Later bed-wetting heightens parental anxiety

Q: Six months ago, my wife and I decided it was time for our 7-year-old to stop wearing GoodNites overnight and for us to encourage him to get up and use the bathroom at night. We would wake him up twice at first, and then reduced it to waking him up once before we went to bed. He has had some successful nights, but even after a round of probiotics from the doctor, he continues to have accidents more often than not. He does not want to go back to wearing GoodNites, so we’re not sure what to do next.

A: Ah, nighttime potty training: the nightmare of so many parents. Your child trains like a champ during the day, only to struggle keeping dry at night, for years and years. This is shocking for parents. How can the child be consistently toilet-trained every day, and then not be able to control their bladder at night?

Well, it turns out there’s a lot we don’t know about nighttime bed-wetting (or nighttime incontinence/nocturnal enuresis). It is extraordinarily common, especially in children younger than 7. Even after that age, many doctors see incidences of bed-wetting, and a majority of these incidences do not have a medical cause. It seems that most children are simply deep sleepers and/ or have an “immature bladder,” meaning it can’t store urine for an entire night. Many cases of bed-wetting are hereditary. It is also worth noting that boys suffer from bed-wetting far more than girls, and cases like this solve themselves in time.

After children reach 6 or 7, doctors usually become involved with the bed-wetting (as is the case with your family). It is rare, but there can be urinary tract infections, diabetes, sleep apnea, spinal cord issues, or deformities of the bladder or urinary tract, and doctors will order tests to start to rule out these issues. Again, these issues are extremely uncommon (only 3 percent of bed-wetting children). Bed-wetting can also be a sign of extreme stress or trauma; these children are usually trained in the day and night, and then will inexplicably begin bed-wetting. If there has been any trauma or important transitions in the family, please let your doctor know, as this will greatly affect your son’s care.

Your son is stuck between a rock and a hard place. Doctors warn it is the emotional stress of bed-wetting that causes the most harm to children, not bed-wetting itself. So what do you do?

• Cultivate the confidence that this will get better. Do you actually know this? No, but your son needs to see hope and confidence. If he feels that you are relaxed and unruffled by this, he will also be able to stay calm and move forward. It is important to regulate your emotions rather than “working” on your son as if he were a project.

• Handle the laundry issue. Buy waterproof sheets, use as little and as easily laundered bedding as possible, and have your son help you. A little bit of agency on his part will help him to feel less like a “failure.”

This is a challenging time, but do your best to stay laid back. One way or another, your son will eventually stay dry through the night. Keep in touch with your doctor, treat this as a laundry issue and remain compassionate.