Guide

Help, my child is wetting the bed (again)

27.2.2023

Did you know that one in ten first-formers still wets the bed? I asked a paediatrician why some kids need longer than others to make it through the night without any accidents and what she makes of some of the tools available.

A few days ago, a good friend of mine was a bit embarrassed to tell me that his nine-year-old daughter had wet the bed. What first brought it to his attention was her sneaking into her parents’ bed (again) during the night and sleeping next to him. He woke up as a result of the warm sogginess gathering next to and under him. His daughter then told him she’d dreamed of stepping into a warm bath. Fortunately for my friend, there haven’t been any more incidents.

However, paediatrician Barbara Deak told me in an interview that this happens to more children of that age than you might expect.

Barbara, do you find that parents often seek help from a paediatrician because their child is wetting the bed?

Barbara Deak: yes, it’s a common topic in consultations.

A lot of parents are probably worried and question whether it’s «normal» if they have a child older than infant age who’s still having these issues. At what age do kids usually realise they have a full bladder and are able to empty it willingly?

Newborns urinate instinctively 12 to 16 times a day. Two-year-olds gradually get a sense for when their bladder is full. During the day, most kids aged two to four feel the need to urinate and develop the ability to deliberately hold it in. Girls usually get control over their bladder sooner than their male counterparts. During the day, four-year-old girls manage to stay dry 98% of the time, while for boys of the same age it’s 88%. These numbers are relevant, as this is the age children go to nursery – a place where they’re expected to be able to use the toilet rather than wet themselves.

What would cause a child to wet themselves often?

In most cases, it’s down to delayed, non-pathological development of bladder control. Not every child notices the signal that their bladder is full – their nervous system still needs to mature. In other words, bladder control isn’t something they can influence.

When people say it’s caused by developmental disorders, can genetics also be a factor?

Yes, that’s true. Studies have shown that when both parents were bedwetters, there’s a 77% likelihood that their child will also have this issue. If only one parent struggled with wetting the bed when they were little, the chance of their child being affected drops to 43%. Conversely, only 15% of kids wet the bed when their parents weren’t affected by this in childhood.

When is it described as wetting the bed?

Once a child hits the age of five, it’s considered bed wetting if the incidences occur twice a month.

Are there surveys into how many children struggle with wetting the bed?

Yes, there are a number of studies but some of the results vary greatly. The percentage of five-year-olds affected ranges from 15% to 33%. When it comes to seven-year-olds, the issue is still seen in 10%, while it’s estimated that 5% of ten-year-olds experience this.

That should reassure a lot of parents who are working through this issue with their children. Is there any medical treatment for bedwetting?

You know what they say. Grass doesn’t grow faster if you pull it. In other words, you need to be patient with kids as they mature – this phase of development isn’t something that can be fast-tracked. If there’s a high level of a psychological stress – for instance if a 12-year-old is going to summer camp – medication can be discussed as an interim solution. You’re best to discuss this with your child’s doctor.

Paediatrician Barbara Deak: «Wetting the bed is still an issue for about 10% of seven-year-olds.»
Source: Martin Rupf

When is it enough of an issue that you should consult their paediatrician?

If the child has good bladder control during the day, you don’t normally need to be so hasty. On the other hand, if they had recovered from bedwetting some time ago and the issue starts up again, that’s when you’d want to get them checked out. When there’s a lot of psychological stress, we help support the whole family.

How can paediatricians find out if there’s a developmental disorder causing the problem?

We conduct an evaluation, which consists of a comprehensive consultation, a physical check-up and urine test. It also helps to ask the child to keep a logbook that lists liquid intake, urinating and bowel movements throughout the day. That way we can rule out rare pathological causes.

What happens if children start wetting the bed again after having recovered from the issue.

In this case, we need to rule out any disorders, such as bladder infections or hormonal imbalances. It’s also conceivable that the issue is down to psychosocial strain. What’s worth noting is that mental disorders aren’t more prevalent in children who have always wet the bed than in their peers who already have control over their bladder.

In these cases, do you send the parents or their kids to a child psychologist?

No, that’s not normally necessary.

What’s your opinion on mattresses or underwear with alarm sensors (site in German)?

I don’t think much of them. If children haven’t matured yet, these tools won’t help. It’s frustrating for the whole family as everyone is awake apart from the child with the bedwetting issue, who’s fast asleep. However, if the child feels a slight need to urinate while they’re sleeping, these aids could be of some use. In the long-term, around half of children stopped wetting the bed after using these kinds of «training» tools. Having said that, they’re rarely used.

Why not, when they work so well?

Exactly because they can’t speed up the maturity or developmental process. And also because using these kinds of aids requires a lot of perseverance. It takes around 30 to 50 nights of bedwetting before it’s a success. On average, you’re talking about three months. That’s three months of parents having to cope with a lot less sleep.

My final question: what’s something parents should steer clear of if they want to support their children?

Pressurising, putting expectations on the child that they can’t meet or even telling them off.

…and perhaps letting their kids know that it happens to a lot of their peers as well.

Hmm, that might just be a comfort to the parents. For children, especially if they’re a bit older, it’s not necessarily helpful to know that. They just want to be able to sleep through the night without wetting the bed. Incidentally, a book I’d recommend to all parents is «Babyjahre (Baby years)» by Remo Largo (in German). It also covers the topic of bedwetting, and it can prove a helpful resource for parents going through this with their children.

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