Sleep Disorders - Bed Wetting

Bed-Wetting or Nocturnal Enuresis

If your child is older than four years of age and has difficulty staying wetting the night, then read the information below or click this button to get successful bed-wetting intervention and screen for other serious sleep problems:

Bed-Wetting or Nocturnal Enuresis

The medical term for bed-wetting is nocturnal enuresis. It is the most common and persistent sleep problem in children. Most children between 18 months and 2 years of age become aware of the sensations of a full bladder during the daytime and begin to communicate that they must go to the bathroom. However, they often do not give much warning. Between 2 and 3 years of age, they are better able to inhibit or hold their urine until they reach the toilet. A child must have mastered these developmental skills before s/he can be trained to remain dry at nighttime. Between ages 2 and 6 years, the child’s bladder becomes able to hold more urine, and an antidiuretic hormone (ADH) is secreted during sleep that leads to a decrease in the volume of urine being produced at night, which helps the child stay dry. Parents of children under 4 years of age should not be concerned if their child is bed-wetting.

In order for a child to meet the diagnostic criteria for nocturnal enuresis, the following conditions must exist:

The child must have a chronological age of at least 5 years (or equivalent developmental age of 5 years for developmentally delayed or handicapped children);
The bed-wetting must occur at least twice per week for at least 3 months or occur enough to cause clinically significant distress or impairment in social, academic, or other important areas of functioning; and
There must be an absence of a physical disorder associated with inability to control the bladder such as diabetes, urinary tract infection or anomaly, spina bifida, or a seizure disorder.

There are two forms of nighttime bed-wetting:

(1) Primary Enuresis, where the child has never had a long period of nighttime bladder control, and

(2) Secondary Enuresis, where nighttime bed-wetting occurs after a year of bladder control at night.

Results of the United States National Health Examination Survey indicated that about 25% of boys and 15% of girls are wetting the bed in elementary school, and as many as 8% of the boys and 4% of girls continue to have bed-wetting events at 12 years of age. Only 1% of teens continue to have nighttime enuresis at 15 years of age. Ninety percent of these cases are primary enuresis. There is often a family history of bed-wetting (nocturnal enuresis), suggesting genetic factors at play. Children with developmental delays or anatomic and/or physiologic delays are more likely to experience bed-wetting. Research also indicates that children who have more bed-wetting events urinate more often and in smaller amounts than peers without bed-wetting events.

A further cause of bed-wetting can be some major pediatric sleep disorders, such as Obstructive Sleep Apnea Syndrome (OSAS) or Periodic Limb Movement Disorder (PLMD). Sometimes children are very exhausted by sleep apnea events or periodic limb movements during the night, or they are in a very deep sleep and do not feel the physical urgings to get up and go to the bathroom. Therefore, if your child is a bed-wetter, you should not only be concerned about bed-wetting, but you should also screen your child for these major sleep disorders (Obstructive Sleep Apnea and Periodic Limb Movement Disorder). If you screen your child with the Sleep Disorders Inventory for Students (SDIS), and your child’s scores are high for Obstructive Sleep Apnea or Periodic Limb Movement Disorder (PLMD), then you need to consult with your pediatrician about a referral to a sleep specialist, Ears, Nose, and Throat Specialist (for Obstructive Sleep Apnea Syndrome (OSAS), or other medical professionals who can diagnose, treat, and correct your child’s sleep disorder.

Other physical disorders should also be ruled out when bed-wetting exists after 5 years of age. This can be done by a medical history and physical examination prior to treatment. This examination typically includes careful palpation of the abdomen for masses, motor and sensory testing of the lower extremities, assessment of anal sphincter function, and examination of the lower back and external genitalia for abnormalities. The urine can be tested for specific gravity, glucose, protein, blood, and evidence of infections. The child’s ADH level may also need to be checked.

Previous beliefs that bed-wetting was due to anxiety or emotional problems have not been substantiated. Various researchers believe that it is the bed-wetting that causes the child’s anxiety and stress, especially if they are frequently criticized, embarrassed, or punished for these bed-wetting events. If the bed-wetting is corrected, usually the anxiety and stress disappear in the child. Many children feel psycho-social stressors if they sleep at another child’s house or at a relative’s home and wet the bed. Many do not engage in these social activities due to anxiety about bed-wetting.

On a positive note, bed-wetting as well as the other major sleep disorders that can cause bed-wetting, are usually correctable with the appropriate interventions. Correction results in improvement of your child’s self-esteem and social life, not to mention sparing you and your child the hassles of getting up in the night to change wet bed sheets, doing excessive laundry, or your child/teen having to wear embarrassing diapers at night. There are many behavioral interventions that can be attempted for bed-wetting, some of which have been proven to be 95% successful in correcting even the most severe bed-wetting problems.

If your child/teen has another major pediatric sleep disorder causing bed-wetting, correction of these pediatric sleep disorders can even result in improved behaviors, achievement, and health for your child / teen. If your child or adolescent is struggling with bed-wetting, you can click the button below to SCREEN your child or teen for bed-wetting and other common pediatric sleep disorders that can cause bed-wetting (nocturnal enuresis). This screening will give you many pages of intervention ideas for bed-wetting or any other major sleep disorder your child / adolescent might have. If your child/teen wets the bed, please SCREEN him/her immediately for Bed-Wetting and other common pediatric sleep disorders by clicking “Parent Screen Your Child” below: