When Does Bedwetting Become a Problem

Does your child sleep so soundly that they wet the bed?

When I was potty training my first born, he was waking up with dry diapers from the get-go. I was happy I didn’t have to buy any more diapers and moved on, not thinking much more about it. But now that I’ve become a more “seasoned” parent, I realize that this was pretty darn good. Many of his peers, at age 5, are still not able to sleep through the night without a pull-up. And, you see the ads for “underwear-like diapers” for big kids, showing that bedwetting can last way beyond the potty training years. So why does this happen, how can you fix it, and when does it actually become a problem? Breezy Mama turned to Dr. Baruch Kushnir, a worldwide expert in bed wetting, bladder control, child development and the author of the book The Magic Bowl: Potty Training Made Easy.

I’ve heard that bed wetting can also be called “eneuresis”—is this the same thing?

Yes. Nocturnal enuresis, commonly called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary (PNE) when a child has not yet had a prolonged period of being dry. Secondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry.

Bedwetting is the most common childhood urologic complaint  and one of the most common pediatric-health issues. Most bedwetting, however, is just a developmental delay—not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.

I’m just potty training my 2 ½ year old—how long should it be before I expect her to sleep through the night dry? (Or knowing to wake up and go to the bathroom)?

Most kids stop bedwetting as part of their natural development. It is possible to try and accelerate the process by taking the child off the diaper for about two weeks. If the number of dry nights increases  gradually – continue without the diaper. If wetting continues – return to using the diaper. From age 3 onward it is possible to consider intervention using the bedwetting alarm.

I see advertisements for “ night diapers” made for older children–why does bedwetting still occur at this age?

Most children achieve bladder control between the ages of 18 months and three years of age. At the age of 5 about 20% of the children wet their beds.  The incidents are reduced gradually with age. At the age of 18 between 1.5% and 3% wet their beds. The problem is usually a result of a dysfunction of the reflex system that controls the bladder.

At what age does bedwetting become a “problem”?

Most children achieve bladder control between the ages of 18 months and three years of age. It is possible to apply effective treatment with the bedwetting alarm from the age of 3. It is recommended to treat the problem before the child reaches an age when he/she begins to feel different from other children and is prevented from participating in summer camps, sleepovers and other social activities requiring sleeping away from home.

How do you teach a child to not wet the bed?

Control of the bladder during sleep is acquired naturally in most children.  However it is possible to try taking off the diaper for about two weeks or intervene with use of the bedwetting alarm.

What if a child is scared to get up in the middle of the night to use the potty?

Parents should learn about the particular type of help the child needs to cope with this fear. Kids should be encouraged to wake the parents for help and be provided with some light along the route to the bathroom.

Is there anything a parent can do to help the child wake up and use the bathroom?

Being dry at night is not dependent on waking the child to go the bathroom.    Most kids and adults sleep through the night and wake up dry, without any “reminders.” An animated film demonstrating the functioning of the bladder can be viewed at: www.dr-kushnir.com.  The most effective approach to dealing with bedwetting is the use of the bedwetting alarm. It alerts the child to go to the bathroom at the right time, and eventually gain control of the bladder while sleeping through the night.

Can stress lead to bedwetting?

Children who have some degree of dysfunction of the reflex bladder control system are prone to have incidents of wetting when under emotional stress.

If yes, and something happens that triggers bedwetting several nights in a row, do you have the child wear a diaper at night even though they have been diaper free for a while?

This could be an elegant way of assisting the child. However, attention should be paid to seeking ways to understand the source of stress and help the child to cope with it. In addition, treatment intervention with the use of a bedwetting alarm should also be considered to achieve a situation where the child will not wet under any conditions, including stress.

Is there a medication that can help an older child from wetting the bed?

The medication most frequently used for treatment of bedwetting is the hormone Minirin (also known as Desmopressin). It is a tablet that dissolves under the tongue, taken before bedtime.  It is effective in about 60% of the children who take it. In almost all these cases there is a complete relapse once the medication is stopped. It could be of significant help in specific events, such as sleepovers, and reduce the social restrictions that bedwetting imposes. However, the most effective intervention for a long term solution is the bedwetting alarm when administered under professional guidance and support.

About Dr. Kushnir: Dr. Baruch Kushnir is a worldwide expert in bed wetting, bladder control, and child development. He graduated from the Hebrew University of Jerusalem, and possesses an M.Sc. in Clinical Psychology and a Ph. D. in Medical Psychology from Leeds and Hull Universities in the UK. Since 1982 Dr. Kushnir has helped more than 24,000 children in his 17 clinics throughout Israel. Dr. Kushnir’s new potty training book and children’s DVD, The Magic Bowl: Potty Training Made Easy, is available now. To order ($15.56 through Amazon) click here.

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  1. jeanette says

    My younger child was dry in the night for years and then about age 6 began to have sporatic problems with wetting the bed. We found that the solution was to take him to the bathroom as we went to bed. He didn’t even seem to wake up during this; so no lost sleep on his (or our) part!

  2. Kristine says

    The bedwetting alarm the doctor mentions really works. We just successfully night trained our 6 year old using this after trying every other method for the past few years.

  3. My 9 year old still wets the bed and we have tried almost everything EXCEPT the alarm and medication. He will have a week or so of staying dry and then its over. I have tried waking him up at night to go, but that is hard on him and me. We have tried cutting out liquids, etc. as well. Both my kids sleep HARD and they don’t typically get up after they fall asleep. I absolutely know he is not doing it on purpose and would like to stop – but he also is crazy terrified of me or him talking to a doctor about it. Gets a little hysterical at the thought of bringing it up to anyone outside the family. My daughter is 4 and she also has not shown signs of stopping the urination at night – most mornings she is still wet, so am thinking she will have the same problem. Frustrating for all of us.

  4. Dear Melissa,
    It appears that your children suffer from an ordinary, Primary Bedwetting.
    Bedwetting is a result of a dysfunction of the automatic reflex system that controls the bladder, the objective of any treatment must be to repair this system.

    Recovery from bed-wetting has substantial positive affect in a number of areas. It improves the general atmosphere in the home environment, as a result of relief from the burden surrounding washing the sheets, unpleasant odors, feelings of anger towards the child, and the need to keep a “secret.” It improves the self-image of the child, who may perceive herself as a failure and is ashamed of the bed-wetting problem. It contributes to building self-confidence and enhances a child’s social adjustment abilities as a result of lifting limitations regarding trips, sleeping over at friends’, etc…

    Treatment with the bed-wetting alarm is considered the most effective for the problem, according to Nelson Textbook of Pediatrics, commonly believed to be the world’s leading authority in pediatric medicine. However, without professional counseling and support the success rate is 15% compared to 90% with our instruction and guidance.

    Please go to http://www.dr-kushnir.com and watch the animated movie on our site, it will clear up many questions regarding the bedwetting problem.

    If you’d like more information on how we may help, please complete the online Diagnostic Questionnaire. We will respond to you directly once we have the information.


    Dr. Baruch Kushnir

  5. I have found metaphors within a night time story to be extremely useful and subsequently wrote a book (Storytelling To Help Your Child) about how this can help a multitude of problems. Have you ever worked with this technique at all? I’d be really interested in your views.


  6. I have a son who is 11 and is a bedwetter. I have never made a big deal out of it. (My dad was also a bedwetter until he was 12) is there a hereditary connection possible? I have not talked to our Dr about it, because my son is embarrassed to talk to ‘a stranger’about it. It has not made him uncomfortable or embarrassed to stay the night with friends, he packs an overnight pull-up discreetly in his bag, and goes. I just wonder if I should continue to let this play out or do something to help it along?

  7. Let me first answer your question directly: You most definitely should do something to help your son and not wait and let it play out.
    When a child between the age of three and four is still regularly wetting the bed, it is time for parents to seek professional help.
    The affect bedwetting has on a child, especially at the age of eleven should not be underestimated. Nocturnal enuresis (bedwetting) is a source of emotional, no less than physical, pain and suffering. From an emotional point of view, in many cases the child experiences a constant sense of failure and shame for being unable to function in the same way as his peers. He/she is a disappointment to the parents and siblings and is constantly aware of their anger and blame. The child is deeply ashamed of the problem and lives in constant fear of having the “secret” revealed. Many times the child is obliged to give up field trips, cannot sleep over at friends’, or vice versa. He/she is socially restricted and feels lonely, frustrated and dejected. If unchecked, this condition can cause irreversible damage to the child’s self-confidence, self-image and the normal development of personality.
    There is a known element of heredity. In over seventy percent of bedwetting cases, a parent, uncle, or aunt was a bedwetter.
    I recommend you visit http://www.dr-kushnir.com and watch the animated movie on the site, together with your son. It explains the problem and cause and is easy to understand. If you’d like further assistance, you may complete the diagnostic questionnaire on the site and I will be happy to further advise you.


    Dr. Baruch Kushnir


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