Accidents and Bed Wetting in Children

Urinary incontinence is common in children under the age of 5. Occasional incontinence is a normal part of a growing child, and should not be considered problematic. Treatment should be initiated for children who continue to wet the bed, or have frequent daytime accidents.

Approximately 5-10% of children up to the age of 10, have trouble with bed wetting, also known as enuresis. Three percent of all 14 year olds still experience occasions of bed wetting. Twice as many girls than boys experience problems with enuresis (bed wetting). Evidence shows that if both parents wet their beds frequently as a child, their children may inherit this condition. There may be up to an 80% chance of inheriting bed wetting tendencies if both parents also had this condition. Research shows bed wetting may be linked to to gene, known as chromosome 13. Other risk factors that are associated with bed wetting are attention deficit disorder, learning disabilities, or children with allergies.

Children who suffer from incontinence are embarrassed and often have low self esteem. They avoid situations such as sleep overs and social situations that extend over more than a few hours. Bed wetting causes a disruption in sleep for the entire family. Children can be so embarrassed that they try to hide accidents from their parents. They do not want to disappoint their parents and are many times ashamed that they continue to have accidents. This condition is extremely frustrating for the entire family, but treatment is effective. Treatment takes time, patience, understanding and positive reinforcement to be successful.

Between ages 5 and 10, the bladder still has a fairly small capacity. Children typically sleep between 8-12 hours a night, and a small bladder capacity cannot hold urine for this length of time. This incontinence usually diminishes as the bladder grows and can hold more capacity. Some children in this age group may also have an underdeveloped signal from the bladder to the brain. This signal tells our brain when our bladder is full and needs to empty. If this signal is not strong enough, the child may not realize that it is time to empty the bladder. Children who sleep very soundly may also not be able to sense the signal or need to urinate.

Our bodies produce a hormone called antidiuretic hormone or ADH. This hormone slows down the formation of urine in the bladder. Our bodies produces more ADH during sleep to alieviate the need to urinate during sleep hours. If the body does not produce enough ADH at night, it can cause an overproduction of urine during the evening hours. The bladder will over fill and wetting can occur.

Anxiety in children can also contribute to urinary incontinence. A traumatic event, an unfamiliar situation, or a significant change in environment can all trigger incontinence. Events such as a birth of a sibling can trigger wetting, even in a child who was potty trained prior to the change. Other stressful situations that can cause enuresis are hospitalization, entering school, neglect, family alcoholism, financial stress, or divorce. Stabilizing the environment and reducing your child's stress with positive reinforcement can usually eliminate the bed wetting.

Obstructive Sleep Apnea

Obstructive sleep apnea is a condition where a child's breathing may be interrupted during the night. This interruption in breathing can occur for a few seconds or minutes, and is usually due to enlarged tonsils or adenoids. Typical symptoms of sleep apnea include enuresis (bed wetting), snoring, mouth breathing, recurrent ear infections, sore throat, and drowsiness during the day. If you suspect your child might have sleep apnea, see your doctor right away for evaluation.

Urinary System Disorders

A very small number of children present with structural problems in their body's urinary systems. Urinary reflux is a condition where urine backs up from the bladder into the ureters (tubes carrying urine from the kidneys to the bladder). Urine should flow from the bladder to the urethra, which carries urine to the outside of the body. When urine travels the wrong way, it backs up into the ureters, in the direction of the kidneys. Urinary tract infections and bed wetting are strongly associated with this condition.

Tips to Improve Bladder Control at Night

Limiting fluids after 6 pm can help reduce the amount of urine produced at night. During the day, try to have your child wait at least 2-3 hours between bathroom trips during the day. Reducing the amount of bathroom trips during the day, allows the bladder to increase capacity to hold urine. This will help ultimately lengthen the time that the bladder can hold urine at night.

Limit sugary, caffeinated or citrus type drinks for your child. These beverages can cause bladder irritation and make the bladder empty before it is ready. Water is the best fluid to drink to keep the bladder working properly. Make sure your child is drinking enough fluids during the day. Just remember to stop fluids by 6 pm.

If bed wetting occurs around the same time every night, waking your child before the accident can help train the child to sense when the bladder is full. They can go to the bathroom before an accident occurs.

Bed wetting alarms have been found useful in children who are having chronic night time incontinence. Sensors with sound or vibration are placed in the child's undergarment. If any sign of moisture occurs, the senor awakens the child in time to make it to the bathroom. See our treatment page for more details on incontinence alarms.

There are also books that you can share with your children to reduce embarrassment and encourage positive reinforcement for improvement with enuresis. Some of our favorites include: