Q: My 8-year-old son is still wetting the bed at night every now and then. Should he see a specialist?

Q: My 8-year-old son is still wetting the bed at night every now and then. Should he see a specialist?


A: Over 90 percent of bedwetting is primary, where the child has never been consistently dry throughout the night. Secondary bedwetting is when the child was dry throughout the night for at least three to six months and then begins to wet the bed again.


I will concentrate on primary bedwetting today.


Five million to 7 million American kids still wet the bed at night (boys more often than girls) after becoming potty trained, which typically occurs between ages 2 and 4. Here is a breakdown by age: 15 to 20 percent of 5-year-olds; 8 percent of 8-year-olds; 5 percent of 10-year-olds; 2 percent of 12-year-olds; and less than 1 percent by age 15.


Primary bedwetting is so common we should talk about it in terms of the wide variation of ages for kids to be completely dry at night, rather than calling it a “problem.”


Primary bedwetting is almost always because of normal variations in the child's physical maturation –– less than 1 percent of cases are because of an underlying medical condition, such as sickle cell disease, diabetes, thyroid conditions, urine infections, kidney disease, bowel diseases, neurological problems or others).


Examples of this delayed maturation include:




Smaller bladder size causing buildup of more pressure with the same amount of urine. Think of a smaller balloon stretching to contain the same volume as a larger balloon.

Decreased sphincter strength. Think of this like the knot tying off the balloon; if it is delayed in developing strength, it is easier for urine to “leak out.”

Lower levels of vasopressin, the hormone responsible for urine retention.

Primary bedwetting is a physiologic issue, NOT a behavioral problem. Supporting this fact, 15 percent of bedwetters have it resolved each year; as their bodies mature, more and more they are able to stay dry overnight.


Furthermore, bedwetting runs in families; there is a 75 percent chance a child will have primary bedwetting if both their parents did and a 50 percent chance if one parent did.


Therefore, the most important "treatment" for primary bedwetting is:




Reassure your child that it is common and they will outgrow it. Telling them of other family members that have gone through the same issue will often be helpful.

Giving positive reinforcement for dry nights, such as gold stars on a calendar, may be motivating.

Make a “no teasing” policy for siblings, family members and others, and strictly enforce it.

For practical and hygienic reasons, a plastic bed covering should be used; explain this to your child.

The child can help change their sheets or be taught to do this themselves if it makes the situation less embarrassing and is viewed as a positive thing. Be sure they understand this is to keep their sleeping area clean and is not a punishment.

Avoid excessive fluids close to bedtime to avoid overstretching the bladder, and have the child empty their bladder just before going to bed.

Consider waking the child when you go to bed to allow them to empty their bladder again. This must not be viewed as a punishment and should not embarrass them or negatively affect their sleep.

Respect your child's feelings, and understand that they may not want to have sleepovers or go to them if they would feel embarrassed.

For those children who have significant delay in nighttime continence, especially if it causes social issues, other treatments may be considered:




Behavioral alarms are activated by bedwetting and work as a biofeedback system to help the child "learn" when an episode has occurred. Up to 70 percent of kids benefit from these, though they sometimes require weeks or months to have effect. However, some children have recurrence after the alarm system is discontinued.

Medications, such as vasopressin, may be indicated in a minority of patients. Close consultation with the child's pediatrician, including a frank discussion of the risks and benefits, is needed to make the best decision.

The evaluation of a child with primary bedwetting includes a complete history and physical along with a urine test to look for anomalies. Other symptoms, such as daytime incontinence or concern for an underlying medical condition, may indicate a need for other testing.

Primary bedwetting is simply a normal variation in when the child's body is mature enough to be dry throughout the night. Those who have bedwetting after age 6 or 7 should be screened by their pediatrician, but this is not a cause for alarm.


Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.