When should you worry about your child wetting the bed?

It’s inevitable – have a baby on your hands and you’ll need to swap sheets often as accidents happen. Usually though, kids have fewer incidents of bedwetting as they get toilet trained, but if incidents continue to occur after a certain point, they are indicative of other issues.

We asked the experts about what’s normal and what should give you cause to worry. Here’s what they said.

At what point does a child usually stop wetting their bed?

Dr Eunice Adei, Specialist Peadiatrician at Dubai-based Genesis Healthcare Center, says: “Children usually stop wetting the bed by the age of five to seven years. Bedwetting is more common in boys than in girls and up to 25 per cent of five-year-olds still wet the bed. Bedwetting is considered to be a problem if a child is above seven years old and continues to regularly wet the bed. However, by the age of 12 years, about 8 per cent of boys and 4 per cent of girls still have one or more bedwetting episodes a month.

Bedwetting is considered to be a problem if a child is above seven years old and continues to regularly wet the bed.

- Dr Eunice Adei

“Sometimes a child who has been dry at night will begin to wet the bed again. This may be triggered by family stress or school problems. As a child's systems mature, they are less likely to wet at night. By the teen years, or much earlier, almost all kids who wet their bed have outgrown the problem with only one per cent or less still having issues,” adds Dr Chadi Al Alam, Specialist Paediatric Neurologist at UAE-based American Center for Psychiatry and Neurology.

If a kid continues to have accidents, what can you do?

Most children outgrow bedwetting on their own, but some will need a little help. If your child is having challenges staying dry during the night after the age of seven, speak to your paediatrician about ways to help them. A few children have an underlying medical condition causing the bedwetting that will need to be assessed and appropriately managed by their doctor, says Dr Adei. One of the recommendations she makes is using a reward system to encourage dry nights.

“Use positive reinforcement: for example, your child can put a sticker on a chart or earn points for every night he or she remains dry. Once a certain number of stickers or points have been earned, give your child a small prize,” she says.

Other things you can do are:

Time water intake: “Reduce fluid intake to two-thirds of the regular volume they consume daily. Increase fluid intake earlier in the day and reduce it later in the day, stopping fluid intake after dinner,” says Dr Al Alam, adding that be careful not to cause a thirst overload.

Schedule bathroom breaks during the day: Get your child on a regular urination schedule (every two to three hours) and right before bedtime, he adds.

Reward success: Praise and encourage your child each time they wake up dry, says Dr Adei.

Be careful of what you feed them: “Eliminate bladder irritants such as chocolate, milk, coca (caffeine), artificial flavouring and sweeteners,” says Dr Al Alam.

Improve sleep hygiene.

Use tech to teach: Use an alarm device that wakes up the child as soon as wetness is detected, says Dr Al Alam. The device is inexpensive and readily available and should be tried before medication. This is ‘conditioning training’, which, if used steadily and consistently for three to four months, appears to work at least 75 per cent of the time.

Reassure your child: Assure your child that bedwetting in children is common. It's nothing to be ashamed of and almost all children eventually outgrow it, he adds.

When do you need to try medication?

Try medication if the child is over seven years of age and other methods have failed, says Dr Al Alam. Parents should consider treatment if their child is still wetting the bed between the ages six and seven, according to the National Enuresis Society, or sooner if the child seems troubled by bedwetting.

Bedwetting can be a symptom of a medical condition that requires assessment and treatment, adds Dr Adei. Consult your doctor if:

What must you not do?

Dr Al Alam says the most unhelpful thing you can do is resorting to punishment. He adds the following to his list of don’ts:

Don’t wake children up to urinate. Randomly waking up your child at night and asking them to urinate on demand isn’t the answer. It’ll only lead to more sleeplessness and frustration for you and your child.

Don’t wake children up to urinate. Randomly waking up your child at night and asking them to urinate on demand isn’t the answer. It’ll only lead to more sleeplessness and frustration for you and your child.

- Dr Chadi Al Alam

Don’t let siblings tease the child. Make sure siblings understand this as well. Don't allow them to tease the bed wetter.

Dr Adei adds: “Don’t talk about your child’s bedwetting in front of others.”

At what point is bedwetting a symptom for something more sinister?

There are two types of bedwetting, says Dr Al Alam: primary and secondary.

“Primary means bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time

Secondary bedwetting is bedwetting that starts up after the child has been dry at night for a significant period of time for at least six months,” he says.

“The child with secondary bedwetting is much more likely to have other symptoms such as daytime wetting, and we should search for medical reasons such as urinary tract infection, diabetes, structural or anatomical abnormalities (brain, spine, and muscles), neurological problems, emotional problems, child abuse and sleep apnoea,” he says.

If it’s not a psychological thing – what could be the other reasons for a child wetting the bed?

Dr Adei explains the factors:

Both doctors call for medical intervention if you are concerned about your child’s bedwetting.

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