Bed wetting (or enuresis) is when children:

• Continue to wet the bed more than twice a month after age 5 or 6
• Begin to wet the bed again after they are toilet trained for a period of time

Children learn to fully control their bladder at different ages. Nighttime dryness is often the last stage of toilet learning.

Parents and caregivers need to use a positive approach in helping a child who wets the bed at night.

Enuresis - bedwetting

Do not punish a child who wets the bed. Bed wetting does NOT occur because a child is lazy or trying to act out.

• Shaming a child for wetting the bed can lead to poor self-esteem and feelings of low self-worth.
• Reassure your child that bed wetting is common and can be helped. Telling the child about parents or other close relatives who also wet the bed often helps the child feel less stressed about the situation.

You can also have your child take an active part in cleaning up from the bed wetting (such as helping to strip the bed and put the sheets in the laundry).

Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. Although this may not solve the problem completely, it can help. Try the chart before you use medicines. It is most useful in children ages 5 to 8.

Make some changes in your child's urination and drinking habits:

• Encourage your child to use the bathroom at regular times during the day and evening. Teach the child not to hold urine for long periods of time.
• Be sure that the child goes to the bathroom before going to sleep.
• You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bed wetting. You should not restrict fluids too much.
• Also have your child avoid drinks that contain caffeine.

You can buy an alarm system at the drugstore.

• You place a sensor either in the child's underwear or on a pad underneath the sleeping child.
• If the sensor detects moisture, an alarm is set off. This alarm can be placed around the child's wrist or near the ear. The alarm may vibrate or make a loud sound.
• Parents or caregivers must make sure the child wakes up if the alarm goes off.

Certain drugs, such as a nasal spray or pills, may also be prescribed to control bed wetting.  

Call your doctor if:

• Your child has had repeated episodes of bed wetting after age 6
• Your child has begun to wet the bed after he or she was toilet trained for a period of time
• Your child complains that it hurts to urinate
• Your child has been drinking excess amounts of fluids
• Your child has been showing strange behavior changes (becoming unusually withdrawn or shy, or suddenly behaving in a sexually suggestive way)

The health care provider will take a medical history from the child and parents, and may ask:

• When did the bed wetting begin? How often does the bed wetting occur? Have there ever been "dry" periods?
• Can the child feel the need to urinate? Does bed wetting cause the child to wake up?
• How often does the child urinate during the daytime?
• Does the child have a problem controlling urine while awake?
• Do stress or liquids containing caffeine make the problem worse?
• What factors make the problem better?
• Is the bed wetting punished? Does the bed wetting cause shame?
• Have other family members had this problem?
• What other symptoms are present?
• What treatment methods have been tried?

Katz ER, DeMaso DR. Enuresis (bed-wetting). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.3.

Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360:1429-1436.