Bed-wetting can be a nightmare for parents and kids a like. One minute the kid is dreaming peacefully — later, they wake up covered in pee. And then it’s the parents’ job to clean it up. When kids are really little, an accident here or there feels like a normal rite of passage as kids transition from diapers to no diapers. But when does bed-wetting go from standard to concerning? Once a child has been fully potty-trained and weaned off diapers, is bed-wetting at age 5, or 7, or 10 normal?

Fast facts about bed-wetting

• At any age, it’s never the child’s fault; ‘trying harder’ won’t achieve a drier night.
• Bed-wetting at age 4 and under is very common; kids don’t always have control over their bladder muscles at such a young age. Also, the hormone that signals a full bladder only appears sometime between age 3 and 4.
• Bed-wetting past age 5 is cause for concern, as by this age most kids are developmentally able to recognize the need to pee in their sleep. If the bed-wetting happens 1 to 2 times a week over a period of three months or more, it’s considered a condition called nocturnal enuresis, and you’ll need to consult a doctor.

Causes of bed-wetting after age 5

Some children have always struggled with bed-wetting; for others, nocturnal enuresis comes out of the blue, after months or years spent dry at night. The causes vary. For some children, there is a strong genetic component — generally a parent will have struggled with bed-wetting at one point in their life. For others, it is the result of an overly small bladder, an imbalance of the hormone that causes the feeling of needing to pee, delayed development of the nervous system, or extremely sound sleep. For a small amount of older children who struggle with bed-wetting, it could be related to an underlying health condition like diabetes.

But the causes matter less than what doesn’t generally cause bed-wetting: neither intention nor emotional/psychological distress. In fact, the opposite is true; bed-wetting often causes emotional and psychological distress, and can contribute to the development of sleep disorders. And in turn, that distress and lack of sleep can lead to poor behavior in children during the day — a vicious cycle for families.

How to help a child struggling with bed-wetting

The younger the child, the more likely it is for regular bed-wetting to cease naturally in time — but there’s no guarantee or way to know if it is something a child will ‘grow out of’; even if it is, the time frame, without treatment, could be years-long, which can take a deep toll on families. Experts recommend children who struggle with bed-wetting receive treatment by at least age 6 (or as soon after it manifests regularly). Until then — and throughout treatment — here are some pointers offered by Charlotte van Herzeele, PhD, a pediatric psychologist at the University Hospital Ghent, Belgium, based on the latest research:

• Consult a doctor by age 6 at the latest.
• Don’t blame the kid. At any age, bed-wetting is not an action the child can control. Blaming or shaming a child (even an adolescent) for not trying hard enough or for being ‘too big’ for bed-wetting, or getting upset at having to change sheets or offended at the smell of urine, will only add to the embarrassment, shame, guilt and sadness they already feel, and create anxiety for them around sleep; it won’t stop the bed-wetting.
• Reassure the child. Bed-wetting, particularly for older children and adolescents, can be hugely isolating and stressful. Reassure your child that many kids struggle with it, that they have your support, and together you’ll find a solution.
• Offer rewards based on effort, not dryness. A child at age 7 or even 12, can’t control whether or not she wets the bed, so rewards for a dry night are meaningless and arbitrary. So instead, parents can offer rewards for preventative behaviors, like drinking more fluids during the day or using the restroom to pee right before bed (two actions likely to be recommended by the child’s doctor), or for helping with clean-up.
• Help the child remember to use the toilet before bed. This voids the bladder, minimizing the chance of incident.
• Limit fluid intake in the evening. For the two hours before bedtime, the child’s fluid intake should be limited, and no drinking fluids allowed at night (outside of unusual circumstances such as illness, etc).
• Encourage plenty of fluid intake during the day. To avoid dehydration from limiting fluid intake in the evening and at night.
• Avoid caffeine. Caffeine is a diuretic — a substance that causes urination — found in many sodas, coffee, chocolate and tea.
• Let kids use diapers/pull-ups at night if needed/desired. Even if they’re ‘too old,’ some kids find wearing a diaper or pull-up at night is less indignity than bed-wetting. It can also increase their comfort and improve their sleep.
• Don’t try to ‘solve’ it by waking a kid to pee at night. It’s not a hindrance to improvement, but it’s also not a long-term solution and won’t actually treat the condition.
• Think of it as a temporary problem. In nearly all cases, bed-wetting can be solved with the right treatment!

Treatment for bed-wetting

Global guidelines recommend treatment should start by the child or parents keeping a daytime and nighttime diary of the child’s urination habits and volume, to help doctors identify the underlying cause. Once that is done, treatment typically involves a combination of a bedwetting alarm — a device that rouses the child upon sensing moisture — and medication.

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