Should You Be Worried About Bedwetting?

Bedwetting is an unavoidable part of potty training. This month, Dr. Arthur Lavin breaks down this common issue and whether parents should be worried about it. Find more trusted health information from Dr. Lavin on the ParentTalk Podcast!

Bedwetting. Even just the word can be discouraging. 

Of course we all start off wetting our diapers in the first year or so of life. But once a child is dry all day and out of diapers, a time will come when their parents will expect them to be dry at night too. It is only after that time that urinating while asleep at night becomes an issue, and starts being called bedwetting.

Bedwetting is a common issue … but should you be worried about it? Let’s discuss.

As children mature over the first five years of their life, more and more are able to make it through the night without an accident, with the largest surge in dryness at night taking hold at age three. By five years old, most children do not wet the bed at night, and by seven years old this number rises to 85% of kids. Of course, the age at which a child becomes reliably dry at night varies widely. Some may even achieve this step before they turn one!

The most curious pattern of bedwetting is seen amongst children and their parents, particularly sons and their fathers. (Boys tend to develop this skill later than girls for unknown reasons.) If a parent wet their bed to a known age, say, eight years old, then a child of theirs who is not dry by five years old will be fairly likely to bedwet to the age of eight. 

This pattern establishes that people continue to urinate while sleeping for reasons set before birth – it’s genetic! For me, this is one of the most powerful demonstrations that one’s genes can play a role in one’s behaviors.

It is hard to believe, but bedwetting in a child who has mastered urinary and fecal continence during the day has nothing to do with continence at all. To be clear, what I mean by continence is the ability, using one’s power of decision making, to hold their urine and stool inside until they get to a toilet.  

So if that is continence … wouldn’t bedwetting in this scenario be a sign of incontinence?  The answer is a resounding no!

Because, in sleep, conscious decision-making goes away. Many resolve to never snore, but, once asleep, snore all the same.  Many folks talk in their sleep, and it seems obvious that even if you decide to not say anything while you’re asleep, it has no impact on whether you will or not. Once you fall asleep, that resolution loses all of its force.

Even adults wet the bed – regardless of steps taken while awake. You can do exercises to keep your bladder full for longer, you can urinate just before bed, you can stop drinking fluids for hours before bed to no avail, because bedwetting has nothing to do with having urine in your bladder overnight or training to hold it longer while awake. 

Bedwetting is a parasomnia. What’s that? Parasomnias are a very interesting set of behaviors that typically happen during the deep phases of sleep. These are behaviors we all have when awake, but most of us do not when we fall asleep. No one knows why the brain runs the software for these behaviors to turn on, but it does. These include:

• Sleep talking
• Sleep walking
• Night terrors
• Bedwetting

So bedwetting is essentially the mind running the “program” to pee during deep sleep. That’s not to say that sleeping deeply causes bedwetting – the same way that we adults all sleep deeply, but not everyone sleep walks or talks. 

Not all parasomnias go away. For example, sleep talking tends to never go away.  But bedwetting almost always stops before puberty, with:

• About 15% of kids bedwetting at age 7 years old
• About 10% of kids bedwetting at 10 years old
• About 2% of adolescents bedwetting  

So, generally speaking, the age that bedwetting should naturally stop is between about age 5 to puberty.

While it’s true that the most common remedies tend to fail – bladder exercises, not drinking for hours before bed, etc. – there are two actions you can take that can work to stop bedwetting.

The first strategy requires that your child bedwets around the same time every night.  Say that time is 1:30 AM. If you wake them up at 1:15, not long before their regular time, that will shatter their deep sleep routine and they will stay dry. But that requires a parent to know the time of the bedwet and to be there to wake them up.

The second – and better – strategy reveals just how much it is the brain, not the kidneys and bladder, that make you pee in your sleep in older childhood. That strategy is the bedwetting alarm. 

A bedwetting alarm is a very, very loud buzzer that will wake almost anyone up, even from the deepest of sleep. And it is activated when a patch in your child’s underwear, wired to the buzzer, gets wet. Yes the alarm happens after they pee, but, for some reason, about 80% of the time, waking after peeing stops the brain from running the software to command a pee during sleep and bedwetting stops.

It’s important to note that there are no physical harms from bedwetting – it is just urinating in the wrong place. It does not hurt the urethra, the bladder or the kidneys and does not infect any of them.

In older kids, wetting the bed can be embarrassing and interfere with feeling ready to have sleep-overs. But that is where wet alarms come in. Bedwetting alarms work better the older the child, and so waiting to use one closer to the age that they will develop an interest in sleepovers makes sense.

In the meantime, if your child wets their bed at night, you face a choice of clean up – pull up or laundry.  Both work fine with no risks. Either way, choosing a waterproof kids mattress or using a waterproof mattress pad can help make cleanup easier. Just take care to find options with non-toxic waterproofing (like Naturepedic). 

• Bedwetting is common – common enough we should consider it a normal part of childhood.
• The older you get, the greater the chance that bedwetting will end. It often ends at the same time a parents’ bedwetting days ceased, suggesting a strong genetic cause.
• Bedwetting is not the result of drinking too much fluid before bed, a weak bladder or sleeping so deeply you can’t wake to pee.
• Bedwetting can be embarrassing, so as a child gets older, if it persists, looking into a bedwetting alarm could help.
• Bedwetting is physically harmless.

In short, should you be worried about bedwetting? Most likely not. Sure, the grass may be greener on the dryer side – but, with some patience, you and your child will make it there just fine.