Bedwetting in Children (Enuresis): Causes and a Guide for Parents

Why does bedwetting happen in children and when is it a problem? This guide covers steps to take at home for night and day enuresis, and psychological support.

Waking up in the morning to find your child's sheet wet again can be a tiring and sometimes embarrassing experience for both you and your child. Bedwetting, known medically as enuresis, is when a child at an age at which toilet training is expected to be complete involuntarily passes urine in bed or in their clothes. This situation, which is much more common than many families think, is usually not related to the child's willpower, and most of it resolves by itself over time. However, because it can affect a child's self-confidence, friendships and peace at home, it is important to approach it with the right information and patience. In this article we explain in detail the types of enuresis, its possible causes, what you can do at home and when you should get support from a doctor or psychologist.

What Is Bedwetting (Enuresis)?

Bladder control is a skill acquired step by step as the child's nervous system and bladder mature. Most children learn to stay dry first during the day and then at night. Night-time control develops later than daytime control, because during sleep it requires noticing that the bladder is full and either waking up or holding the urine.

In general, wetting that continues regularly after the age of five is considered enuresis. Accidents before this age are regarded as a normal part of development. Enuresis is classified in several ways:

• Night-time enuresis: Wetting the bed only during sleep. This is the most common type.
• Daytime enuresis: Leaking urine into clothing while awake. In this case a medical assessment is especially important.
• Primary enuresis: The child has never been able to stay dry for a long period.
• Secondary enuresis: The child starts wetting again after having stayed dry for at least a few months. This type can often be linked to a change or a source of stress.

In a significant proportion of children who wet the bed at night, the situation improves gradually over the years without any intervention. Even so, waiting with the thought "It'll pass anyway" is not always right; because as the process goes on, the shame and anxiety the child feels can build up. For this reason it is useful to make even the decision to wait together with your doctor.

If you are still going through the toilet training process, our article on toilet training can guide you on the stages of this period.

What Causes Bedwetting?

Enuresis most often arises from several factors coming together. The important thing is to know that the child is not doing it "on purpose" or "out of laziness".

Physical and developmental factors

• Developmental maturation: In some children the systems that provide bladder control mature later than in their peers.
• Family history: Enuresis is known to be more common in children whose mother or father had a similar situation as a child.
• Deep sleep: Some children sleep so deeply that they find it hard to wake when the bladder is full.
• Night-time urine production: In some children the amount of urine produced during the night may exceed the capacity of the bladder.
• Constipation: A full bowel can put pressure on the bladder; constipation and wetting can often occur together.
• Medical conditions: Urinary tract infection, certain metabolic and neurological conditions, or breathing problems during sleep can lead to enuresis.

For this reason the first step is always an assessment by a paediatrician or a doctor specialising in paediatric urology.

Emotional factors

Secondary enuresis in particular can be related to changes in the child's life:

• The birth of a new sibling (you can look at our article on sibling jealousy)
• Moving house, starting school or nursery
• Parents' separation, conflicts within the family
• The loss of a loved one, illness or a hospital stay
• Frightening events that shake the sense of security, such as an earthquake
• Difficulties at school or peer bullying

Emotional factors can be thought of less as the sole cause of enuresis than as triggers that bring out an existing predisposition or cause a child who had been dry to regress.

The Effect on the Child's Emotional World and Family Life

Enuresis itself is often harmless; the real burden is what the child feels about it. School-age children in particular may struggle with shame, guilt and thoughts like "Why am I not like the others?" Going to a friend's for a sleepover, joining a school camp or staying with relatives can turn into frightening situations.

Imagine a seven-year-old who comes up with excuses when invited to stay with their cousins. In fact they are afraid that if they wet the bed at night, their cousins will find out. In this example the real problem is not the wet sheet but the shame and social anxiety the child carries inside.

Emotional effect by age

Ages 5–6: Children of this age often don't make much of the situation themselves; but they watch the parent's reaction closely. A calm attitude keeps the matter from growing.

Ages 7–10: As awareness of peers and comparison increase, bedwetting can become a source of shame. The child may begin to avoid activities such as sleepovers and camps.

Age 11 and over: In pre-adolescence and adolescence the need for privacy increases markedly. At this age the subject must be talked about very carefully even within the family, taking the young person's consent into account. It can be expected that the young person will feel worthless, withdraw or become angry.

In extended-family settings in Turkey, relatives' comments, however well meant ("She's a big girl now, still at it?"), can wound the child deeply. Parents too can feel tired and impatient because of the endless laundry, broken sleep and pressure from those around them. These feelings are understandable; but it is very important that they are not passed on to the child.

How Can Bedwetting Be Overcome? Steps You Can Take at Home

1. Stop blaming first

Enuresis is not a behaviour within the child's control. Getting angry, punishing, shaming or talking about it in front of others does not improve the situation; on the contrary, it can make things worse by increasing anxiety. You can tell your child: "This is not your fault. For some children, the body learns to stay dry at night a little later. We will work on it together."

2. Regulate daytime toilet habits

• Remind them to go to the toilet at regular intervals during the day, for example on waking, after lunch, when they come home from school and after dinner.
• Some children are reluctant to use the toilet at school and hold their urine; talk to the teacher about this.
• Support a high-fibre diet and enough movement against constipation; if constipation continues, consult your doctor.

3. Spread fluid intake across the day

It is important for the child to drink enough water during the day; restricting fluids completely is not right. Instead, you can have them take most of their fluids in the morning and afternoon and reduce the amount in the evening. Avoiding caffeinated and sugary drinks in the evenings can also help.

4. Create a bedtime routine

• Going to the toilet just before bed and then a second time a little while later
• Leaving a dim light in the corridor so they can go to the toilet at night
• Making sure the way to the toilet is easy and safe; this is very important for children who are afraid of the dark

5. Involve the child in the process

Allow the child to take responsibility in an age-appropriate way; but present this not as a punishment but as participation that supports their sense of control:

• Ages 5–7: Putting their wet pyjamas in the laundry basket, choosing their own clean pyjamas
• Ages 8–10: Helping to take off the sheet, laying a protective cover on the bed
• Age 11 and over: Keeping track themselves, managing, if necessary, a plan prepared together with the specialist

6. Reward the effort, not the dry nights

Since a dry night is not something the child can directly control, rewarding only dry nights can create disappointment. Instead, notice the behaviours the child can control: going to the toilet before bed, paying attention to how much they drink in the evening, helping to remove the wet sheet in the morning. A simple sticker chart can be motivating for younger children.

7. Make life easier with practical measures

• Use a waterproof mattress protector; keep spare sheets and pyjamas ready for changing at night.
• For situations such as sleepovers and camps, make a discreet and practical plan together with your child.
• Don't let siblings make fun of the subject; talk openly in the family about this matter being private.

8. Be careful about waking them at night

Although waking the child at night and taking them to the toilet provides short-term relief for some families, if it is done without the child fully waking, it may not help them learn bladder control in the long run and may disturb their sleep pattern. It is healthiest to decide together with your doctor whether methods such as night waking and an enuresis alarm should be used.

9. Manage communication with school and relatives

For a child with daytime leakage, talking to the teacher in confidence allows small arrangements such as easier permission to go to the toilet and keeping a spare set of clothes at school. For children who wet the bed at night, decide together with the child who this information will be shared with. If grandparents or other relatives are going to know, ask them too not to comment, not to compare and to respond calmly. The child's trusted adults showing the same attitude is the foundation of their feeling safe.

A wet night is not a failure; what your child needs most from you is patience and acceptance.

When Should You Seek Professional Support?

In the following situations it is recommended that you first see the paediatrician:

• If the child still wets regularly although they are over five
• If they start wetting again after having stayed dry for a long time
• If there is also daytime leakage
• If there is burning or pain when passing urine, frequent urination, excessive thirst, a change in the colour of the urine or constipation
• If sleep problems such as snoring or pauses in breathing during sleep catch your attention

After a medical assessment has been made, psychological support can also be helpful in the following situations:

• If the enuresis started after a loss, divorce, move or frightening event
• If the child experiences marked shame, anxiety, anger or withdrawal
• If they avoid friendships, sleepovers and social activities
• If the subject has become a source of serious tension within the family

How Is Bedwetting Approached in Therapy?

Psychological support does not replace medical treatment of enuresis; but it can complement it. It makes an important contribution especially where emotional triggers play a role and in reducing the shame and anxiety the child feels.

Meetings with parents: The child's developmental history, the onset of the wetting, changes in the family and the methods tried so far are assessed. How to build a consistent, non-blaming approach at home is planned together.

Play therapy: Young children often express challenging experiences such as the birth of a sibling, separation or fear not in words but through play. Child-centred play therapy offers the child the chance to process these feelings in a safe relationship. You can find this approach in detail on the child and play therapy page.

Cognitive behavioural approach: With school-age children, work can be done on behavioural steps such as regulating toilet habits, tracking charts, positive reinforcement and supporting adherence to the methods the doctor recommends. The child's negative thoughts such as "I'm bad" are addressed and their self-confidence is strengthened.

Therapy also addresses the social difficulties the child experiences. For example, a realistic plan is prepared together with the child for situations such as sleepovers and school trips, and what to say and how to behave in possible moments of embarrassment are practised with role-play. In this way the child learns to live without restricting their life even if the bedwetting continues, and to accept themselves as they are. It is also an important part of the process for parents to have a space in which they can talk about their own tiredness and disappointments.

In cases requiring medical treatment, the process is carried out in cooperation with your doctor. For a general framework on when you should consult a child psychologist, you can also read our article on when to see a child psychologist.

Frequently Asked Questions

Up to what age is bedwetting normal?

The ability to stay dry at night develops at different times from child to child. In general, wetting before the age of five is considered normal. If it continues regularly after five, an assessment by a doctor is recommended.

Does punishing a child for wetting work?

No. Enuresis is not behaviour the child does on purpose. Punishment and shaming can make the situation harder by increasing anxiety and can damage the child's self-confidence.

Why does a child who had been dry start wetting the bed again?

This is called secondary enuresis. Besides medical causes such as a urinary tract infection, sources of stress such as the birth of a sibling, moving house, starting school or changes in the family can also be triggers. A medical assessment should be made first, and then the child's emotional needs should be addressed.

Does using night-time pants delay the process?

At a young age, and especially in situations such as sleepovers, night-time pull-up pants can be a practical solution. With older children, however, it is important to ask the child's opinion and to decide together with your doctor. For some children, noticing the wetness is part of the process.

• #bedwetting
• #enuresis
• #night wetting
• #toilet training

Yazar

Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

Eğitimler