Bedwetting is an extremely common childhood problem.  The child that is 

wetting under the age of about 4 years should really not be considered 

enuretic. Whilst the parent may long for dry sheets, the child may still not have 

the bladder control required before this age. Even once dryness has been 

achieved, the odd wet bed can be expected and is not considered a problem 

and should resolve itself by about age 7. This is not a 'naughty' child!  

Achievement of night time dryness varies enormously from child to child and 

so comparisons should be avoided.

  

If the child is over 4 years and wetting several nights a week, it can become a 

problem for the parent and the child.  The child may feel ashamed and 

embarrassed and when it comes to school going age, sleep- overs become 

a cause of greater anxiety.  Contrary to how it may sometimes seem, this 

child is not being stubborn, manipulative or plain 'naughty'.  It is not their 

intention to keep you, the parent, slaving over the washing! If you and your 

child are battling with this problem, you need to consider possible underlying 

causes so that they can be addressed. Armed with some understanding, you 

will feel like you have more of a plan and be able to respond appropriately 

rather than react out of frustration and a sense of helplessness.

  

There are 2 types of bedwetting - primary and secondary.  Primary 

bedwetting is when the child has never managed to achieve a significant 

period of night time dryness (a couple of months), but has continuously wet 

from birth.  Secondary bedwetting refers to the child who begins wetting after 

having achieved dryness for a significant period.  Secondary bedwetting is 

more common and yes 3 times more boys than girls bed wet!

  

Diurnal (daytime wetting), is less common than nocturnal (night time wetting) 

and can often be attributed to poor retention and bladder control due to a 

maturational lag.  This child often gets carried away with the fun of play, and 

simply does not get there in time!  They should be encouraged to go to the 

toilet before they play and, if possible, be taken to the toilet at regular intervals 

until maturation is achieved.

  

There are many factors that need to be considered when trying to help the

enuretic child. In my experience working with children in my private practice 

and counselling parents at The Parent Centre, the most common cause for 

secondary enuresis is an emotional crisis that causes anxiety.  This crisis can 

be brought on by any big change such as starting school, moving home, 

illness, parents divorce or the birth of a new sibling. Even events that you may 

consider insignificant may cause the child anxiety. The child who is not able to 

express his/her anxiety appropriately may well begin bedwetting.

Other factors to be considered:

• It is interesting to note that many parents of bedwetters were 

bedwetters themselves!  • It could be attributed to a maturational lag in which case bladder control 

is not yet developed.   

• It is possible that the child could have urinary tract infection.   

• Overly punitive or indifferent toilet training  

What to do

The parent's reaction to the child's bedwetting is paramount. Attacking, 

shaming (teasing), criticizing or punishing the child will only increase anxiety 

levels and exacerbate the problem.  This then leads to a vicious cycle with 

both the parent and the child ending up very unhappy and frustrated. These 

methods of dealing with the problem are commonly used because the parent 

simply does not know what else to do.  

  

Above all, the parent needs to remain patient and supportive - remember they 

are not doing this to punish you!!  You need to remain emotionally contained 

and show confidence in the child's ability to eventually control his bladder 

function - he will eventually get it right! Above all we need to avoid creating 

more anxiety by our reaction.

  

It is a good idea to involve the child in brainstorming some solutions - this 

involves the child in the process and is more likely to be effective.  Adopt a 

"we're on the same side" attitude rather than parent vs. child.

  

A star/sticker chart is good way to positively reinforce the dry nights. Whilst 

the wet nights are ignored, the dry nights are rewarded with a sticker.  Once a 

target of, perhaps 5 dry nights, is achieved, an additional reward can be 

given.  This could be in the form of special time with a parent.  These charts 

are especially successful when used with the younger child.

  

If you are aware of any external stressors, you need to think of ways to 

reduce the child's anxiety.  Reassurance, cuddles, extra quality time all go a 

long way to making a child feel secure in the midst of change.  You may not 

be able to 'fix' the external trigger, but enabling the child to express their 

feelings appropriately will help to diffuse the anxiety that can lead to 

bedwetting. Reflecting feelings (both positive and negative) and 

actively listening to your child will equip them with an emotional language and 

teach them that their feelings are acceptable. When you spend time 

supporting and understanding your child, you may become aware of 

underlying areas of conflict. 

  

It is always a good idea to limit fluid intake after 6pm in the evening and 

making sure that he/she has been to the toilet before going to bed. During the 

day, however, drinking of fluids should be encouraged in order that bladder 

control and retention can develop.

 When an accident happens, it is important to remain calm, and matter of 

fact.  Remember the child is not being 'naughty'!  It is a good idea, however, 

for them to take some responsibility for the consequences of their 'problem'. 

For instance, the school going child can be encouraged to strip the bed and 

put the wet linen in the washing machine.  

Another plan that is effective is to try and figure out how long after going to 

bed the child is wetting.  Set an alarm to go off just before this.  On waking to 

the alarm, the child must go to the toilet.  Once the child has been dry for a 

week, set the alarm for half an hour early. Continue reducing the time of the 

alarm until eventually it need not be set at all.

  

A word on medication - Your doctor can advise you on certain medications 

that can be effective in controlling bedwetting.  It has, however, been found 

that once medication is discontinued, bedwetting usually recurs.  Whilst 

medication can be useful in breaking the cycle, it is important to address 

the child's underlying anxiety.  

  

If your child's bedwetting persists despite all your attempts, it may be 

necessary to seek professional help.  Both you and your child may need 

support and guidance in dealing with this issue. 

. 

In addition to offering counselling and workshops for parents, The Parent 

Centre also has an extensive library of books covering various aspects and 

difficulties experienced in parenting