Accidents Happen: What to Do if Your Child Still Wets the Bed

When children learn to use the toilet and graduate from diapers and pull-ups to underwear, parents celebrate the rite of passage—but even for “big kids,” accidents are still bound to happen.

About 5 million children wet the bed, according to the American Academy of Pediatrics. This includes nearly 37% of 4-year-olds—who usually have frequent accidents—and 11% at age 7, when it tends to become a secret. Around 5% still do at 10. By their teenage years, even in severe, long-lasting cases, almost all children outgrow bed-wetting.  

The phenomenon typically doesn’t harm children’s health, despite families’ concerns. Still, it can be uncomfortable and embarrassing, affecting self-esteem over time. Experts consider “enuresis,” the medical term for bed-wetting, in the context of your child’s unique life and development.

“Ultimately, bed-wetting isn’t the kid’s fault,” emphasized Brooke Slater, NP, who oversees Cedars-Sinai Guerin Children’s bladder management clinic within the Pediatric Urology Program. “It’s not anything they’re doing wrong, but it is something we can support them with and even fix.”

With appropriate care, you can help them reach the milestones that matter, free of shame.

“For both the child and parents, we’ve attached unnecessary shame to bed-wetting, when in fact, it is ubiquitous.”

Understanding Children’s Timelines  

For many children, bed-wetting is a normal developmental phase. The vast majority of those who experience this problem urinate involuntarily only at night and don’t have any other symptoms.

This challenge usually begins taking a toll around age 9 or 10, when children’s social lives expand in exciting ways—sleepovers, camps, best friends they confide in, traveling for sports and more time away from parents. If they can’t stop wetting the bed, the social cost becomes “emotionally traumatizing,” Slater explained.

She has seen patients who stuff diapers in their sleeping bags or backpacks, then change at their friend’s house. Some never sleep outside the home, or over time, learn to avoid situations where they could be exposed. Parents are often equally hesitant to bring up bed-wetting socially, frustrated that their child is still in diapers past a certain age.

“For both the child and parents, we’ve attached unnecessary shame to bed-wetting, when in fact, it is ubiquitous,” said Cedars-Sinai pediatric urologist Andrew Freedman, MD, the Walter and Shirley Wang Chair in Pediatric Surgery. “There’s no reason we assign any kind of shame to it, because it’s out of your control. We don’t shame people for having asthma.”

Reassure your child in terms they can understand, Freedman suggests: If your 9-year-old wets the bed, and 10% of kids his age do, that means two other kids in his class likely wet the bed.

The challenge usually runs in families.

Experts encourage parents who wet the bed growing up, or who have a family history of the genetic trait, to honestly share their experience. Recognizing that a loved one has dealt with the same thing can help children feel less isolated in their struggle. Bed-wetting doesn’t define a person—and for most, eventually clears up.

Every year, about 10% to 15% of kids become “dry” on their own, defined as having no accidents for at least six months.

Digging Deeper Into the Brain-Bladder Connection

While most children with this issue are only affected at nighttime, children who also struggle to hold their bladder during the day, or whose patterns abruptly shift, may need a closer evaluation.

“People tend to think all bed-wetters are the same, but there are lots of different reasons why children might share this symptom,” Freedman said.

About 20% of the time, “secondary enuresis” pops up after at least six months “dry.”

If your child’s accidents are new, returning or they leak into the daytime as well, seek professional support at a dedicated medical office such as the Guerin Children’s pediatric bladder management clinic. They coordinate with the full spectrum of specialists you might need.

These accidents could be a sign of emotional turmoil, usually triggered by a life-disrupting event such as a major move, new school, shifts in the family dynamic including divorce, the birth of a sibling, or death of a grandparent or another family member. Serious traumas such as the L.A. wildfires or school shootings can also be a culprit.

Bed-wetting after just a couple of weeks or months “dry” isn’t considered a regression.

The brain-bladder connection is rooted in science: As you sleep, the brain sends a hormone (antidiuretic hormone, or ADH) to your kidneys reminding it to conserve the water it has while you can’t drink and to block urine production.

“I always tell kids, ‘Your bladder is kind of dumb; it’s going to fill up and empty, because that’s all it knows how to do—it’s the brain that’s in charge of telling you to hold it,’” Slater explained.

Any obstacles to that communication can cause kids not to be able to hold their urine, for example, a neurological problem or an underlying sleep disorder such as sleep apnea. Most bed-wetters are extremely deep sleepers and struggle to be woken up, in turn, missing their bladder’s cues.

The neurodevelopmental disorder ADHD (attention-deficit/hyperactivity disorder) is linked to bed-wetting, too, though the reasons are still unclear.

Kids might also have a malfunctioning, overly eager detrusor muscle, which squeezes the bladder when it’s full.

“Think of bed-wetting as a balancing act,” Freedman suggested.

Also in the complex equation: the amount of urine. Their kidneys could make too much, due to a shortage in or lack of response to the hormonal “pause” button that directs urine production. Coupled with drinking habits at night, your son or daughter might just have too much liquid for their 8-ounce bladder to hold on to.    

A complete medical evaluation should also check for urinary tract infections that cause excessive peeing, especially if the child can’t wait as long as usual or has accompanying pain.

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Severe Bed-Wetting Is Treatable

Experts recommend first treating any emotional trauma with a therapy referral from your pediatrician, particularly when confidence is suffering or bed-wetting has kept them from activities they enjoy.

For children who continue to have accidents like clockwork and wake up soaked well after they’re old enough to control their bladder, usually 5 or 6, a “bed-wetting alarm” is considered the gold-standard cure.

These special, pager-like devices can be bought over the counter and work for 60% to 70% of kids who follow the treatment regimen. Its vibrating alarms immediately activate when underwear gets wet, teaching the brain to be more aware of the bladder and recognize when it’s full.

That takes time—at least three months to determine if the bed-wetting alarm helps—but around half of families quit in the first couple of weeks because of the aggressive, loud noises that wake everyone up.  

Stay the course, Slater suggests: Your child should be the one waking up right away, not a parent or sibling, or it won’t have the intended effect.

“If they sleep right through the alarm, put it away for a year, let the brain mature, and then try it again, because the older the kid gets, their brain develops and becomes more aware, and the treatment is more likely to be successful,” she said.

Specialists can also prescribe as-needed medication as a temporary fix. Taken at bedtime, desmopressin (DDAVP) imitates the hormone that regulates the bladder. You can use the pills to keep accidents in check for sleepovers, camp, field trips or other special occasions.

Bladder-Healthy Habits for Children

Foster an environment that accommodates your child and enables them to participate in as much as they want. Before a sleepover, or even earlier, speak with trusted parents, such as those of your child’s best friend, so they can give them their medication dose or stock pull-ups in their house. When discreet, this can keep kids dry—while preventing embarrassment among peers.

At home, the cost of training underwear, and hours of daily laundry, can add up. Even though it’s frustrating, forcing the child to pee the bed by cutting off these supports or “punishing the child won’t help anyone,” Slater emphasized.

Having training underwear on hand doesn’t promote bed-wetting.

“Kids don’t get lazy or used to diapers or pull-ups,” stressed Freedman.

To comfortably share the load, instead try offering your kid the choice of either doing the laundry with a parent, diapers or pull-ups. Some hate wearing diapers, while others get itchy rashes and can’t stand waking up wet.

Specialists focus on retraining children’s bladders, advising simple habits you can instill and reinforce at home:

• ‍Move your child’s fluids earlier. Water and liquids should be spaced throughout the day—in the morning, at school, after coming home, and a small glass at dinner.
  
  “You can’t just have them avoid liquid before bed, because if the kid hasn’t had anything to drink all day, they're going to be thirsty,” Slater explained, “and they’re going to go sneak water at some point when you’re not watching anyway.”

• While awake, pee every two to three hours. Ensure they don’t hold pee in for longer than that, and that they drink enough water that the pee is clear when they do go. ‍

• ‍Take your time in the bathroom. Elementary school kids tend to squeeze their stomach to go quickly, or they’re taught to push while potty training.
  
  “That’s actually damaging to the pelvic floor: You want them to relax and exhale like they’re blowing through a straw when they pee,” she said.
  
  “Mooing” like a cow can have the same release effect. Position is also important: Have them sit in a wide-legged stance, or use a squatty potty, to loosen their pelvic floor muscles.

• When trying to stay dry, your child should avoid the three Cs: caffeine, carbonation and citrus. Watch for spicy foods and those like chocolate that often contain ingredients which are aggravating to the bladder.

• ‍Make sure their bladder—and stomach—are empty. Urine is irritating if it sits in the bladder too long, so it can make kids unable to hold their pee, and they have to go more often.
  
  Surprisingly, if your child is suddenly having accidents, the most likely source is constipation. Too much poop backed up can prevent them from expelling all their urine. And like pee, they shouldn’t rush or strain, since both functions are supported by the same pelvic floor.

• ‍Add a “dream pee” before bed. Parents can slip in to take their child to the bathroom one last time before the parent goes to sleep.
  
  But don’t wake children up repeatedly overnight. It doesn’t help, Freedman cautioned, and it can disrupt their sleep and school performance.

Rather than making them feel worse for still wetting the bed, encourage your child with personalized motivation, such as their favorite gummy bears or a sticker chart.

“We know this isn’t your fault,” Slater said, “and it’s going to get better.”

Schedule a consultation with Cedars-Sinai Guerin Children’s dedicated pediatric bladder management clinic to find answers for your child’s bed-wetting challenges.