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Preventing nighttime accidents
Beth Aledo
Beth, once children are toilet-trained during the daytime it can take from months to years before they stay dry during the night. Although most children stop wetting the bed by age 4 or 5, many continue until 6 or 7, or even into their teens. In fact, at 5 years of age 15 to 20 percent of kids still wet the bed; at 10, 5 percent do; and at 15, 1 to 2 percent still do.

What causes bedwetting? It tends to be hereditary, and it’s likely that a parent, sibling or another close relative also had a problem with bedwetting. Also, each child’s development is different, and children become ready to control their bladders at different ages. For some, it may take longer to control their bladders because they produce more urine during sleep, have smaller bladders or sleep deeply and don’t wake up to urinate when their bladder is full. Sometimes bedwetting can be caused by emotional problems such as stress with the birth of a new sibling, moving, divorce, family violence or abuse. In rare cases bedwetting is caused by a medical problem such as a urinary tract infection, anatomical defects of the urinary tract, abnormal nerve control of the bladder or untreated diabetes.

It’s important to talk with your daughter’s doctor about her bedwetting. For 3 to 5 year olds, if the child has no other symptoms of concern, doctors often suggest that you “wait and see” since over time children usually grow out of bedwetting on their own. If a child is 6 or older, most doctors will check to make sure your child doesn’t have any medical problems causing the bedwetting. The doctor may do a urine test, blood test and special x-rays, ultrasounds or other tests of the urinary tract. In the rare event a medical problem is discovered the doctor will recommend a specific treatment.

In most cases, it will just take time for your child to develop control of her bladder. Here are some suggestions that may help:
  • Decide about diapers or pull-ups. Follow your child’s lead. If she wets the bed most nights and still wants to wear diapers or pull-ups, let her. If she stays dry most nights and does not want to wear diapers or pull-ups, that’s OK, too.
  • Protect the bed. Anticipate that your child might wet the bed and take steps to make cleanup easier. Use a waterproof mattress protector, a rubberized sheet or disposable plastic-lined under-pads.
  • Limit evening fluids. After dinner, don’t let your child drink anything for a couple hours before bedtime, especially soda or cola, which can increase urine production and irritate the bladder.
  • Have your child urinate before bed. This way she starts the night with an empty bladder. You may also consider waking your child in the middle of the night to urinate. Keep a nightlight in the room so she can get up to go to the bathroom on her own.
  • Use positive reinforcement. Shaming or punishing your child for wetting the bed doesn’t help—it only makes it worse. It’s best to be understanding of your child’s difficulties and look for opportunities to encourage, motivate and praise her. Reassure your child that it’s not her fault and she’ll outgrow wetting the bed as she gets older. Do not let siblings or other family members tease her. It can be helpful to set up a sticker chart with rewards for a string of dry nights. It may also help to have your child write a story with a successful resolution to the problem.
  • Ask the doctor about a bed alarm. This special alarm is attached to your child’s underwear or bed and detects moisture when your child urinates. The alarm—either a sound or vibrating device—should awaken your child to get up and go to the bathroom. If your child doesn’t awaken with the alarm, you can take her to the bathroom. Over time, usually several months, the alarm teaches your child to awaken at night to urinate before wetting the bed. This has been succes
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician