Waking up to soiled sheets again? Why bedwetting is common for some kids — and how parents can help.
“Mom, it happened again.” Many a parent has woken up to these words, sometimes morning after morning. Kids and adults alike can become frustrated and even confused about ongoing bedwetting beyond what they think is “normal.”
It’s so common that in a class of 30 6-year-olds, four to five kids will still be wetting the bed, according to psychiatrist Dr. Sid Khurana, medical director of Nevada Mental Health. But your grandmother was mostly when she joked that nobody goes to college in diapers: Khurana notes that by age 14, only 1% of children are still wetting the bed.
But what causes bedwetting, and how can kids get through it? Here's what parents — the ones throwing the bedding in the laundry once again, or adding another set of nighttime pull-ups to their Amazon carts, — need to know.
What is considered bedwetting?
Bedwetting, also known as nocturnal enuresis, is the accidental or involuntary release of urine while a kid is sleeping. It can happen even after toilet training, and gradually stops on its own, typically between the ages of 4 and 6, according to the Cleveland Clinic.
Just because a kid wets the bed once in a while doesn’t mean they have a bedwetting issue. “This has to happen twice a week for three months to be considered a disorder. So occasional accidents or bedwetting episodes are not considered to be diagnostic,” Khurana says. “The diagnosis of enuresis is not made until the age of 5, as bedwetting prior to that is considered normal, explained by the physiological and psychological development.”
Dr. Danielle Sweeney, a pediatric urologist at Vamio Health, cites monosymptomatic enuresis as the "most common type of bedwetting." That's when kids without any lower urinary tract symptoms wet the bed at night. This can be defined as either "primary" (for children who have never experienced at least a six-month-long stretch of nighttime dryness) — or "secondary" (for children who start wetting the bed after a dry period of six months or longer). Secondary enuresis is usually the result of a medical or psychological condition.
Essentially, a pediatrician will want to know if a child was not wetting the bed and then started to, or has always done so (and was never “nighttime potty-trained”).
What causes bedwetting?
Parents should assume bedwetting is completely unintentional unless they have a good reason to think otherwise, like a child telling them they are doing it on purpose.
Most commonly, bedwetting is caused by a lack of bladder maturity and control, Sweeney says. But there can be other issues at play. "Other common causes include genetic factors, increased nighttime urine production (nocturnal polyuria), children that are heavy deep sleepers, individuals with a small bladder capacity [and] children with overactive bladder and constipation,” she explains.
Children with ADHD also more commonly experience bedwetting, as do those with sleep apnea, constipation, diabetes, bladder infections, and other conditions, adds Dr. Denise Scott, a pediatrician who works with JustAnswer.
“Children with ADHD are six times more likely to have bedwetting than children without ADHD, and have slightly lower success rates when treating it, but it is not directly known why," says Sweeney. "We do know that children who have difficulty focusing due to ADHD or other neurodivergent disorders, do not pick up on the subtle cues from the body regarding bladder emptying and urination and this may play a role. It can take longer to achieve resolution of the bedwetting in these children, and the best chances for success is to ensure that the ADHD is being addressed appropriately.”
As clinical psychologist Emily Edilynn has previously noted for Parents, stress and trauma may contribute to a "minority" of nighttime bedwetting cases. "Children can go through a period of bedwetting when they have undergone a big life change, such as the arrival of a sibling or starting a new school, stressful events like a parental separation, or even exposure to a trauma, such as witnessing violence," she wrote.
When should parents worry?
Anytime a child is doing something beyond what seems to be a typical timeline, parents naturally worry — and bedwetting is no different. Monitoring kids and their bathroom habits and other potential symptoms can help parents better understand if an underlying condition is at play.
Sweeney notes that some children have lower urinary tract issues during the day that can lead to bedwetting, including:
Not completely emptying their bladders
Dribbling urine
Holding urine
High urgency when they have to pee
Daytime incontinence
Urinary tract Infections
If a kid has these symptoms, parents should alert their pediatrician, who might get a pediatric urologist involved too. In addition to those lower urinary tract symptoms, parents should bring bedwetting up with their doctor if they also notice:
Weight loss
History of protein in urine
Fatigue
Persistent nausea or vomiting
Excessive thirst or getting up in the night to get drinks
Enlarged tonsils
Sleep apnea symptoms like snoring or stopping breathing during sleep
History of spinal abnormalities
Each of these can point to another condition that needs treatment, from sleep apnea to kidney disease. And given the connection between bedwetting and ADHD, parents can also look out for symptoms such as an excessive fidgeting or an inability to focus.
What's the best way to react?
Parents might be concerned about their child having an accident at overnight camp or sleepovers, or needing pull-ups post-potty training. But the last thing parents should do is shame kids who wet the bed. As with any topic that might lead to a child feeling embarrassed, parents should proceed with some sensitivity and a sense of privacy around the issue. Normalizing that this is an issue much beyond toddler years can also help your child understand they are far from alone.
“Bedwetting can be emotional and embarrassing for a child, so giving positive reinforcement when they remain dry and instituting some behavioral changes are beneficial, including reassurance that this will get better with age and that you are there to help them," says Scott. "A parent should avoid discussing this with anyone in front of the child other than their doctor."
Sweeney agrees that parents should be positive and reassuring. “Do not punish or blame the child for the accidents as this can make it worse.," she says. "Reward dry nights and efforts to work through treatment options.”
She points to research published in the Journal of Urology in 2021 that found that parents who got psychological intervention to learn strategies to better understand bedwetting had reduced conflict and were better able to cope. This led to reduction in punishment toward children and even helped solve the problem; children in this group saw a greater percentage of dry nights.
To manage the day-to-day challenge of bedwetting, Scott recommends that parents adopt a matter-of-fact manner ("OK, the sheets are wet. Let's strip the bed and get you cleaned up."). Until the issue is resolved, it's worth using waterproof sheet liners and bed pads, nighttime pull-ups or incontinence mats.
What should be avoided?
If a child is stressed about having sleepovers due to bedwetting, it can be easier to stick to daytime get-togethers (like a sleepunder) for a while.
In addition, experts recommend avoiding:
Caffeinated beverages, like soda, and sugary drinks, especially in the evening
Liquid two hours before bedtime
Situations that would lead to a child trying to “hold it” during the day; having a regular bathroom schedule will help avoid accidents
Finally, treat constipation, which can be connected to bedwetting, by encouraging kids to eat high-fiber foods and get physical exercise.
Other treatment options
Many kids will outgrow bedwetting on their own. In the meantime, sometimes parents like to try other treatments. All of our experts say there are medications available to help with bedwetting, though they are often only for short-term use.
Khurana also recommends a “40:40:20 rule." He explains, "If a kid drinks 10 cups of water in a day, then have him/her drink four cups by noon, four cups by 4 p.m. and only two cups between 4 p.m. and bedtime.”
Parents can also have kids use the bathroom twice before bed, or even consider waking them up in the night for one last bathroom break. Bedwetting alarms, like a "moisture alarm" that wakes a child up when their sheet is soiled, can also be effective.
“Depending upon the age and maturity/developmental level of the child, a plan should be made between the parents and the child," Khurana says. "For the child to be an active participant in the development of the plan is important."
The takeaway
While bedwetting can be exasperating, parents have an opportunity to teach their child about navigating frustrating events, being an advocate if there’s a medical issue and being involved in solution-seeking treatments with the help of a pediatrician. It’s key to not shame kids in any way, and to treat the problem with a positive attitude and a bit of patience.
