Practical Advice for Parents Dealing With Bedwetting

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Wet sheets, stinky mattresses, dirty underwear, hidden under the bed. As a young psychologist, I was surprised by how often I found myself helping parents deal with issues of pee and poop, as opposed to the issues of psychosis, Oedipal complexes, mania, and depression that I expected.

But, in fact, most parents looking for help are usually seeking practical, real-world assistance to deal with problems that are affecting their whole family. Bedwetting is one of the issues I see often, if not weekly, with children and families that enter care with my agency.

Bedwetting and shame

The most difficult thing about bedwetting, and the thing that makes it hard for parents to address on their own, is all of the shame and secrecy attached to it. Children and families experience a host of negative feelings about bedwetting. Many parents feel guilty and embarrassed about it, worry that it happens because they’re bad parents, blame the child as though it is intentional.

Both parents and children struggle with feelings of shame around the odor problems associated with bedwetting. Children feel embarrassed and ashamed. Kids who have problems staying dry at night have problems sleeping over with friends or having friends stay over or visit, out of fear that someone else will discover their secret, or that they’ll make a mess. They may not be able to attend sleepover camps. Children and parents struggling with these issues feel anger, resentment, shame, and guilt. Both parents and children often feel powerless to control or fix the problem, and as bedwetting persists, problems sometimes emerge in the parent and child relationship.

Bedwetting is common

Sadly, because there is such a social taboo around talking about toilet issues, people rarely realize how common problems with bedwetting are. While everyone seems to expect children to be potty-trained by the age of one year, the range of “normal” actually extends up to as late as age 3 for children to really become regular and consistent around using the toilet. In 5-year-olds, between five and ten percent still have problems staying dry through the night consistently.

Between 3-5% of 10-year-olds still have problems staying dry. But unfortunately, every parent I see struggle with this issue fears that there is something terribly wrong with their child, having no idea how many of their friends’ and coworkers’ children and families are also struggling with this.

Reasons for bedwetting

Though it can feel like this is an insurmountable issue - it really does get better.

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One of the biggest fears around bedwetting is that the behavior is because of some very scary underlying problem. In almost all cases, it’s not. I’ve had numerous parents come and say that they’ve heard that most serial killers wet the bed. The implicit fear is, “Oh God, is my child going to grow up to be Jeffrey Dahmer?” Of course not. For every one serial killer that wet the bed (and did other scary warning behaviors), there are thousands of children who wet the bed but grew up, learned to stay dry, and are now dealing with their kids’ bedwetting problem (and yes, there does seem to be a familial or genetic link in many cases).

Other parents and caregivers fear that the behavior is a sign that the child has been sexually abused. Sometimes, it is. For many children, enuresis that comes and goes, or comes on suddenly, can be one sign that the child is struggling with difficult emotions, and needs adult help to sort them out. Usually, this is more of a concern when bedwetting comes on suddenly, in a child who previously was able to stay dry. In that case, I encourage parents to seek some help sorting out what it is that’s going on.

Why children wet the bed is a complex issue, with many different potential causes. Genetics plays a part, as do the history of toilet training, psychological stress, sleep disorders, and biological issues, around bladder function and the functioning of chemicals within the body. I always recommend families see their family doctor, to rule out medical problems. Sometimes, this involves a urology consult, and often docs take a wait and see attitude, but it’s always important to rule out biological causes.

Treatment for bedwetting

The treatment of bedwetting is relatively straightforward, though it takes effort, consistency, patience, and time. The first thing I tell parents is to start removing the shame around the behavior. The more we make children ashamed of the wet bed, the more we make the child turn the wet bed into a secret. Shame is not an effective intervention.

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It’s okay for parents (and children) to be frustrated and angry and embarrassed about this behavior. That’s okay! This is a tough thing to deal with! But, let’s acknowledge those emotions and feelings, and then start working on the problem, without letting the anger and frustration be in the driver’s seat. I encourage parents to start working with the child’s bedwetting in a very matter-of-fact, “this isn’t a big deal” way. If we model for the child, helping the child believe that this isn’t that big a problem, we can deal with this, then it is a lot more likely that the family will be successful in getting the behavior under control.

For many parents, the first thing they try is a restriction of fluids before bedtime. To some degree, this makes sense, and I do recommend that children wetting the bed not have fluids, and certainly no caffeine, right before bed. In fact, it might be best if children struggling with this didn’t get caffeine in general, as it increases urination and affects the child’s sleep, often worsening the problem.

Sometimes though, parents take this too far, restricting children from drinking any fluids, in a way that isn’t healthy and isn’t effective in reducing the bedwetting. Physiologically, bedwetting just isn’t about too many fluids — once the ability to keep the bladder closed is established, most people can usually stay dry, even after they’ve had lots of fluids.

Parents often also use pull-ups (larger-size diapers), trying to control the behavior and the mess. Pull-ups can be effective in reducing the mess of bedwetting, but in general, will prolong the problem. Pull-ups are, at best, a stop-gap measure, while we try other things.

The first thing I recommend to parents is to get a child on a very set, regular, and predictable schedule for bedtime, going to the bathroom before bed, and going to sleep. The more regular their sleep cycle is, the easier it is to control the bedwetting. Do some practical things, like putting a pad or cover on the mattress, so when it does happen, the mess is less.

Assuming the kids go to bed before the grownups, have the grownups start waking the child up to go pee before the parents go to bed. Do this consistently and regularly enough, and the child’s sleep cycle will adapt to it, and they’ll start doing it on their own. Often, in many, many children that I see, these steps alone are effective. When accidents happen, and they will, approach them in that same, matter-of-fact way. Reward the child when they have a dry night! And ignore, as much as possible, the accidents.

When the bedwetting is tougher to control, there are a few next steps. The first that I usually recommend is the use of an enuresis alarm. This is a little buzzer that connects to a sensor that sets off the buzzer when the child first starts to pee. The buzzer is amazingly loud and will wake the child up, at the same time startling them and causing their bladder to snap shut (if you’ve ever stopped peeing when someone surprises you, this works the same way). It’s also loud enough to wake up the parents to come help the child go to the bathroom. When this happens enough, the child often learns to stay dry very quickly, sometimes in just a few weeks. Enuresis alarms are easily found on the Internet, and usually cost an average of sixty or seventy dollars.

There are also medications that a family doctor can prescribe to reduce the amount of urine produced in the night. It is really important to use these medications with careful monitoring by the doctor. In tough cases, the most effective treatments involve all of the above components, including a supportive environment, a regular schedule, no caffeine, an enuresis alarm, and medications.

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Parents and children struggling with bedwetting often fear that this problem is never going to go away. In fact, only 1% of children have problems with bedwetting at age 15. So, even just left alone, these problems are usually grown out of. However, given the shame, anger, embarrassment, fear, and frustration that often surrounds wet beds, I encourage parents to start trying these simple steps and helping their children, and their families, to air out that dirty laundry!