My four-year-old has been potty trained during the day for a long time, but he still wets the bed almost every night. Is there something wrong? Why can't he master this part of training, and what can we do about it?
The development of nighttime urinary control is a biological process. As children grow and develop, so does their ability to control their bladder. There is a wide range of normal for when this nighttime control occurs. Bed-wetting, called enuresis (enyur-EE-sis), is common among young children. Since almost 50 percent of all three-year-olds and up to 40 percent of four-year-olds wet the bed several times a week, it is considered normal behavior at this age. Additionally, 20 to 25 percent of five-year-old children and 10 to 15 percent of six-year-olds don't stay dry every night. In addition, many young children who are dry at night for a long period of time begin to wet the bed again, sometimes after a time of change in their life or stress. (If your child suddenly has a change in nighttime or daytime bladder habits, it's a good idea to check with your health care provider to make sure your child doesn't have an infection or other health issue.) By the age of nine, only 5 percent of children wet the bed, and most of those children do it only once a month. As children get older, fewer and fewer have bed-wetting accidents. In the majority of cases, the problem goes away even when parents don't use any special treatment for the condition.
The most common reasons for bed-wetting are biological. Your child's kidneys aren't sending a signal to his brain when he's asleep, his bladder hasn't grown large enough to contain a full night's supply of urine, his bladder overproduces urine at night, or he sleeps so deeply he doesn't wake up to go to the bathroom. As children grow, all of these conditions are self-correcting.
Bed-wetting is also hereditary, so if one or both parents were bed-wetters, a child has a greater chance of doing the same. Diabetes, food sensitivities (specifically to caffeine, dairy products, fruit, and chocolate), some medications, or other health conditions can contribute to nighttime bladder-control issues. Bed-wetting also can be a symptom of a sleep disorder, so if your child has other signs (see page 383), you may want to investigate this possibility.
While at this age it's not necessary to work on nighttime dryness, you can help a child who wants to stay dry at night by doing the following:
• Limit liquids for an hour or two before bedtime. You don't need to cut out liquids entirely, though. Limiting liquids only reduces the amount of nighttime urine; it doesn't stop the reasons for bed-wetting.
• Make several prebedtime trips to the bathroom—one at the beginning of your bedtime routine and once again at the very end, just before lights out.
• Avoid using absorbent training pants, and use a special mattress cover instead. Absorbent pants or diapers can delay the normal development process, because a child can't feel when urination occurs.
• Make sure that your child uses the potty often (about every two hours) during the day. This encourages normal bladder function and can help with nighttime dryness.
• Use positive reinforcement with a sticker chart to help her monitor her success.
• Keep a night-light on for a clear path to the bathroom, and give your child permission to use the bathroom during the night if he needs to. Just the subconscious message may help.
• Avoid placing any blame on the child, and don't make her feel guilty or ashamed. Let her know that it's normal and will take time to change.
No child chooses to wake up cold and wet. Bed-wetting almost never happens because a child is lazy or disobedient. It's just like learning to walk or learning to talk—there's a wide range of normal and no reason to rush the process.
For a bed-wetting toddler or preschooler the best solution is the most simple one: allow your child to sleep in a diaper, padded training pants, disposable absorbent underpants, or use a special mattress cover until he begins to stay dry all night.
According to the National Kidney Foundation, you only need to talk to a doctor about bed-wetting if your child is six or seven years of age or older, or if there are other symptoms of a sleep disorder. With older children, a specialist can help direct parents as to the use of bed alarms, bladder-training exercises, diet changes, therapy, or medication.
There are plenty of things we parents must worry about and strive to change, but usually during the toddler and preschooler years, this isn't one of those things. All you have to do is be patient. In time it's very likely your child will be dry at night without your having to be involved in a solution at all.