Bedwetting, also known as nocturnal enuresis, is a common condition that affects many children. It refers to involuntary urination while asleep after the age when bladder control is normally achieved. Bedwetting is generally considered normal up until a certain age. This article will discuss what ages bedwetting is considered developmentally normal, the causes behind why children wet the bed, and when you may want to seek medical advice.
What is the definition of bedwetting?
Bedwetting specifically refers to urinating in bed while asleep after the age of 5. Before 5 years old, bedwetting is very common and considered normal and developmental.
Some key facts about bedwetting:
– It involves involuntary or unintentional urination. The child is not intentionally wetting the bed on purpose.
– It happens while asleep. The child is not awake and consciously choosing to urinate.
– It occurs after the age of 5, when a child’s bladder is normally developed enough to go through the night without wetting.
What are the causes of bedwetting?
There are a few reasons why children over the age of 5 may continue to wet the bed at night:
– Overproduction of urine at night – Some children’s bodies make more urine at night. Their bladders may not be large enough to hold all the urine produced while sleeping for 6-8 hours.
– Small bladder capacity – Some children may have a lower functional bladder capacity, meaning their bladders are physically smaller and unable to hold as much urine.
– Hormonal changes – Developmental hormonal changes can influence urine production, leading to increased bedwetting.
– Sleep arousal difficulties – Issues with nighttime sleep arousal signaling can prevent the brain from rousing the child when their bladder is full.
– Genetics – Bedwetting can run in families, indicating there may be a genetic component.
– Stress/anxiety – Stress, anxiety, and emotional difficulties may increase bedwetting episodes.
– Urinary tract infection – A UTI or inflammation of the urinary tract can cause increased urination and accidents.
– Constipation – Severe constipation and bowel movement difficulties may put pressure on the bladder leading to accidents.
– Anatomical problems – On rare occasions, there may be physical issues with the urethra, bladder, or nervous system that affects control.
At what age is bedwetting normal?
Here is a general guideline for what ages bedwetting is considered normal and developmental:
– Up to age 5 – Bedwetting is very common and normal. Most children achieve nighttime bladder control between ages 3-6.
– Age 5 – 7 years – Bedwetting is still considered normal and common at this age, affecting about 15-20% of 5 year olds and 7% of 6 year olds. It is not usually a cause for concern prior to age 7.
– Age 7 – 9 years – After 7 years old, incidences of bedwetting decrease but it is still considered normal for about 5% of 7 year olds and 3% of 9 year olds. If it is infrequent (once a week or less), it is likely within normal limits.
– Age 10 years – Only about 2% of 10 year olds still wet the bed regularly. It is worth having a child evaluated to identify any underlying causes.
– Age 12+ years – Less than 1% of 12 year olds wet the bed. Bedwetting at this age or in the teen years warrants a medical evaluation.
So in summary, wetting the bed up to age 7 is very normal. Between 7-9 it is still common and considered normal if infrequent. After age 10, it becomes less typical and merits an evaluation.
Nighttime bladder control developmental timeline
Here is a typical timeline for when most children achieve nighttime bladder control:
Newborn – 18 months – No bladder control. Bedwetting expected.
18 months – 3 years – Bladder capacity starts growing. Many achieve some control but accidents still frequent.
3 – 4 years – Most can stay dry for naptime or parts of the night. More accidents overnight.
4 – 5 years – Gains full bladder control during the day. 50% still wet at night.
5 – 6 years – 75-80% are dry overnight. Bedwetting in 20% is still normal.
6 – 7 years – Around 93% are dry overnight. Bedwetting in 7% is still considered normal.
9 – 10 years – 98% achieve nighttime control. Only 2% still regularly wet.
12+ years – Over 99% have consistent nighttime bladder control. Bedwetting uncommon.
Age for daytime control
Most children gain complete bladder control during the daytime by age 4.
Is primary vs secondary bedwetting different?
There are two classifications of bedwetting:
– Primary bedwetting – This means the child has never reliably had a 6 month period of nighttime dryness. They have consistently wet the bed since potty training.
– Secondary bedwetting – This is when a child starts wetting the bed after at least 6 months of nighttime dryness. It is a relapse or recurrence of bedwetting.
Primary bedwetting is more common, accounting for approximately 80-85% of bedwetting cases. Secondary bedwetting is less common but may merit a medical evaluation to identify if any new underlying cause. However, both types are considered normal and developmental up until age 7.
When to see a doctor about bedwetting
Consult a doctor if:
– Bedwetting persists after age 7
– Occurs multiple times per night
– Secondary bedwetting (child regresses after being dry at night)
– Associated with daytime accidents or other symptoms
– Causes emotional distress or social issues
– Child has special needs, developmental delay, or neurological condition
– Runs in family along with increased thirst and urination
– You suspect any underlying medical, emotional, or neurological cause
Medical conditions related to bedwetting
While simple bedwetting is normally just a developmental delay, in some cases it may be indicative of an underlying medical condition that needs treatment. Examples include:
– Urinary tract infection – Chronic or recurrent UTIs can cause urinary symptoms.
– Diabetes – Uncontrolled blood sugar in diabetes leads to excessive urination.
– Kidney disease – Kidney problems, reflux, or infection may be linked to accidents.
– Bladder problem – Overactive bladder, small capacity, or nerve issues affecting the bladder.
– Sleep apnea – Breathing interruptions during sleep can impact bedwetting.
– Constipation – Severely impacted bowel movements put pressure on the bladder.
– Neurological problem – Conditions like spina bifida that affect nerve signaling related to the bladder.
– Physical obstruction – Rarely, a physical blockage like a ureteral valve problem.
– Psychological issue – Severe emotional distress, past trauma, anxiety disorder.
If bedwetting corresponds with any signs of medical problems like UTI symptoms, increased thirst, bowel issues, or daytime accidents, consult a doctor.
When to worry about bedwetting
Bedwetting is not usually a concern before age 7, but parents should be observant for any of these red flags:
– Child is 7 years or older
– Bedwetting increased suddenly (more than 3 times a week)
– Child was previously dry at night and started wetting again (secondary enuresis)
– Accidents also happening during the day
– Signs of leaking, urgency or frequent urination
– UTI symptoms – pain, odor, blood, frequency
– Child is distressed, ashamed or socially withdrawing
– Corresponds with other physical or emotional symptoms
– Runs in family along with increased thirst/urination
– Associated with bowel movement problems like constipation
If you notice any of the above, consult a pediatrician or urologist to identify if any underlying cause needs attention.
Tips for bedwetting
If bedwetting is within normal limits for the child’s age, these measures can help manage it:
– Use overnight diapers or pullups to reduce discomfort
– Limit fluids 2-3 hours before bedtime
– Have child use toilet right before bed each night
– Avoid caffeine products
– Set a middle of the night alarm to wake and use toilet
– Use washable mattress covers and waterproof bed pads
– Have child assist with changing sheets and cleaning up
– Reward systems for dry nights; don’t punish for wet nights
– Reassure child it is normal and be patient and supportive
Medical treatments for bedwetting
If bedwetting becomes a concern or there is an underlying cause, doctors may recommend:
– Prescription bedwetting medication – Helps reduce nighttime urine production
– Antibiotics – If UTI is contributing to symptoms
– Desmopressin (DDAVP) – Synthetic hormone helps reduce urine output
– Reducing fluid intake – Especially in evenings
– Bladder training – Help stretch bladder capacity over time
– Biofeedback – Teaches techniques to prevent accidents
– Wet alarms – Awakens child when wetness is detected
– Treating underlying cause – Such as constipation or sleep apnea
When can you expect a child to stop wetting the bed?
Most children outgrow bedwetting on their own with time. Here are the typical ages when nighttime dryness is achieved:
– 15% resolve per year from ages 5-9
– 5-7% per year from ages 10-15
– Less than 1% after age 15 continue bedwetting
For children with primary bedwetting with no underlying medical cause, statistics show:
– 15% resolve each year from ages 5-9
– Remaining 5-10% resolve each year from ages 10-15
– Less than 1% still struggle after age 15
So while a small portion may continue to have issues into adolescence, most children will outgrow bedwetting by age 10-12 without intervention. Consult a doctor if it extends into the teen years.
Long term effects of bedwetting
Frequent long-term bedwetting can lead to:
– Skin irritation, rashes, infections
– Disrupted sleep for child and parents
– Stress, low self-esteem, social issues if child is teased
– Embarrassment performing sleepovers or camp
– Requirements for pullups, padding, and products into later ages
– Odor and laundry difficulties
– Damage to mattresses, furniture, carpets
If bedwetting is affecting a child’s emotional health, social life, or quality of sleep, seek medical advice. Treating any underlying causes and implementing coping strategies while waiting for natural resolution can help reduce adverse effects. Most children do eventually outgrow it.
Parent tips for handling bedwetting
– Remain calm and reassuring
– Avoid criticism or punishment
– Emphasize it is normal and temporary
– Allow child to assist with clean up
– Follow doctor recommendations
– Use night protection like padding or pullups
– Limit evening fluids
– Set a middle of night alarm
– Watch for signs of a UTI
– Be supportive; it’s usually not intentional
– Consider counseling if emotional issues develop
Conclusion
Bedwetting is very common in young children and considered normal up until about age 7. Though frustrating, it is usually just due to developmental delay and most children will outgrow it by age 10-12. It helps to use protective padding at night, limit fluid intake, and implement gentle waking strategies. If bedwetting extends beyond age 7, occurs multiple times per night, causes distress, or is associated with other symptoms, consult a pediatrician or urologist. Underlying issues like UTI, diabetes, constipation, or neurological problems may need to be addressed. With patience and a supportive response, children typically achieve nighttime bladder control.