For a child and their parents, gaining control over their bladder and bowel is a key developmental milestone like learning to walk and talk. Most children have complete control of their bowel by four years of age and of their bladder by five years of age. Having said that, approximately 15% of children may still wet the bed at five and this reduces to 2-3% at ten years of age. More frequent bedwetting (four nights or more out of seven) tends to resolve more slowly.
Bedwetting is seldom a sign of an underlying medical or emotional problem particularly if it has always been there from the word go, when you will often find other family members have had the same problem. Some children can be dry for six months (without help) and start wetting again and these children need to be checked for problems like urinary tract infection, diabetes, constipation and emotional stress. Some children with ADHD or Autism have difficulties with bladder and bowel control including bedwetting, as do children with significant snoring.
The underlying cause of bedwetting is fairly simple; the bladder stores urine by day and night and its biggest challenge is to get through the night without needing to empty. This relies on good storage ability and a normal size bladder. If for whatever reason, the bladder does need to empty during the night, some children can wake up and go to the bathroom then back to bed, in which case they are dry, but others are unable to wake to their bladder signalling and end up wetting. Treatment of bedwetting addresses these simple issues.
Good general advice for all children or young people who bedwet includes:
Make sure your child has a daily bowel motion which is soft and sausage shaped. Constipation can make bedwetting worse
Train your child's bladder to store and hold better by encouraging your child to drink 6-8 cups of healthy, low sugar drinks equally spaced throughout the day and finishing a minimum of one to one and a half hours before bedtime
Use a sensible night-time routine with a settling down period half an hour before bed without any screens
Encourage your child to be comfortable about using the bathroom and not delaying during the day, and always remember to pass urine before bed even if there is no feeling of need
Some children respond well to star charts but make sure they are being rewarded for something in their control e.g. weeing before bed or having their last drink with dinner
With older children agree to form a bedwetting-busting team and agree on which bits you will do e.g. remaking the bed, and what your child can do e.g. stripping the bed and putting the sheets in the washing machine
Remember it is not your child's fault that they wet the bed and remain positive, supportive and calm. Punishment makes things worse.
Should things not move in the right direction, then specific treatment for bedwetting can be considered including the bedwetting alarm which teaches the child to recognise the bladder signals in the night and to wake and use the toilet. Various medications including Desmopressin have also been shown to be safe and helpful.
For further reading the following resources are useful: