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Nighttime bedwetting

Is there anything a parent can do about bedwetting?

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I first heard about bedwetting in older children from Sarah Silverman. In her 2010 autobiography aptly titled The Bedwetter, she revealed that she had struggled with wetting the bed until she was in her teens. Her parents simultaneously tried to fix the problem and make light of it, unintentionally making things worse. Silverman felt alone and ashamed, which led to an onset of depression for which she ended up being prescribed 16 Xanax per day at just 14 years old.

What you may not know (I didn’t) about nocturnal enuresis—the official term for bedwetting that happens at least twice per week after age 5—is that it is not unusual: it affects as many as 1 in 5 kids ages 4–14. Also, it’s not a psychological problem—it’s physiological. What most commonly causes noctural enuresis is that the central nervous system hasn’t completely matured: the child’s bladder is full, but the brain isn’t getting the message.

It’s also hereditary. If one or both parents were nighttime wetters, there’s a 44%–77% chance a child will be, too.

Still, no matter how “normal” it is, that doesn’t mean it’s easy for kids (or grown-ups) to deal with.

So what can you do about nighttime bedwetting?

Is there a solution to bedwetting? Sort of. Here’s what parents can do to address it.

First, it’s important to note that most kids will just grow out of it naturally at some point, so you could just wait it out. But if you’re more action-oriented or just looking for guidelines on getting through this phase, the following tips may help.

1. Build healthy habits. If a child’s bladder is empty before bed, they will likely have fewer accidents. Limiting liquids (within reason) before bedtime and doing a full void or “safety pee” as it’s called in my house is always good practice. It won’t eliminate the problem, but it can help. If you’ve done this already—and if you’re reading this, you probably have—it’s time to move on to #2.

2. Provide reassurance and support. “The biggest risk of nighttime wetting,” child and family therapist Michele Kambolis warns, “is the effect it can have on a child’s self confidence and self esteem.” It’s important for kids to know that this is not their fault, that it’s normal, and it affects 15% of 4- to 12-year-olds. Hammer it home: this is a natural part of growing up and all bodies grow at different rates—but you will outgrow it.

3. Talk about it…but not too much. If you ignore the problem completely, your child might think it’s something to be ashamed of. But don’t make it a big deal, either. When there are wet sheets and wet PJs to clean up, take it in stride. Whenever your child feels embarrassed, disappointed, or stressed, reassure them. Talk to siblings and be sure they get it, too—and that they know making their brother or sister feel worse about it is not okay.

4. Be prepared. Place an absorbent mattress cover under the sheet and keep clean sheets and PJs in an easily accessible spot so you can do middle-of-the-night changes quickly.

Stock up on bedtime pants, which are different from diapers because, number one, they’re not called “diapers”, but also because they’re designed for older kids: sizes are available for kids from 28 to 100+ pounds. These days, you can even find underwear with absorbent inserts that look just like regular underwear, which can help kids feel comfortable on overnight trips and at sleepovers.

5. Rule out certain conditions. Medical problems related to bedwetting are rare, but if your child is daytime wetting, has other symptoms (like pain when urinating), or was previously dry at night, there may be other factors involved. See your family doctor to rule out these less-common causes.

6. Consider the pros/cons of alarms and medications. Bedwetting alarms have worked for some kids and are sometimes recommended, though generally not for children younger than age 7. The downside? They don’t always work and kids might relapse. That perceived failure could add stress to an already stressful situation. Alarms also interfere with your child’s sleep, which is not great for brain development or overall well being in terms of mood, behavior, and learning. Kambolis cautions parents against medications, which have “high relapse rates and the potential for serious side effects”. Any interventions should be discussed beforehand with your child’s doctor.

7. Do nothing. Or, at least, nothing other than being prepared. The rate of nighttime wetting decreases by 15 percent with each year of maturity. By adolescence, only 1 to 3 percent of kids still wet the bed. If you normalize it and trust that your child will grow out if it, they probably will. If your child is fine with wearing bedtime pants until nocturnal enuresis stops spontaneously, that’s the safest therapy out there.

Silverman has said her bedwetting is responsible in some part for her success—she never would have had the nerve to be a comedian if she hadn’t been a bedwetter. Of course, none of us wants our kids to experience undue hardship on the off chance it’ll result in an Emmy nomination someday. But if they can get through this phase without shame or guilt, there’s a good chance it’ll become a childhood anecdote and you’ll all get through it just fine.

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