. Provide a potty in the bedroom if the bathroom is far away. And remember, sleeping in a top bunk makes getting to the lavatory difficult.
‘Lifting’ your child to the lavatory, and encouraging him or her to pass some urine at bedtime may help to prevent a wet bed (Prescriber 2010;21:28–34).
Encourage your child to drink plenty during the day – at least six drinks. This helps train the bladder to hold larger quantities and will prevent excessive drinking in the evening. Check that the school provides access to drinks during the day.
Restricting drinks in the evening is controversial. Some experts think it does not help, but others advise stopping drinks an hour or two before bedtime (Prescriber 2010;21:28–34). If your child seems to be drinking a lot in the evening, it may be because he or she is not drinking enough in the day, so the best approach is to encourage daytime drinking. It makes sense to restrict cola drinks after midday, because they contain caffeine which can make bladder control more difficult. Some people suggest avoiding drinks containing blackcurrant juice. Any sugary drinks or foods with high sugar content (candy, cookies) should be restricted in the evening. Also, children should not drink fluids (cola) or foods with caffeine (chocolate candy etc.).
Help your child to train his or her bladder. Explain that the bladder is like a balloon and needs to be stretched. This will help to make it strong, so that urine is easier to control. Once a day (twice a day at weekends), encourage him or her to drink a lot, and then hang on (hold) until the urge is strong and then a few minutes more if possible. This will only work if your child understands what he or she is trying to do, and if you have an encouraging and slightly laid-back attitude. Do not get angry if your child finds hanging on difficult.
Try a ‘star chart’ if your child is 9 years or older. You will need some stick-on stars, and a calendar that has a large space for each day. If you do not have a suitable calendar, make a chart. Each morning, your child sticks a star on the calendar as a reward if a specific behaviour has been achieved (such as getting out of bed when he/she wakes up).
Think of the star chart as a way of rewarding successes (even if they are very few), rather than a record of failures. So do not make any fuss about the mornings when a star cannot be given but praise your child on a successful morning. The stars have to be for something your child can achieve. For example, awarding stars for dry nights if he or she is wetting several times in the night will make your child feel a failure when this cannot be achieved. Instead, give a star for some progress, such as going to the toilet last thing at night, a smaller wet patch, or waking if wetting occurs.
Consider constipation, which seems to be an important factor in bedwetting (J Pediatr Urol 2018;14:494–501). One study found that improving constipation cured or significantly improved bedwetting in 6 out of 10 children (New England Journal of Medicine 2009;360:1429–1436). The best posture for passing faeces is for the child to sit in the middle of the toilet with the legs apart and the heels flat on the ground or supported on a footstool. He or she should be told not to rush or push. If necessary, buy a constipation remedy suitable for children from a pharmacy (such as polyethylene glycol); ask your doctor or the pharmacist for advice. What is more, a bedwetting alarm may be helpful.
Discuss the problem with your health care provider. You should see your doctor if:
- the problem is really getting to you, and you are starting to feel angry with your child
- your child seems upset about the bedwetting or about other problems, such as school
- your child is aged 5 or over; at this age a bedwetting alarm may be helpful
- your child also wets during the day, or seems to have a feeble urine stream
- your child has any other health problems or is not growing as quickly as other children.
First published on: embarrassingproblems.com
Reviewed and edited by: Diane Newman
Last updated: May 2021