Parents | Zoe Hansen
My 6-year-old still occasionally wets the bed—and it's been happening frequently enough to warrant pull-ups at night so we don't have to keep washing the sheets every other day. Obviously, something is causing the problem. But we're not quite sure how to address it without making him more upset about it. How do we get the bedwetting under control without making him feel bad?
I have some great news for you: experts agree that nighttime bedwetting is not abnormal before age 7 because the bladder is still developing muscle control. Enjoy this moment of being able to let go of at least one parenting worry! That said, other factors could be contributing to the problem if it continues into age 7, and there are a few tips to keep in mind. Even if the current cause is purely biological, there's a chance that his emotional experience of the bedwetting now may make it last even when his bladder has full muscle control. But you can help avoid this reaction later by your being thoughtful in your response now.
It might help your state of mind to begin with some basic information about kids and bedwetting. Based on the American Academy of Child and Adolescent Psychiatry statistics, about 20% of 5-year-olds and 10% of 7-year-olds wet the bed. Nighttime bedwetting is considered common and not a problem. Most often, it is normal and expected to happen at times before puberty.
I appreciate the last few words of your question, "without making him feel bad." When it comes to bedwetting and other types of toileting accidents, children can very easily feel embarrassed and ashamed. Our natural reactions of being frustrated and disgusted can unintentionally add to these feelings, so it's wise to be vigilant about how we respond.
This does not appear to be the case for you, but I want to note that some parents believe in embarrassing a child as a strategy to stop the problem. That tactic is more likely to worsen it. Using shame for something a child cannot control adds to a child feeling powerless, which can lead to self-blame and a belief that they are a "bad kid." (Obviously, he's asleep, so how could he do this purposefully?)
Instead, explain that the bladder is like a balloon inside of us that holds our urine, and leaks when it's too full. Babies pee all night long because the muscles in their bladders don't work yet to hold in the urine. At his age, his muscles have gotten stronger, but they aren't quite done growing. Around age 7, most kids' bladder muscles are strong enough to work all night to hold in the urine.
When you explain this to him in a matter-of-fact tone, you can also express confidence that he will outgrow it soon. This calm and confidence from you may in itself do wonders to relieve his own stress and upset, then minimizing the chances that his emotions may make it last beyond biological reasons.
Besides a bladder that hasn't yet developed enough muscle control to hold urine all night, some other potential causes of nighttime bedwetting in children older than 3 or 4 include the following:
A deep sleeper who doesn't wake to the sensation of needing to pee.
Constipation, causing pressure on the bladder.
Not emptying the bladder before bed. (I'm confident you have him go to the bathroom before bed, since this is one of the easiest things to try!)
In a minority of cases, emotional and psychological reasons.
If the problem does persist past age 6, a pediatrician should evaluate medical causes first. They may refer you to a pediatric sleep specialist, as nighttime bedwetting can sometimes be a sign of a sleep disorder. If these evaluations do not uncover medical concerns, a psychological evaluation may be useful to determine emotional factors.
Stress and Distress
The fancy term for nighttime bedwetting is "nocturnal enuresis," and there can be a connection with a child's stress or trauma. Children can go through a period of bedwetting when they have undergone a big life change, such as the arrival of a sibling or starting a new school, stressful events like a parental separation, or even exposure to a trauma, such as witnessing violence. Again, your child still falls in the normal age range for bedwetting, but you could think about whether he's also experiencing stress, especially if it continues past age 6. But the majority of children with nighttime bedwetting do not have emotional or psychological factors.
What to Do
I imagine you have followed the steps most often recommended, but for review, make sure his bedtime routine includes limited fluid intake before bed and a trip to the bathroom. Because he does not have control over the bedwetting, avoid any type of punishment. Focus on your confidence that he will outgrow it soon, and do a happy dance on dry mornings. You can stick with the nightly pull-ups until he has confidence he can do without, so you can avoid the hassle of washing sheets!
The Bottom Line
Sometimes the greatest intervention for a parenting dilemma is assurance that what feels like a problem is actually not one. With child development covering such a wide range of normal, it's easy to worry at times when we don't have to. With so much to worry about in parenting these days, I hope you can let go of this one. Tuck away some of this knowledge if the bedwetting persists into age 7, but in the meantime, reassure him about his body, use pull-ups as needed, and do happy dances when you can until his bladder grows just a bit more.
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Emily Edlynn, Ph.D., is the author of The Art and Science of Mom parenting blog and the upcoming parenting book Parenting for Autonomy. She is a mother of three from Oak Park, Illinois, and a clinical psychologist in private practice who specializes in working with children and adolescents.
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