Potty training can be a very exciting and eventful time for young children. It represents a major shift in childhood development and a big step towards gaining independence. But becoming potty trained, as anyone who has gone through the process knows, is usually not as simple as an on/off switch. Many children who master one element of potty training (such as peeing on the potty) may struggle with other aspects (such as stooling on the potty). Commonly, the last thing that children will be able to master is staying dry at night.

For context, there is a pretty wide range of “normal” for when children start and complete potty training. Some children and their families are ready to start the process as early as 18 months, while others prefer to hold off until closer to ages 3 or 4. Similarly, some children progress quickly and are dry at night shortly after switching out of diapers, whereas other children will have mastered potty training during the day but continue to have accidents at night. Though bedwetting (nocturnal enuresis) is considered to be the persistence of nighttime accidents after age 5, up to 10% of children will still have accidents at age 7, and some will continue to have accidents until age 10.

If you’re wondering if your child’s nighttime accidents are concerning, your pediatrician is a great place to start! There are a variety of things that they will consider, a few being:

• Onset – Has your child always had nighttime accidents, or is this a new development?
• Sleep – Is your child a deep sleeper? Do they snore? Are there other concerns regarding sleep?
• Stressors – Are there other stressors in your child’s life or other behavioral concerns?
• Family History – Is this something that runs in the family?
• Medical – Does your child have any other medical issues that could be contributing?

What to do about bedwetting?

The most important starting point is to remember to be supportive. Your child wants to stop having accidents, and if they’re still having them, their bodies are just not ready. Often, children will feel embarrassed or ashamed by ongoing accidents, so it’s important that they get the right message of unconditional support from their parents.

There are some initial steps you can take to try to decrease the frequency of accidents, but it’s best to wait until your child is having at least four dry nights per week before making these changes:

• Reduce the amount of liquid consumed 1-2 hours before bed. If trying this, it is important to give extra fluids either in the morning or afternoon to promote good hydration.
• Eliminate caffeinated drinks or drinks that are high in sugar.
• Remind your child to use the bathroom before bed each night.
• Wake your child when you go to bed to see if they can use the bathroom again (they may be partially asleep when you are walking with them to the bathroom).
• Keep a calendar of when accidents occur. This will be helpful to see if your intervention is working.
• Try a sticker chart or other reward system. When making a sticker chart, emphasize things that your child can control, such as remembering not to have fluids right before bed, remembering to use the toilet, or even helping with cleaning up in the morning.

Additional strategies

Part of being supportive is helping your child reduce the impact of their bedwetting. Using easily cleanable sheets and pajamas is a good step. When accidents do happen, use moisturizers to address skin irritation. Make sure to plan extra time in the morning to focus on proper cleaning after the accident to minimize the impact and reduce negative feelings that can come as a consequence of bedwetting.

If, in conjunction with your pediatrician, you’ve decided to try further interventions, there are two common options to consider. One option is a medication called desmopressin. This medicine, when taken before bed, can help prevent the bladder from filling overnight. This is more of a short-term fix, as it doesn’t get to the underlying cause of bed wetting, but it can be helpful in situations such as sleepovers or summer camp to allow your child to stay dry when it could be socially disruptive. If the medication is discontinued, typically, bedwetting returns.

Another option to consider trying is a bedwetting alarm. A bedwetting alarm is a pad or sensor that can detect the first sign of increased moisture and will either vibrate or make a noise to wake your child and remind them to use the bathroom. The hope is that over time, this will start to teach your child’s body to recognize the sensation of a full bladder, and will eventually become unnecessary. These can start working within weeks but can also take a number of months to start being effective, so setting appropriate expectations (both for you and your child) and being patient is critical. Bedwetting alarms work best when your child has 3-4 dry nights per week.

When to contact your pediatrician about bedwetting

If you’re ever unsure if your child’s pattern of bedwetting is concerning, you can always reach out to your pediatrician to discuss further. Though most children are accident-free by age 10, every situation is different and requires an individualized approach. A few reasons to reach out are:

• New bedwetting after previously being dry.
• Your child is experiencing excessive thirst.
• Bedwetting is causing significant distress.
• Your child is experiencing painful urination.
• You’re worried as a parent.

Remember that bedwetting is neither your nor your child’s fault. Almost everyone gets there eventually, and the way you support your child throughout the process is just as important as the end goal of staying dry itself.