Dirty Little Secret


Dear Mamas,

My 5-year-old son is a healthy, happy little guy who’s very outgoing, smart, and wonderful in every way. Except that he still wets the bed. Like almost every night.

I restrict his fluids after dinner and even get him up to go before I hit the hay later on, but nothing seems to work for very long. When I try a new strategy it seems to help for a couple nights, but then it’s back to the same old thing. I feel like he’s the only child his age with the problem, and something must be wrong with him, but the doctor says he’ll outgrow it. I know this sounds crazy, but I’m ashamed of being ashamed.



Dear Emma,

I get it. Really. Been there with one of my own, and in spite of knowing the truth of what your doc told you – it’s a normal developmental stage – I shared many of your feelings. The truth is that bedwetting is so common that fully 20% of 5-year-olds wake up wet at least 2 nights a week.  That’s 1 in 5.  About 5 kids in the average kindergarten class.

So why doesn’t anyone talk about it?  Why does bedwetting become the dirty family secret?  I have some theories about that, including the persistence of old myths like ‘kids who wet the bed are lazy’ and ‘bedwetters have psychological problems.’  But here are the real causes of bedwetting and some simple tools to help you and your kiddo cope.  Out of the closet, now!

The key to the problem is DNA — yes parents, you’re to blame.  But then so were your parents, and theirs.  Wetting the bed is inherited.  Three out of four kids who wet the bed have a parent who did, too.   Researchers have located the genes responsible, but that doesn’t help a whole lot.

Whatever the genetic signals, children who wet may share some characteristics that contribute to the problem:

Lower hormone levels- ADH (anti-diuretic hormone) slows urine production in the kidneys at night.  Kids who wet may have less of it at younger ages.

Deeper sleepers- These are the kids who can sleep through anything.

Sleepy bladders- The bladder and the brain learn to coordinate activity during sleep, but that takes more time for some kids.

Poop pressure- Constipation and a full bowel can press on the bladder and irritate it during sleep.

Twice as many boys do it as girls.  The great news is that 95% of wetters stop by age 10 as maturation and development catch up.  Truth is, it’s a normal part of growing up for millions of kids, not a disorder.  Nighttime bladder control is a developmental process, and it doesn’t happen at the same time for all children.  But those who wet think there’s something wrong with them, and that they’re the only one, and that is problematic.  So how can we help until Mother Nature takes care of it?

Most important, talk to your child.  If you (or Dad) wet the bed as a kid, tell him so.  Talk about how you felt and when the wetting ended, if you remember.  This is a bonding opportunity that can have big-time pay off, so take advantage of it.  Let him know that lots of kids have wet sheets sometimes, even though they may not admit it.  It’s no big deal.

Cover the mattress with a plastic barrier and develop a ‘quick-change’ routine that works for your family.  A double-layer sheet set with plastic in between can help you avoid stripping the entire bed at 3 AM.  Make it as much of a non-event as possible.  Leave the laundry for the AM.

OR use those pull-ups for bigger kids made just for that purpose. Some kids don’t like that they make them feel like a baby, but if it works for yours, great. And they’re perfect for travel and sleepovers.

Keep limiting fluids in the evening and always have him pee right before ‘lights out’.  Once more just before you pack it in for the night is right on target.

Go ahead and try techniques like bedwetting alarms (they sense moisture and buzz to wake him up), bladder training, or medication with your doctor’s supervision if you feel it’s necessary, but the vast majority of kids will outgrow it naturally before they’re 10, with or without special help.

Reassure, reassure, reassure. Your child needs to know this is a normal stage that he’ll grow up and out of.  If you feel ashamed, he will too.

~ Good Luck!

The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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