Bed wetting. How old is too old to wet the bed and what can I do?
My first son potty trained easily. He enjoyed sitting on the toilet, and still does! I assumed that my other 3 sons would follow the same pattern, but I quickly learned that I was wrong. My second son potty trained slower, he didn’t enjoy sitting on the potty as much and wore trainers longer. When my 3rd son, at 2.5 potty trained before his older brother, I started to wonder if something was seriously wrong. My nearly 5 year old son still wets the bed nightly, has an occasional day accident and is now even falling behind his youngest brother.
What’s normal with bed wetting?
I first had to ask myself: “What’s normal?” At my pediatrician’s office, I filled out a form for a physical and there was a box to check for bed wetting. It said “Bed wetting past the age of 5.” At the time, my son was 4.5 and I thought…we still have time. However, between the ages of 5-7 bed wetting remains an issue for some children and all kids develop bladder control at their own pace (1). While a child may be day-trained, night training is a different story. The body must subconsciously control the bladder while sleeping and bed wetting is not on purpose.
What causes bed wetting?
For most children, there is no underlying illness that causes bedwetting. For a small percentage, there is an issue that may involve a physical illness or sleep disorder. However, most children will train by the age of seven. Factors that influence bedwetting include the inability to hold a full bladder at night, not waking up to the sensation of having a full bladder, the child makes a lot of urine at night or possibly has poor daytime toilet habits. Daily toilet habits should include going to the bathroom regularly and not holding pee in to play. (2) In addition, having a small bladder, chronic constipation and stress can play a role. (1)
Things to watch for
How do you know if there is an underlying illness causing bed wetting? For my child, he has a physical disability but I have been reassured by his specialist that it does not impact his bladder control. What does? Symptoms including painful urination, blood in urine or a strong urge to urinate that can indicate a urinary tract infection. The need to pee frequently, possibly related to high blood sugar or diabetes. The return of bed wetting after being night-trained for a period. “Snoring, frequent ear and sinus infections, sore throat, or daytime drowsiness” related to sleep apnea (1).
In some instances, a hormone imbalance involving the inability to produce anti diuretic hormone (ADH) can be at fault. Stress, and events involving emotional events such as starting school, the addition of a new family member or loss can be related and children who suffer physical, emotional and/or sexual abuse (1). Rarely, a structural problem or neurological issue can be at fault. However, most often bed wetting is not related to disease and will resolve over time. (1,2)
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Who’s more likely to bed wet?
Statistically, according to the Mayo Clinic, being a male with ADHD and a history of bed wetting in the family places a child at highest risk. (1) However, most of the time a child is simply observed until the age of 7 without intervention. Typically, a child stops bed wetting around the same time that the family member who also bed-wet did. If Dad wet the bed until he was 6.5 chances are his son will stop around the same time. (1,2)
What can I do?
Common interventions can include a full history and physical exam by the pediatrician and possibly a trip to a specialist who focuses on urinary disorders. Urine tests, blood work, x-rays or other image studies looking at the bladder and kidneys and a full history are common. (1) Your pediatrician may be able to identify something that you haven’t, and in my experience a second opinion doesn’t hurt.
For older children, limiting fluid intake a few hours before bed, toileting before bed and going at regular intervals during the day can help. (1,2) Reprimanding, yelling and shaming a child is seriously not recommended. Unlike punching his brother in the face, bed wetting is not on purpose and instilling guilt and anxiety can make it worse. (1,2) For some children, a reward chart helps, for others it makes them feel bad because the issue is out of their control.
What’s about the wet bed?
Bed wetting pants are a great way to go. As my son reaches the age of 5 I am stocking up on pull-up bed wetting pants that he can put on himself. Bed wetting pants come in reusable, that simply get washed and go on like regular underwear, and disposable that pull up like a diaper but are more absorbent and designed for night time wetting. Disposable bed wetting pants are even covered by some insurance companies for children over the age of 4 who meet medical criteria.
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In addition to bed wetting pants, I find an adult sized reusable bed protector to be very valuable. It often saves me from washing the sheets and mattress protector which is a huge help! I not only use these for the child I talk about here, but I use these under my baby just in case his diaper leaks. They’re really pretty fantastic.
Bed alarms. I find bed alarms to be controversial, however some parents say they work. I personally will not use one. When my child wets, he is in a very deep sleep and as I mentioned several times earlier, this is not on purpose and unconscious. Setting off an alarm would cause him anxiety, wake the whole family and not help in our case. Since anxiety is already known as a bed wetting cause…I don’t want to cause any more. However, ideally the bed alarm wakes your child just as he begins to urinate and signals him to get up and go to the bathroom. For some, they do work.
When I tuck my son in at night and put on his “night time pants” I always say “I’m putting this on just in case you have an accident. It’s okay if you do, we just want to protect the sheets.” When he wakes up in the morning, he knows to toss his AppleCheeks size 3 or training pant into the right bin and puts on underwear. Remember, this isn’t easy for them either. As children get older and become more aware, they will realize that they’re behind and that others do not view bed wetting as kindly as Mom does. Let’s be honest, some kids can be really mean.
Warding off the critics.
The fact that my son bed wets is on a need to know basis with friends and family. I also do not encourage, and quickly shut down, any discussion about the topic. Grandma is pretty famous for asking, in front of everyone including my son, if he still wets the bed. In private, I have asked her to not bring up the topic around others and say “I’m not worried about it and we’re NOT discussing it now” if she brings it up despite my wishes. My son needs to know that he’s not going to be shamed by anyone for bed wetting.
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