One of the questions I've heard more than a couple times in clinic is: "Is my child's bed wetting a problem?" The answer? It depends.
Toilet training typically begins around age 2. Some kids show interest earlier, some later. Many things have to be in place before toilet training can be successful, ranging from the ability to sense the need to use the bathroom, to the ability to indicate that need to a caregiver, and finally to the ability to 'hold it' and control the muscles responsible for going. And, of course, the child must show interest, else attempts at getting them to use the bathroom are futile.
Nighttime bathroom use is generally the last stage of toilet training. At this point, children are usually able to use the bathroom appropriately during the day, but frequently have accidents at night. It is important to note that it is not their fault. Usually bed wetting is a result of deep sleep, when the signals of a full bladder are not processed to result in waking up to use the bathroom. It may take years after daytime training for nighttime training to be complete.
Importantly, if mom or dad (or both) were bed wetters as children, the child is more likely to take longer to achieve nighttime dryness. Boys are also more likely to wet the bed than girls, so don't use an older sister as a comparison.
If a child is still wetting the bed at age 5, it should be brought up to the pediatrician. In one study, most children had stopped bed wetting by age 41 months, or about 3 1/2 years old. However, at age 5, up to 25% of children are still wetting the bed, so it's not outside the realm of normal. The reason you should bring it up with your pediatrician is that it might be indicative of a developmental delay, so that possibility should be explored. It could also be an ongoing issue of constipation, as excessive stool may compress the bladder and lead to more accidents. However, it is not really considered 'abnormal' until the child is 7 years old or so.
There are some behavioral modifications you can do to help reduce your laundry load. This includes making sure the child stays well hydrated during the day (so they don't need to catch up on fluid intake at night), and reducing the amount of liquid at dinner time. The child should be asked to use the bathroom before bed, and even woken up when the parents go to bed to use the bathroom again. There are some sensors and alarms that can also be used to wake a child when they start wetting, but these tend not be very effective. Finally, there are some medications that can be used to decrease urine production during the night in extreme cases.
This is assuming the child has never had a period of dryness at night. I'm not talking about a day or two stretch here and there, but a period of consistent dryness lasting several weeks. If the child begins bed wetting again after this point, you should always bring it up to your pediatrician, because this is always abnormal.
In some cases, it will be due some sort of stress (divorce, new family member, etc), which can be treated with therapy. In others, though, it may signal another condition, such as diabetes (one of the early symptoms of diabetes is increased urination), a urinary tract infection, or even issues with sleep.
Bed wetting can be a stressful thing for both children and parents, but allow time to take its course and most of the time, it will resolve on its own.
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