Ask a Pediatrician: My Child Still Wets the Bed—What Should I Do?

So, you made it through potty training in one piece and now it’s smooth (dry) sailing ahead, right? Not always. Controlling the bladder at nighttime is something else entirely, and accidents may happen for a few years going forward. (The National Sleep Foundation says that bedwetting is not even considered to be an issue until after age seven.) But what happens if your child does have nighttime wetting? We partnered with Goodnites®, the #1 Bedwetting Underwear* and Dr. Mona Amin to help offer a few different strategies that families can try to improve the situation.

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Dr. Mona Amin is a board-certified pediatrician, IBCLC, and a mom of two. She works in private practice and her passions include early childhood development, focusing on the impact of healthy sleep, a healthy relationship with food and healthy coping skills in the first five years of a child's life. She shares educational information on parent's most common concerns on her Instagram account, podcast (The Pedsdoctalk Podcast) and Youtube channel (Pedsdoctalk TV).

Nocturnal enuresis (nighttime bedwetting) is common and can occur for many reasons, the most common being normal bladder maturation. The process of bladder control development is—the child first becomes aware of bladder filling, then develops the ability to urinate in the toilet. These skills usually are achieved during the day by approximately four years of age. Nighttime bladder control is achieved months to years after daytime control, but is not expected until five to seven years old.

There are many reasons that nighttime bladder control takes longer than daytime control: maturational delay (their bladder and brain need time to connect), genetic factors (bedwetting is common in family history) and small bladder capacity. Some parents of bedwetters may report that their child is a “deep sleeper.” However, this may be a bias of observation since caregivers rarely attempt to wake children without bedwetting.

Other things to consider include constipation and pelvic floor dysfunction. A child who has constipation may withhold urine and leak during sleep, while a child with dysfunction of the pelvic floor may have accidents during the day with laughing, sneezing and play, as well as nighttime wetting. There are many other reasons for bedwetting, such as neurological conditions, endocrine conditions, sleep apnea, urological conditions or infection.

Nocturnal enuresis is common and is most likely not a sign of an underlying medical issue; however it is important to monitor the following: daytime accidents and wetting in a potty-trained child, high blood pressure, swelling of hands and feet, straining or pain with urination, drinking large volumes and urinating large volume throughout the day and night, dribbling of urine, persistent dampness in underwear, history of poop accidents/constipation, or snoring and concern of pauses in sleep.

Nocturnal enuresis affects 15 percent of children 5 years of age. It becomes less common as a child gets older but can last to 12 years old and in some small cases past 15.

Most bedwetting resolves on its own and most likely will end by age seven. If there is an underlying medical condition such as sleep apnea, constipation, kidney issues, etc., the child should be followed by a medical provider as to how to treat the medical issue.

Bedwetting usually becomes a problem for a child when it interferes with their ability to socialize hang out with peers. A child may feel embarrassed and avoid social interactions, sleepovers with friends or sleepaway camps. Therefore, if it’s nocturnal enuresis, the medical provider will want to know if the family wants short-term dryness (such as using a medication) for things like sleepovers or sleepaway camps or if they want a long-term solution.

For nocturnal enuresis, consider the following:

• Use Goodnites Bedwetting Underwear to keep them comfortable and dry. Goodnites protects against leaks no matter how your child sleeps, and helps them to have up to 100 percent leak-free nights. They are available in four sizes up to XL (fitting up to 140 lbs.), offering more sizes for a comfy, custom fit. Moving your kids to regular underwear will not teach them to stay dry while sleeping.
• Don’t make a big deal about it. Celebrate if they are dry in morning, but don’t punish if not.

It’s important to remember that neither the child nor caregiver is at fault for bedwetting. The child is not doing this on purpose. It is good to know that most bedwetting is normal and have a reminder that it will most likely resolve on its own in the majority of children.