Bedwetting in children

Bedwetting, also known as nocturnal enuresis, is defined as involuntary urination during sleep in a child over the age of five. Before this age, it is normal for children not to have full bladder control at night, so bedwetting in younger children is not considered enuresis.

According to Ugeskrift for Læger (Danish Medical Journal), bedwetting is common during the early school years and gradually becomes less frequent as children develop. Most children eventually become dry at night on their own, but for a smaller group, bedwetting continues into later childhood or adolescence.

What Is Bedwetting, and How Common Is It?

Bedwetting, also known as nocturnal enuresis, is defined as involuntary urination during sleep in a child over the age of five. Before this age, it is normal for children not to have full bladder control at night, so bedwetting in younger children is not considered enuresis.

It is very common for children in their early school years to continue experiencing bedwetting. Approximately 10% of children in their first year of school wet the bed at night, and this proportion gradually decreases as the child's body develops.

Most children eventually become dry at night without treatment, but for a smaller group, bedwetting continues into later school years or adolescence.

At What Age Should My Child Stop Wetting the Bed?

Most children develop nighttime bladder control between the ages of two and four, but there is considerable individual variation. The term enuresis is only used when a child is at least five years old and continues to experience regular bedwetting.

It is important to remember that children develop at different rates, and bedwetting between the ages of five and seven is not necessarily a sign of a problem requiring treatment.

If your child continues wetting the bed after starting school and it begins to affect their well-being or self-esteem, it may be appropriate to discuss the available options with a doctor.

Symptoms of Bedwetting

The main symptom is involuntary urination during sleep, but the pattern can vary considerably from child to child. Some children wet the bed every night, while others experience it only a few times a month.

For most children, urination during the day is completely normal. However, a smaller group also experiences daytime symptoms, such as frequent urination, passing small amounts of urine or a sudden, intense urge to use the toilet.

When bedwetting occurs alongside daytime symptoms, it is referred to as a mixed form, which may influence which treatment is most appropriate.

It is worth noting that children who wet the bed often sleep very deeply and may not wake up even when their bladder is full. This is part of the condition and does not mean that the child is not trying hard enough.

What Is the Difference Between Primary and Secondary Bedwetting?

Bedwetting is divided into two types, which have different implications for diagnosis and treatment.

Primary bedwetting occurs when a child has never had an extended period of being dry at night. This is by far the most common form and typically occurs because the interaction between the bladder, brain and the hormone that reduces urine production at night (antidiuretic hormone) has not yet fully developed.

Secondary bedwetting occurs when a child has previously been dry at night for several months but then begins wetting the bed again.

This form is less common and may sometimes have an underlying cause, such as a urinary tract infection, constipation or a stressful life event, such as parental divorce or a death in the family.

If a child who was previously dry at night suddenly starts wetting the bed again, it is a good reason to have them assessed by a doctor.

Causes of Bedwetting in Children

Bedwetting rarely has a single cause. Instead, it usually results from a combination of factors related to the child's development.

The most common explanation is that the child's body does not yet produce enough of the hormone that reduces urine production during the night. This means that the bladder fills more quickly than the child can recognise while asleep.

In other children, the bladder's capacity at night may be smaller than expected for their age, causing it to empty before it is completely full.

Genetics also plays an important role. If one or both parents experienced bedwetting during childhood, their child is significantly more likely to experience the same problem.

Deep sleep can also make it harder for the body to wake the child when the bladder signals that it is full.

In less common cases, bedwetting — particularly the secondary form — may be associated with a urinary tract infection, constipation or psychological stress. However, these causes are considerably less common than developmental factors.

Can Stress or Psychological Factors Cause Bedwetting?

For the vast majority of children, bedwetting is not caused by psychological problems. It is a common misconception that children wet the bed as a form of protest, dissatisfaction or emotional distress.

In children with secondary bedwetting — those who were previously dry at night but have started wetting the bed again — psychological stress, such as problems at school, parental divorce or a death in the family, may sometimes play a role.

If you notice that your child's bedwetting coincides with a major change in their life, it may be appropriate to discuss the overall situation with a doctor.

Examination and Diagnosis

When a child experiences bedwetting, the doctor will typically begin by discussing the child's urination patterns, both during the night and throughout the day.

It can be helpful to keep a fluid intake and urination diary for a short period before the consultation. This allows the doctor to understand how much the child drinks, how often they urinate and how much urine they pass.

As part of the assessment, the doctor will often request a urine sample to rule out a urinary tract infection or another condition affecting the kidneys or urinary tract.

In most cases, further investigations are unnecessary. However, in certain situations, an ultrasound scan of the kidneys and urinary tract may be considered if the doctor wishes to rule out a physical cause.

The vast majority of children with bedwetting do not require extensive investigations and can be assessed and monitored by their GP.

Treatment of Bedwetting in Children

Treatment for bedwetting is tailored individually and depends on the child's age, motivation and the type of bedwetting involved.

The doctor will always assess which approach is most appropriate for the individual child and family.

For younger children, the main form of "treatment" is often information and guidance for the family, as many children simply need more time to develop nighttime bladder control.

Active treatment is typically considered when the child personally experiences bedwetting as a problem and both the child and parents are motivated to address it.

This is often around the ages of six or seven, although for some children it may not be until the age of eight or later.

For children who need a more active approach, two well-established treatment methods are available.

Bedwetting Alarm

A bedwetting alarm is a device with a sensor placed in the child's underwear or on the mattress.

The sensor detects the first drops of urine and activates an alarm to wake the child.

Over time, the child's body learns to respond to the sensation of a full bladder before urine leakage occurs, allowing the child to wake up and reach the toilet.

Treatment with a bedwetting alarm requires patience and usually continues for several weeks. Initially, parents often need to help wake the child when the alarm sounds.

The method requires commitment from the whole family but is one of the most effective long-term solutions.

Medical Treatment

If bedwetting is primarily caused by excessive urine production at night, medication may be appropriate.

The medication is taken as an orally dissolving tablet at bedtime and may be effective from the very first night.

However, its effect stops when treatment is discontinued, which is an important difference compared with bedwetting alarm therapy.

The choice between these two treatment methods depends on an overall assessment of the child's symptoms, age and family circumstances.

The decision is always made individually by the doctor in consultation with the family.

Practical Advice at Home

Whether you choose active treatment or decide to wait, a few simple adjustments to everyday routines can make the situation easier.

It may help to shift more of the child's fluid intake to the morning and afternoon and avoid large amounts of fluids during the final hour before bedtime.

It is also a good habit to ensure that the child uses the toilet immediately before going to bed.

Perhaps most importantly, bedwetting should never become something the child feels ashamed of.

Children do not wet the bed deliberately, and a calm, supportive approach from parents can make a significant difference to how the child experiences the situation.

What Is Diurnal Enuresis (Daytime Urinary Incontinence)?

Diurnal enuresis, also known as daytime urinary incontinence, is a separate condition in which a child experiences involuntary urination during the day.

Symptoms may include frequent urination, passing small amounts of urine or a sudden, intense urge to use the toilet.

The condition is more common in girls and most frequently occurs between the ages of three and eight.

Daytime urinary incontinence and bedwetting can occur together.

When this happens, the doctor will often recommend treating the daytime incontinence first, as achieving dry nights is generally more difficult when the child also experiences bladder control problems during the day.

When Should You Seek Medical Advice for Bedwetting?

Bedwetting up to the age of five or six is normal and generally does not require medical attention.

However, speaking with your GP can always provide reassurance if you are uncertain.

It is particularly appropriate to seek medical advice if your child is six or seven years old and continues to wet the bed regularly, or if bedwetting begins to affect their self-esteem or social life — for example, if they avoid sleepovers with friends.

You should also consult a doctor if a child who has previously been dry at night for an extended period suddenly starts wetting the bed again.

In this situation, a doctor should always be involved, as identifying a possible underlying cause may be important.

Treatment at Charlottenlund Privathospital

At Charlottenlund Privathospital, your child can be examined by a specialist in paediatrics who will work with you to identify possible causes of bedwetting and develop a plan for the next steps.

You can find an overview of all departments on our departments page.

We place great importance on providing a calm and reassuring examination environment where both the child and parents feel informed and supported throughout the process.

If your child continues to struggle with staying dry at night and you would like a professional assessment of the available options, you are welcome to book an appointment with us.

Sources

- Ugeskrift for Læger (Danish Medical Journal): Nocturnal Enuresis in Children – Assessment and Treatment.