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Bed-wetting

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a normal part of a child's development.

Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 7 isn't a concern. At this age, your child may still be developing nighttime bladder control.

If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting.

Symptoms Causes Risk factors Complications

Bed-wetting is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.

Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

When to see a doctor

Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.

Consult your child's doctor if:

  • Your child still wets the bed after age 7
  • Your child starts to wet the bed after a few months or more of being dry at night
  • Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring

No one knows for sure what causes bed-wetting, but various factors may play a role:

  • A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
  • Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
  • A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
  • Stress. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
  • Urinary tract infection. This infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination.
  • Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, or daytime drowsiness.
  • Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
  • Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
  • A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

    Several factors have been associated with an increased risk of bed-wetting, including:

    • Being male. Bed-wetting can affect anyone, but it's twice as common in boys as girls.
    • Family history. If one or both of a child's parents wet the bed as children, their child has a significant chance of wetting the bed, too.
    • Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.

    Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. However, bed-wetting can create some issues for your child, including:

    • Guilt and embarrassment, which can lead to low self-esteem
    • Loss of opportunities for social activities, such as sleepovers and camp
    • Rashes on the child's bottom and genital area — especially if your child sleeps in wet underwear
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