Am Fam Physician. 2003;67(7):1509-1510
Bed-wetting, or losing urine during sleep, is a common problem in children. As many as 7 million children in the United States wet the bed at night. Bed-wetting happens three times more often in boys than in girls.
Another name for bed-wetting is nocturnal enuresis (say: nock-tur-nal en-you-ree-sis). Children are not considered to have this problem unless they are at least 5 years old and still wet the bed at least two times a month.
With time and patience, bed-wetting stops in most children.
What causes bed-wetting?
The cause is not known for sure. A child may be a bed-wetter for more than one reason.
Bed-wetting often runs in families. If one or both parents were bed-wetters as children, their child is more likely to wet the bed.
In some children who wet the bed, the bladder may not hold enough urine to get them through the night. The bodies of other bed-wetters may not have enough of a certain hormone. This hormone cuts down the amount of urine that the body makes during the night.
Do children with bed-wetting have a sleep problem?
Parents of a bed-wetter often believe that their child sleeps too soundly. However, the findings of sleep studies are no different in children who wet the bed than in children who do not.
Is bed-wetting a sign of a mental problem?
No, it is not! Also, children do not wet the bed because they are naughty or lazy. These are important points for parents to remember—and to stress to their child. Parents should not punish their child for wetting the bed. The child probably has little or no control over the problem.
Because of bed-wetting, children can have poor self-esteem. Treating bed-wetting helps these children feel better about themselves.
Can bed-wetting be the sign of a more serious problem?
Most children who wet the bed are completely healthy. Urine tests are the only tests they might need.
Bed-wetting usually is not a sign of a kidney problem unless the child has other signs, such as wetting during the day or pain with urination.
Talk to your doctor if your child has been dry at night but starts wetting the bed.
How is bed-wetting treated?
Even with no treatment, many children “outgrow” bed-wetting. But, there are some treatments that can help.
The bed-wetting alarm seems to have the best cure rate. The child wears the alarm at night. When the child begins to wet the bed, the alarm goes off. The child wakes up and gets up to go to the bathroom. For this treatment to work, the alarm may need to be used for 3 or 4 months. If a bed-wetting alarm is prescribed by your doctor, your insurance company may cover its cost.
Desmopressin (brand name: DDAVP) is a medicine that is used to treat bed-wetting. It comes in a nose spray or pill. Desmopressin works quickly, but it is expensive. Many children start wetting again when they stop taking the medicine. Sometimes, the bed-wetting alarm and desmopressin can be used together.
In the past, imipramine (brand name: Tofranil) was used to treat bed-wetting. However, it is used less often now, because it has side effects and does not work as well as other medicines.
What can I do as a parent?
No matter what treatment is chosen, here are some things you can do:
Be positive—and reassure your child that bed-wetting will stop or be cured with time. Do not punish your child for bed-wetting!
Give your child the job of changing the wet bed. A younger child can be asked to take the sheets off the bed. An older child may be asked to do the laundry.
Don't let your child drink water, milk, or other beverages too close to bedtime.
Before you go to sleep at night, wake your child up to use the bathroom.
Develop a system of rewards, such as stickers for dry nights, to encourage your child.
Where Can I Get a Bed-Wetting Alarm?
Nytone Alarms, 2424 South 900 West, Salt Lake City, UT 84119
Palco Laboratories, 8030 Soquel Avenue, Suite 104, Santa Cruz, CA 95062
Potty Pager (silent alarm)
Ideas for Living, 1285 North Cedarbrook, Boulder, CO 80304
Telephone: 1–800–497–6573 or 303–440–8517
Alpha Consultants, 94 Selwyn Place, P.O. Box 569, Nelson, New Zealand 7001