Five million American children go to sleep every night not knowing if their bed will be wet or dry in the morning. However, because bedwetting is one of those “hidden” problems of childhood, most children (and some parents) think they are the only ones with the problem.

I sympathize with kids who wet the bed because it’s hard to deal with something that occurs when you’re sleeping. Even more frustrating is the fact that children don’t know if it’s going to happen. Although some wet the bed every night, most do it less often.

Because parents are often uninformed about the nature of bedwetting, some children are punished for being wet at night. Parents should always remember two facts about bedwetting. First, it is a medical problem. Second, no one wets the bed on purpose.

Bedwetting is divided in two groups. Primary bedwetting refers to children who have never been consistently dry at night. Secondary bedwetting refers to children who were dry for at least six months before they started wetting again. Because nighttime wetting is common in young children, most doctors don’t diagnosis a child as being a bedwetter until he reaches age 6.

Bedwetting is hardly ever caused by a serious medical problem. In most cases, it is due to a maturational delay in the way the brain and bladder communicate with each other at night. There are four main factors that contribute to the problem.

  • Bladder size. Children who wet the bed usually have bladders that are smaller than their peers. This causes them to urinate more frequently during the day and their bladder has less room to “hold” urine at night.
  • Nighttime urine production. The brain produces a hormone at night that reduces the amount of urine the kidneys make. Some children who wet the bed produce less of this hormone and thereby produce more urine while they sleep.
  • “Deep” sleep. Some children have difficulty waking up at night in response to internal or external stimuli. As a result, the brain may not respond when the bladder signals that the child needs to urinate.
  • Constipation. Because the rectum is located behind the bladder, constipation can interfere with bladder emptying or the way the bladder signals the brain that a child needs to go. This can lead to both daytime and nighttime wetting episodes.

Although behavioral techniques may help, the most effective treatment for bedwetting is a product called the bedwetting alarm. Most bedwetting alarms are small, battery-operated devices that children wear to bed at night. The device teaches the child’s brain to pay attention to his bladder while he’s sleeping. Bedwetting alarms have two basic parts: (1) a wetness sensor that detects urine and (2) an alarm unit that produces a loud sound when a child wets the bed.

So what can you do if your child wets the bed? Well, the first thing to do is to let your doctor know what’s going on. It was recently discovered that most parents do not raise the issue at checkups either because they don’t think the doctor can help or they are afraid it will embarrass their child. Also, many doctors don’t ask if bedwetting is a problem because they figure parents would tell them if it were.

Trust me, we’re listening.

Bennett is a pediatrician in Washington, DC. The second edition of his book, Waking Up Dry: A Guide to Help Children Overcome Bedwetting, was published in May 2015. You can find out more about bedwetting at Dr. B’s website: www.howardjbennett.com

You can find more parenting coverage washingtonpost.com/onparenting, and sign up for our newsletter here. Like On Parenting on Facebook for more essays, advice and news.

You might also be interested in: