Bedwetting can be an embarrassing, frustrating, and quite often a messy experience for you and your child.

In the US, bedwetting affects 1 in 5 children under 8 years of age and 1 in 20 older children and adolescents, which means your child isn’t the only one who’s suffering. Coping with the problem can be challenging for you and the child.

Bedwetting is common enough that it’s considered normal for children younger than 7 years old. Its causes may include:

• Family history of bedwetting. 75% of children who struggle with bedwetting have a parent or immediate family member who also wet the bed as a child.
• An underdeveloped bladder. Bedwetting quite often is a result of your child’s bladder not being mature enough to hold urine produced during the night. The bladder is a muscular organ that children learn to control, much like learning to walk and control your leg muscles.
• Difficulty recognizing a full bladder. The nerves that tell your child’s brain their bladder is full may not be fully developed. Deep sleepers may also have a hard time recognizing the signal to wake up and go to the bathroom. For these kids, a bed-wetting alarm might help them wake up.
• Urinary tract infection. Signs may include frequent or painful urination, pink/red or cloudy urine, foul-smelling urine, or urinary accidents during the day.
• Underdeveloped hormone production. Anti-diuretic hormone is released from the pituitary gland and acts on the kidneys to decrease urine production. Babies typically don’t produce this hormone, and thus urinate throughout the night. As kids grow older and start producing the hormone, they should have better nighttime control.
• Attention deficit disorder (ADD). If your child has ADD, they’re more likely to wet the bed.
• Diabetes. If your child is usually dry at night, then starts wetting the bed, it could be one of the first signs of diabetes. Increased thirst, weight loss despite eating well, and fatigue are also signs of diabetes.
• Anatomic or nervous system problems. The structure of the kidneys and bladder or the nerves that supply them may have developed abnormally.
• Sleep apnea. This can disrupt sleep patterns and disrupt hormones including anti-diuretic hormone.
• Chronic constipation. Long-term constipation can cause the bladder and other muscles to not function properly. Bedwetting and chronic constipation often go hand-in-hand.

As a parent, you probably worry about the effects prolonged bedwetting can have on your child. Some of the more common effects include:

• Disrupted sleep and undue stress on the family/child relationship.
• Embarrassment or anxiety. Prolonged bedwetting may influence your child’s self-esteem and their willingness to develop social relationships.
• Hampering of social activities that include camping, sleepovers, or overnight activities.
• Rashes. Prolonged contact with urine soaks clothing and bedding and can contribute to rashes.

The problem of bedwetting can be made worse when a family doesn’t cope well. Blaming, embarrassing, or belittling your child won’t fix the problem. How can you cope with a child who has bedwetting?

• Avoid talking about your child’s bedwetting in front of others. Being sensitive to their feelings will help a stressed or anxious child through this difficult time. Always celebrate your child’s effort, even if it doesn’t work out as planned. Don’t let siblings or others tease your child about their bedwetting.
• Plan for easy cleanup. Failing to plan for bedwetting will frustrate everyone. Keep a protective cover on your child’s mattress under the sheet. Use pajamas that are easy to remove. Keep a change of pajamas and extra bedding next to the bed.
• Take advantage of disposable or reusable absorbent underpants. Many parents find the cost is well worth it to avoid nightly cleanups.

Families need to remember that bedwetting takes time to improve. Patience and understanding are crucial, and rewarding successes, however small, are one of the most important things you can do. Here are some simple but important lifestyle changes and things you can do to help your child increase their amount of dry nights.

• Encourage your child to drink water early and throughout the day. Getting enough water is important for your child’s overall health and developing bladder control. Have your child decrease the amount of water after dinner and especially before bed.
• Teach your child to use the toilet on a regular basis. Remember, the bladder is a muscle and can be strengthened and trained. Going every two hours during the day can help them to avoid that feeling of urgency and teach them good bathroom habits.
• Teach your child to do double-sitting voids. Boys and girls both should sit on the toilet and relax to empty the bladder, then when they’re done, stand up, but then stop and sit down again and empty the bladder one more time. These double-sitting voids help to completely empty the bladder. Boys who stand to void sometimes don’t completely relax all the muscles in the pelvis and thus don’t empty their bladders. Ensure your child empties their bladder just before getting into bed.
• Reward success! Each morning your child wakes up dry, praise them verbally. Many families like to track the success on a sticker chart or calendar. A bigger reward (something the child has chosen) for a certain number of dry nights can be given when they reach that goal. The number of nights doesn’t need to be in a row, since the pattern of bedwetting is extremely difficult to control.
• Avoid giving caffeine to your child. Caffeine can stimulate the bladder, so avoid it as much as possible.
• Bathe daily. Switching to a morning shower or bath can eliminate stale urine on the skin, which will prevent the unpleasant urine odor and keep their skin from getting irritated and developing a rash.

Bedwetting treatment options are limited, and they may decrease but not stop bedwetting completely. In most cases, your child will outgrow bedwetting without medical treatment, given enough time. These options can help decrease bedwetting, improve the child’s self-esteem, and give them more dry nights:

• Bedwetting alarms. When you child is asleep and starts to urinate, a sensor or pad triggers an alarm, which hopefully wakes the child up. The idea is that the alarm will give your child enough time to get up and finish urinating in the toilet. Families must be patient, since bedwetting alarms may take up to 12 weeks to show improvement. The alarms are available at most pharmacies without a prescription. Insurance doesn’t usually cover their cost.
• Your child’s doctor may prescribe medications that can slightly increase the number of dry nights. Desmopressin (DDAVP) acts as an antidiuretic hormone and reduces nighttime urine production. Side-effects can include water retention, concentrated urine, and in rare cases electrolyte imbalances, including low blood sodium (hyponatremia). Anticholinergic drugs like oxybutynin (Ditropan XL) affect the nerves of the bladder and may slightly increase the bladder’s ability to hold urine. Side-effects may include drowsiness, dry mouth, and constipation.

Most kids will outgrow bedwetting on their own. But that doesn’t mean you shouldn’t consult your child’s doctor and discuss your concerns. It’s a good idea to talk to your child’s doctor if:

• You suspect your child has a urinary tract infection.
• Your child was previously dry at night for at least six months but has begun bedwetting again. This can be a sign of other serious medical conditions.
• Your child is experiencing daytime accidents as well.
• Your child is older than 7 and still wetting the bed.