10 Tips for Managing Bedwetting Behavior in Children: A Pediatrician's Guide

by Dr. Manjiri Somashekhar, Lead & Senior Consultant - Paediatric Surgery, Aster Women and Children Hospital, Whitefield, Bengaluru

It’s disconcerting- night after night, day in and day out; your child wets the bed (and it’s not what you expect). Other than the practicalities of changing all those sheets and cleaning up, losing the delicacy of a child’s self-esteem due to bedwetting may be emotionally draining. Can you imagine waking up each morning feeling humiliated and shy for fearing any sort of judgment from one’s mates or even family members? A lot of children keep their bedwetting problem as a secret leading to loneliness.

On top of that, children who wet their beds might miss out on social activities such as sleepovers or overnight camps. The kids’ fear of having an accident in front of their friends makes them avoid such experiences which are essential for their growth both socially and mentally at this age. Moreover, the constant worry about wetting the bed can disrupt a child's sleep patterns leaving them feeling tired and irritable during the day. This lack of quality sleep can affect their concentration on studies, academic performance as well as mood generally.

Bedwetting, also known as nocturnal enuresis, can be a source of worry and frustration for both parents and children alike. Wondering why it keeps happening, how it's happening, and what impact it might have been natural.  It's important to distinguish this from occasional accidents during potty training. If your child wets the bed twice a week for three consecutive months, then bedwetting might be a concern. Essentially, bedwetting occurs when a child's bladder control hasn't fully developed, leading to involuntary urination during sleep. This nightly challenge not only disrupts your child's rest but can also affect their confidence and social interactions.

Two main types of bedwetting exist: Primary Enuresis and Secondary Enuresis. In primary enuresis, children continue to wet the bed despite their ages, having never achieved consistent nighttime dryness. Conversely, secondary enuresis is observed in children who start wetting the bed at night after a period of dryness. Also, some children have secondary bedwetting, they are fine until 3-4 years and suddenly bedwetting happens again it may be psychological or pathological reason. Differentiating between these two forms of bedwetting allows parents and caregivers to pinpoint any possible root causes so as to adopt the best way of managing and supporting them. Bedwetting acceptable day and night till 3-3.5 years and at nighttime till 5-6 years, however one needs to worry and reach out for professional help if it continues beyond this age.

Here are 10 tips to manage bed-wetting in children:

·         Normalize the Experience: Assure parents that bedwetting is a common developmental milestone for many children and often resolves with time.

·         Consider Genetic Factors: Inform parents that bedwetting tends to run in families, so if one or both parents experienced it as children, their own child may as well.

·         Rule Out Medical Causes: Encourage parents to consult with a pediatrician if bedwetting persists or is accompanied by additional symptoms like frequent urination or constipation.

·         Address Psychological Factors: Acknowledge the impact of emotional stress or life changes on bedwetting behavior and provide strategies for emotional support during transitions.

·         Fluid Intake Management: Advise parents to monitor their child's fluid intake, especially in the evening, while ensuring they remain adequately hydrated throughout the day.

·         Establish a Bedtime Routine: Suggest creating a consistent bedtime routine, including calming activities and bathroom breaks before sleep, to help prevent nighttime accidents.

·         Try Bedwetting Alarms: Recommend the use of bedwetting alarms as a tool to train the child's brain to wake up when their bladder is full, promoting nighttime dryness.

·         Use Positive Reinforcement: Emphasize the importance of praise and encouragement for dry nights, while avoiding punishment or negative reinforcement.

·         Consider Medical Intervention: In cases of persistent bedwetting beyond age seven or accompanied by concerning symptoms, suggest seeking medical evaluation and intervention from a pediatrician or specialist.

·         Seek Support: Encourage parents to connect with support groups and online communities for guidance and reassurance and refer them to pediatric urologists or other specialists for additional support if needed.