Bedwetting in older children

What is bedwetting?

Bedwetting happens when a child doesn’t wake up during the night when they need to empty their bladder (urinate or wee). It can happen every night, or now and again. Bedwetting is also known as nocturnal enuresis.

Some children continue bedwetting from birth, while others start bedwetting again when they are older.

It can be very upsetting for a child, and distressing and frustrating for you. But it isn’t their fault. Bedwetting has nothing to do with bad behaviour.

What causes bedwetting in older children?

Some children sleep very deeply and don’t wake up when they need to urinate.

They might have a bladder that only stores a small amount of urine. Or they might produce a lot of urine at night.

Some children don’t make enough of a hormone called antidiuretic hormone (ADH). This makes the urine less watery overnight. If children don’t make enough of this hormone, their bladder can struggle to store the extra liquid.

Bedwetting can also be related to constipation in children.

Bedwetting tends to run in families. If one or both parents wet the bed when they were young, then it is more likely to happen with their children.

Emotional problems, caused by a stressful event, can sometimes cause an older child to wet the bed. Physical problems are uncommon.

When should my child see the doctor?

It’s a good idea to seek professional help if your child continues bedwetting after about 6 or 7 years of age. If your child starts wetting the bed again after a period of being dry, you should take them to your doctor for a check-up.

Also see your doctor if you are worried, or your child is very upset about bed wetting.

How is bedwetting in older children diagnosed?

Your doctor will ask about your child’s bedwetting, including how often it happens.

They may also ask about your child’s:

• sleeping patterns
• bladder and bowel (toileting) habits
• whether they have any problems with wetting during the daytime

Your doctor might examine your child. In some circumstances they might recommend a urine or other tests, but further testing is often not needed.

The doctor might refer your child to a health professional with specialist training in children’s bedwetting.

How can bedwetting in older children be treated?

It’s important to encourage your child to not feel embarrassed or ashamed about bedwetting. Bedwetting generally doesn’t need to be treated before the age of 6 years. That’s because it usually gets better on its own.

There are several treatments available for bedwetting in older children, including self-help measures and bedwetting alarms.

Self-help measures

Here are some tips to help your child stay dry.

• Remind your child to go to the toilet before going to bed.
• Put a nightlight in the toilet and encourage your child to get up to urinate (wee) during the night if they need to.
• Encourage your child to drink plenty of water during the day.
• Avoid any food or drinks that contain caffeine (for example, chocolate or cola drinks) before bedtime.
• Protect the mattress from urine with a waterproof pad or cover, if not using nappies or pullups.
• Note that waking your child and walking or carrying them to the toilet does not help them become dry long term.

Remember to be patient, encourage your child, and involve them in treatment.

Bedwetting alarms

Alarm therapy is the most effective treatment available for bedwetting in children older than 6 years. Both you and your child need to be motivated for a bedwetting alarm to work.

Bedwetting alarms work by teaching your child to wake up and go to the toilet when their bladder needs to be emptied. The alarms are designed to be loud enough to wake your child from sleep at the first sign of any moisture. Vibrating alarms are also available.

It takes 6 to 8 weeks for bedwetting alarms to work. Using a reward chart for waking and using the toilet (even when your child is not completely dry) can be helpful. Keeping a diary to chart your child’s progress is also usually recommended.

Your doctor can advise you whether your child could benefit from alarm therapy and how to use it.

Are there medicines available to help treat bedwetting?

In most cases medicine is not needed for bedwetting, but it can be useful in some situations where a night alarm has been tried and not worked.

Your child’s doctor may prescribe a medicine called desmopressin, which reduces the amount of urine made at night. Short-term use of this medicine may sometimes be tried for special occasions, such as sleepovers or school camps. This medicine is only available on prescription and is not suitable for all children.

Tips for encouraging your child

A child’s self-esteem can be damaged by punishing or embarrassing them. It also hurts when siblings or friends make fun of them. To encourage your child:

• be understanding and do not punish your child for wetting the bed
• do not get angry — it does not help and may make your child more anxious
• do not shame your child — it does not help your child gain bladder control
• be patient and supportive, and remember that bedwetting is not your child’s fault