Bedwetting in older children
Getting up at night to change wet sheets and sooth an embarrassed child is something most parents have been through. But when bedwetting continues beyond age 6 or 7, or recurs after a child has been dry, here’s what you need to know.
Bedwetting at night – known formally as ‘nocturnal enuresis’ or ‘nocturnal incontinence’ – is a normal part of child development, as children learn to control their bladders. It can be humiliating for the child and frustrating for tired parents, but occasional accidents are common.
According to the American Academy of Pediatrics, at age 5 about 20% of children wet the bed; at age 7, about 10%; and by their late teens, 1-3% still do. In South Africa, 16% of children aged 5-10 wet the bed, according to a study in the British Journal of Urology International. That’s around one in six children – or four to five children in your child’s class, as celebrity medical doctor Michael Mol puts it in a reassuring post on Facebook, titled ‘You are not alone’.
The important thing to keep in mind, say he and other medical and psychological experts, is that your child can’t help wetting the bed – and should never be teased, humiliated, or worse, bullied or punished, for it. And that almost all children grow out of it eventually.
What causes bed-wetting?
Bedwetting is mainly caused by the nerve connections between bladder and brain not being fully developed, resulting in the bladder releasing urine whenever it feels full. As children get older, they gain control over this, initially during the day, and eventually at night, says Vredenburg paediatrician Dr Susan Annandale.
Reasons why it takes some children longer to master this than others range from genetics (having one parent, and particularly two, who wet the bed as kids raises the likelihood), to hormones – some children don’t have enough of the anti-diuretic hormone that causes their body to make less urine when they sleep.
Drinking too much liquid before bedtime, and sleeping so deeply that they battle to wake in time to wee, can play a role, as can constipation, when an over-full bowel presses on the bladder. More rarely, a child may have a small bladder that doesn’t hold as much urine as others, a urinary tract defect, or a medical problem such as a urinary tract infection (UTI), kidney disease, or diabetes.
And when a child starts bedwetting again after being dry for six months or longer (known as ‘secondary enuresis’), stress or an emotional upset can play a role. “This could be anything from moving home or school, to being bullied or abused, or having a divorce or death in the family,” says Gauteng counselling psychologist Karin Steyn.
All this makes it important to talk to your paediatrician and have your child checked out if they are still ‘having accidents’ after age 6 or 7. “As doctors, we are slightly more tolerant of a child of this age who has not yet been ‘dry’ for six months (‘primary enuresis’), and to just observe,” says Dr Annandale. “But if the child has been dry for longer than six months (‘secondary enuresis’), it’s important to exclude a UTI or emotional issues.”
