Most children achieve nighttime bladder control between the ages of 3 and 7 years old. However, it’s completely normal for bedwetting to persist past age 5. Bedwetting that continues past age 6 is known medically as nocturnal enuresis. While frustrating for both parents and children, nocturnal enuresis is a common childhood condition that most kids eventually outgrow. With patience, understanding and following some key tips, you can help your child achieve nighttime dryness.
What is the normal age for nighttime dryness?
Most kids are able to stay dry through the night by age 5. However, it’s still considered normal for children to experience occasional nighttime accidents until age 6 or 7. Here’s an overview of when most kids achieve nighttime bladder control:
- By age 2: Roughly 20% of 2-year-olds are dry through the night.
- By age 3: About 75% of 3-year-olds can stay dry all night.
- By age 4: Approximately 80% of 4-year-olds awaken with a dry diaper or underwear in the morning.
- By age 5: Around 85% of 5-year-olds are dry at night.
- By age 6: About 90% of 6-year-olds have achieved nighttime continence.
As you can see from these numbers, nighttime dryness is achieved gradually. Only about 15% of 2-year-olds are dry all night. Whereas about 90% of 6-year-olds have gained complete nighttime bladder control.
While the percentage of dry kids increases with each year of age, it’s still considered clinically normal to wet the bed up until age 7. Bedwetting that persists past age 7 may require evaluation by a pediatrician. But try not to worry if your soon-to-be first-grader still wets the bed at night. With time and patience, your child can get there.
What causes bedwetting after age 5?
If your child is still wetting the bed after age 5, rest assured there’s likely an explainable reason. Here are some of the most common causes of delayed nighttime dryness:
Overactive bladder
An overactive bladder contracts involuntarily, triggering urination at inconvenient times. Kids with an overactive bladder may urinate frequently or have daytime accidents in addition to bedwetting.
Underactive bladder
With an underactive bladder, the muscles fail to contract fully to empty the bladder. This can result in incomplete voiding and accidental urination, including at night.
Small bladder capacity
Some kids simply have a lower bladder capacity compared to peers. They may need to urinate more frequently and are at greater risk for accidents when sleep delays bathroom trips.
Deep sleeping
Some heavy sleepers don’t rouse from sleep fully when their bladder signals the need to pee. The child continues sleeping and involuntarily releases urine.
Hormone imbalance
Levels of antidiuretic hormone (ADH) normally rise at night to reduce urine production. An imbalance of this hormone can result in excess urination at night.
Genetics
Bedwetting often runs in families. If one or both parents wet the bed past age 5, a child is more likely to experience delayed nighttime dryness.
Developmental delay
Children with developmental delays, such as autism spectrum disorder, may have greater difficulty regulating bladder control.
Urinary tract infection
A UTI can cause painful, urgent urination and accidents. Nighttime wetting may persist for a while after a UTI has resolved.
Constipation
Constipation puts pressure on the bladder, which can weaken bladder control and lead to accidents. Successfully treating constipation may resolve associated bedwetting.
Diabetes
Excess sugar in the urine causes frequent urination, including at night. Bedwetting can be the first sign of diabetes.
Sleep apnea
Breathing interruptions with sleep apnea prevent the brain from properly regulating urine production during sleep. Treating sleep apnea may improve associated bedwetting.
If there’s no identifiable medical cause, a doctor may diagnose your child with primary nocturnal enuresis. This means the bedwetting is happening on its own without an underlying medical issue. Primary nocturnal enuresis often resolves on its own over time.
Tips to help your child stay dry at night
While you can’t force nighttime dryness to happen on a set timeline, you can take steps to help your bedwetting child gain bladder control:
Use nighttime diapers or pull-ups
Have your child wear absorbent nighttime diapers or pull-ups to bed. Waking up wet can feel defeating. Diapers help preserve self-esteem while your child works on overnight dryness.
Limit fluids before bedtime
Stop giving your child extra drinks about 1-2 hours before bed to help reduce urine production through the night. But don’t restrict water to the point of dehydration.
Encourage bathroom trips before bed
Make sure your child goes to the bathroom right before bedtime each night. Regularly emptying the bladder before sleep can help minimize wet nights.
Wake your child at night
If your child sleeps very deeply, try waking them once during the night for a bathroom break. This can help empty the bladder and avoid an accident.
Use a night light
Nightlights along the path to the bathroom can make middle-of-the-night toilet trips easier. Your child is less likely to have an accident if they can find the bathroom easily.
Motivate with rewards
Celebrate dry mornings with a small treat or fun activity. But don’t penalize wet nights. Offer praise for effort and be patient.
Try an alarm
Wetting alarms clip onto underwear and beep when they detect urine, rousing the child to finish peeing in the toilet. But alarms can temporarily increase bedwetting.
Medication
If other approaches don’t work, there are prescription medications that can help reduce nighttime urine production. Discuss options with your child’s doctor.
Ruling out medical causes
Have your child evaluated to make sure an underlying condition isn’t causing the delayed bedwetting. Treating an issue like constipation could improve bladder control.
Working closely with your child’s doctor can help determine if there’s a medical reason behind persistent bedwetting. But in many cases, time and patience are the keys to overnight dryness. With the right support and tactics, your child can get there!
What’s the outlook for bedwetting after age 5?
While bedwetting past age 5 is frustrating, the outlook is generally very positive:
– Spontaneous resolution is common: With no intervention at all, roughly 15% of children outgrow bedwetting each year.
– Most kids will achieve dryness: Nearly all children attain nighttime continence eventually. Only about 1-2% continue wetting the bed lifelong.
– Bladder control can take time to develop: It’s normal for nighttime dryness to happen between ages 5 and 7. Try not to panic if your just-turned-6-year-old still wets.
– Treatment greatly improves dryness: When needed, approaches like alarm therapy and medication successfully treat bedwetting in 70-80% of children.
– Relapses happen but aren’t concerning: Periodic backsliding after achieving dryness is normal. Stay the course with patience and consistency.
– Bedwetting is not intentional: Never punish or shame a bedwetting child. They aren’t wetting the bed deliberately.
With support and a thorough understanding of normal bladder development, nearly all kids can overcome delayed nighttime dryness. Work with your child’s doctor to determine if any intervention is needed. But mainly, offer encouragement, praise and patience as your child works toward this important developmental milestone.
What age should you talk to your pediatrician about bedwetting?
As a general guideline, it’s reasonable to consult your child’s pediatrician about persistent bedwetting in the following circumstances:
– Age 5 to 6 with no progress toward dryness
– Age 6 to 7 with wet nights more than twice a week
– Age 7 and older with any amount of continued bedwetting
– Bedwetting accompanied by daytime accidents or other symptoms
– Sudden increase in bedwetting frequency after a period of dryness
– Bedwetting associated with new onset constipation or pain with urination
While occasional wet nights up to age 6 or 7 are normal, frequent or increasing bedwetting warrants a discussion with your pediatrician. They can help determine if there’s an underlying issue, provide guidance on approaches to help your child gain bladder control and offer reassurance that this frustrating issue will very likely resolve with time and consistency.
When should you limit fluids before bedtime?
Limiting fluid intake before bedtime can help reduce urine production overnight and decrease your child’s chances of a bedwetting accident. Here are some guidelines on when to cut off fluids:
– Age 5 and under: Avoid extra drinks 1 to 2 hours before bedtime.
– Age 6 to 7: Stop giving extra drinks about 2 hours before bed.
– Age 8 and up: Cut off additional fluids about 3 hours before bedtime.
Some tips on fluid restrictions:
– Don’t let your child get thirsty or dehydrated. Restrictions are not meant to withhold needed hydration.
– Give the last drink of water at home well before bed, not right before lights out.
– Avoid giving extra or unlimited beverages in the evenings.
– Limit caffeine (soda, chocolate, tea), which acts as a diuretic.
– Juice and milk tend to increase urine output; opt for small sips of water near bedtime if needed.
– Adjust fluid cut-off times based on your child’s needs and input from your pediatrician.
– If morning urine is very dark or concentrated, increase hydration earlier in the day.
With some minor limits on fluid intake in the evenings, you can help reduce the chances of wet pajamas overnight. But be sure your child stays properly hydrated during the daytime hours.
What types of alarm systems are effective for helping kids stay dry at night?
Using a bedwetting alarm can be an effective way to help children achieve nighttime dryness. These alarms are triggered when they detect moisture and alert the child that it’s time to finish urinating in the toilet. There are two main types of bedwetting alarm systems:
Wearable alarms
Wearable alarms clip directly onto the child’s underwear. Sensors on the alarm detect urine and trigger an audible alarm and/or vibration to wake the child. Popular wearable alarm options include:
– Chummie Bedwetting Alarm
– Malem Medical Wet Bed Alarm
– Nytone Bedwetting Enuresis Alarm
– Therapee Bedwetting Alarm
Pad-based alarms
These systems use a moisture-sensing pad placed on the bed under the sheet. When the pad gets wet, it transmits a signal to an attached alarm unit that alerts the child. Examples include:
– Wet-Stop3 Bedwetting Alarm
– DRI Sleeper ENE Bed Wetting Alarm
– TAT Bedwetting Alarm
– Bedwetting Buddy Super Sensor Pad Alarm
Key factors in choosing an alarm system include reliability, loudness of the alarm, comfort and ease of use. Wearable alarms tend to have quicker sensor response times. But pad-based options don’t require wearing clips or sensors. Work with your child’s doctor or bedwetting specialist to select the most suitable alarm option.
What techniques can help kids learn to wake up to use the bathroom at night?
Helping a bedwetting child learn to rouse from sleep and independently use the bathroom at night can promote self-reliance and eventually eliminate wet nights. Here are some effective techniques:
– Set a middle-of-the-night alarm to wake your child for bathroom trips. Choose a time when their bladder is likely full. Gradually adjust to earlier times.
– Use positive reinforcement. Offer fun rewards like stickers or treats when they wake up dry.
– Make sure the path to the bathroom is clear and well lit with nightlights. This makes overnight bathroom visits easier.
– Consider using a wearable wetness alarm that alerts your child when they start to urinate at night.
– Make sure your child goes to the bathroom right before bedtime each night.
– Encourage stopping fluid intake 1-2 hours before bedtime to help decrease nighttime urine production.
– Rule out any underlying cause of heavy sleeping, like sleep apnea.
– Assess medication side effects. Some drugs like antihistamines can increase bedwetting.
– Avoid pulling diapers off or waking your child fully overnight. This can hinder their ability to learn to wake independently.
With persistence, patience and praise for steps in the right direction, your child can learn self-awakening skills to stay dry through the night.
At what age should you take a child to a pediatric urologist for bedwetting?
Most pediatricians advise consulting a pediatric urologist if nighttime bedwetting continues past the following ages:
– Girls over age 8
– Boys over age 9
Additional signs it may be time to see a urologist include:
– Bedwetting accompanied by daytime accidents
– Bedwetting that persists after prior dryness for 6+ months
– Lack of any progress toward dryness by age 6-7
– Bedwetting associated with new onset constipation
– Pain or discomfort when urinating
– Strong family history of delayed bladder control
A pediatric urologist specializes in treating urinary conditions in children, including bedwetting. They can identify any underlying cause and offer specific treatment options like:
– Prescribed oral medication
– Bladder training therapy
– Nerve stimulation therapy
– Surgery in rare cases
While many kids eventually outgrow bedwetting on their own, a pediatric urologist can help develop an individualized treatment plan for children who continue to struggle with overnight dryness by age 8-9. They can provide both medical interventions and emotional support as you help your child work toward this important milestone.
Conclusion
Achieving nighttime bladder control is an important developmental step that occurs gradually between ages 2 and 7. While most kids stay dry by age 6, it’s still considered clinically normal to wet the bed occasionally until age 7. For bedwetting that persists beyond that, a thorough evaluation by your pediatrician is recommended to determine if any underlying condition is contributing to the problem. With patience and consistency using measures like rewards, bedwetting alarms and medication when appropriate, nearly all children can overcome delayed nighttime continence. Stay positive through the process, avoid punishment or pressure, and celebrate each dry morning, no matter how infrequent at first. With time and encouragement, your child will gain the skills needed to say goodbye to wet PJs and bedding!