When it needs assessment
Bedwetting can be a normal part of developing bladder control before the age of five. From five years onwards, if it continues or is affecting your child, it is worth discussing assessment and treatment. The doctor will ask whether your child has always wet the bed, or whether it returned after six months or more of being dry, and whether there are daytime symptoms such as urgency or leaking.
Why it happens during sleep
Several factors can combine: producing more urine at night, a smaller functional bladder capacity, and difficulty waking when the bladder is full. It can also run in families. Constipation, snoring and breathing problems during sleep should be assessed too, along with any symptoms that suggest an infection or another illness. It is not true that every case means weak kidneys or a psychological problem.
Does every child need scans?
Assessment is based on the history, an examination and a bladder diary. A urine test may be requested, especially if the problem started recently or comes with other symptoms, but an ultrasound and extensive tests are not needed for every simple case of night-time wetting. Excessive thirst, passing large amounts of urine and weight loss need prompt assessment for possible diabetes, and fever or burning when passing urine also need checking.
Steps that help at home
Give your child enough to drink, spread across the day, and cut down on large drinks and caffeinated drinks close to bedtime. Encourage regular toilet trips during the day and just before bed. Treat constipation if it is present, and reward your child for sticking to the plan rather than only for dry nights. Avoid restricting water all day or embarrassing your child in front of others.
Alarm or medication?
A bedwetting alarm senses the start of wetting and gradually helps the child wake up and respond. It needs the whole family's involvement and several weeks of patience, and it can give lasting improvement. Desmopressin, on the other hand, reduces the amount of urine produced at night. It is considered when a quick improvement is needed or when an alarm isn't suitable, and wetting may return after it is stopped.
The medicine is used on prescription, with fluids restricted from one hour before the dose until eight hours after it, to avoid low sodium levels in the blood. It is stopped temporarily during vomiting, diarrhoea or any illness that calls for drinking more, as your doctor advises. The nasal spray is not used for this purpose.
If the wetting continues
The plan may be adjusted, or the alarm and medication combined in suitable cases. If your child doesn't improve, daytime symptoms, constipation and how the treatment is being used are reviewed before another treatment is added. The goal is better sleep, confidence and bladder control, with supportive follow-up, without blame and without promises of an instant cure.
This article is general health education and doesn't replace a consultation with your doctor.
