Written by Rachel Ealy, M.Ed, LPC-Intern
Enuresis, also known as bed-wetting, is an elimination disorder common in children that can occur both involuntarily and intentionally. Approximately 5 to 7 million children experience bed-wetting (Baird, Seehusen, and Bode, 2014). Dr. Kimberly Levitt reported that bed-wetting is twice as likely to occur in boys, is more common in children with a family history of bed-wetting, and children with ADHD are more likely to experience bed-wetting (2018). There are three types of enuresis:
1. Nocturnal: occurring at night-time only
- The focus of this particular blog
2. Diurnal: occurring in the daytime only
3. Combination Nocturnal and Diurnal
The Diagnostic and Statistical Manual (DSM-5) criteria for enuresis are as follows (American Psychiatric Association, 2013):
· Repeated voiding of urine into bed or clothes whether involuntary or intentional
· Behavior must be clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic, or other important areas of functioning
· Chronological age is at least 5 years of age (or equivalent developmental level)
· The behavior is not attributable to the direct physiological effect of a substance (such as a diuretic, antipsychotic, or SSRI) or to incontinence uncured as a result of polyuria or during loss of consciousness
o Polyuria is an abnormally large production of urine which typically results in frequent urination
· All of these criteria must be met in order to be diagnosed
· These symptoms must not be due to a general medical condition (e.g., diabetes, spina bifida, or a seizure disorder)
Even though bed-wetting is common in children, it still has the potential to affect your child’s self-confidence and self-esteem. As frustrating, expensive, and time-consuming as it can be, it is extremely important for parents to remain calm, patient, and understanding. Notice that the DSM criteria states that enuresis is not diagnosed if it is due to a medical condition. It is recommended that you have your child examined by a pediatrician to rule out any medical conditions. If all medical conditions have been ruled out, doctors recommend trying these 7 things (Cleveland Clinic, 2014):
1. Increase fluid intake earlier in the day and decrease later in the day
2. Encourage your child to take regular bathroom breaks every 2-3 hours and right before bedtime
3. Reward success! Let your child know that you are in this journey together and that you are noticing progress, even if it is small
4. Eliminate bladder irritants at night such as caffeine, citrus juices, artificial flavorings, dyes (especially red), and sweeteners.
5. Give your child a water bottle to drink throughout the day to avoid drinking too much water after school
6. Do not wake your child up in the middle of the night to urinate. Many parents try waking their child up throughout the night to no avail. Having your child urinate on demand does not typically work and causes frustration
7. Consider the possibility of constipation. The rectum is located right behind the bladder, so difficulties with constipation can present as bladder problems
You can also try having your child use a bed-wetting alarm. The most common alarm is a wearable alarm where a sensor is attached to your child’s underwear and a vibratory or audible alarm is attached to your child’s pajama top. A wireless alarm may reduce the possibility of the alarm falling off your child’s pajama top. With a wireless alarm, the sensor is still attached to your child’s underwear and the alarm can be placed on a desk or nightstand. This option can also help because your child will have to get up to turn off the alarm which can remind them to go to the bathroom. A bell and pad alarm is not recommended because the child can roll off of the pad and the alarm can sound inconsistently due to an insufficient amount of moisture. Dr. Kimberly Levitt (2018) stated that a bed-wetting alarm should be used until your child had achieved 14 consecutive dry nights. However, if an incident occurs again, replace the alarm for an additional month of successful use.
Try incorporating a reward chart to encourage your child to stick with the process and to communicate to your child that you are in this together!
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Baird, D. C., Seehusen, D. A. & Bode, D. V. (2014). Enuresis in children: A case-based approach. American Family Physician, 90(8), 560-568. Retrieved from https://www.aafp.org/afp/2014/1015/p560.html#
Enuresis DSM-5 307.6 (F98.0). (n.d.). Retrieved from Theravive: https://www.theravive.com/therapedia/enuresis-dsm--5-307.6-(f98.0)
How to help your child stop wetting the bed. (2014). Retrieved from Cleveland Clinic: https://health.clevelandclinic.org/how-to-help-your-child-stop-wetting-the-bed-2/
Levitt, K. (2018). Bedwetting. Retrieved from https://www.mottchildren.org/posts/your-child/bedwetting