Up to 50% of children will continue to wet the bed (nocturnal enuresis) at three years of age. Many children are much older than this before they achieve nighttime bladder control. Usually children who continue to be enuretic (bed-wetters) after five or six years of age have a parent who was late in obtaining bladder control also. Those children who have never achieved bladder control by the age of six years, probably should have an office visit to discuss the problem, as work up is needed and because there are treatment options available to them. Rest assured however, that the vast majority of enuretic children will eventually outgrow the problem with no long lasting complications. Because an enuretic child cannot help wetting the bed at night, any negative reinforcement of the problem such as spanking or shaming the child, is not recommended and will do damage to your child’s psyche.
Let us repeat this fact with emphasis: children who wet the bed, cannot help it. Most children who wet the bed at night are deep sleepers and because of this have relatively low levels of the anti-diuretic hormone (ADH) at night. ADH is produced in the hypothalamus and stored in the pituitary gland of the brain. It is released in response to lowering blood pressure and increasing sodium levels as water is lost from the body. With less water in the blood, the brain produces ADH to conserve the needed water. When present, this hormone (ADH) instructs the kidneys to not make as much urine, but to keep the needed water in the body. ADH lasts only a few minutes in the blood stream after being produced. The brain constantly reacts to the water balance of the body with either withholding ADH (urinating more) or producing ADH (urinating less) in response to the situation of needed water of the body. With heavy sleepers, the brain does not produce as much ADH as is really needed and hence extra urine is made. The child sleeps so deeply that they cannot tell that their bladder is full and that they need to urinate. Because the ADH is low, they actually make MORE urine. The outcome of these two factors is this: they wet the bed because they have made more urine and can’t tell their bladder is full. Because of these factors, fluid restriction at night is ineffective. The kidneys without ADH influence will make increased urine even in the presence of fluid restriction. So, here is some simple advice for most children who wet the bed at night: give it time. It will go away. With time and maturity, sleep becomes less deep for children and ADH levels rise. As they rise, bed wetting gets better. Give it some time. There are treatment options available for children 5 or 6 years of age and older should you desire.
Children who have been dry in the past and who develop bed wetting or even daytime enuresis need to have an appointment at the office for evaluation. Urinary tract infections and emotional stress are the most common causes of this.