As parents, we often assume that our children will be fully toilet trained by the time they’re four or five and that we’ll never have to worry about accidents again. Don’t throw the pull-ups away just yet! Approximately 20 percent of five-year-olds still have some trouble staying dry at night with boys being twice as likely as girls to wet the bed.

Bedwetting – or nocturnal enuresis – generally isn’t cause for concern before the age of seven. Some children may take even longer to develop nighttime bladder control. While you might be relieved to hear that bedwetting is such a common problem, you’re probably wondering why children and parents alike are so confused and embarrassed about it.

According to experts, there are still many myths surrounding nocturnal enuresis that prevent children from getting the help they need. Here’s everything you need to know about bedwetting and how to support your child through this awkward developmental stage:

What causes bedwetting?

There are several reasons why kids might wet the bed, but one thing is clear: they don’t do it on purpose or because they’re lazy. Children may wet the bed because:

• They sleep very deeply and don’t wake up when they need to urinate.
• They produce large amounts of urine at night.
• They have small bladders.
• They don’t produce enough antidiuretic hormone (ADH) which slows urine production at night.

In about 1 percent of cases, bedwetting can be due to an underlying condition such as a urinary tract infection, diabetes, sleep apnea or emotional problems. Children with attention deficit hyperactivity disorder (ADHD) are more likely to wet the bed.

Bedwetting also tends to run in families, so if you or your partner wet the bed, your children might be more likely to do it too.

How can bedwetting be treated?

Bedwetting can be frustrating, but try to be patient and avoid shaming or punishing your child because it might make matters worse. Treatments can include:

• Encouraging good drinking habits: Make sure your child drinks plenty of fluids throughout the day so that they don’t end up drinking too much right before bedtime because they’re thirsty. Cut out all caffeinated beverages such as cola, hot chocolate and tea before bed, because they can increase urine production.
• Carrying or waking: You can carry your child to the bathroom while they’re sleeping or wake them up to pee before you go to bed. This can help prevent bedwetting in the short term, but it probably won’t solve the problem entirely.
• Bedwetting alarms: There are two types of bedwetting alarms – rubber mats that go on your child’s bed or personal alarms that go in their underwear. They ring when they’re wet to train your child to wake up when they start to urinate. These devices are generally recommended for children ages seven and up, since they can be distressing and can wake other family members. Talk to your doctor to find out whether they’re right for you.
• Medication: If bedwetting persists, your doctor may prescribe one of several medications. One that’s commonly used is a synthetic form of ADH that helps to slow down your child’s urine production at night.

Until your child can make it through the night without wetting their bed, using a waterproof mattress protector can save their mattress from being ruined. A waterproof bed pad can also be placed over their sheets to make nighttime accidents easier to deal with. Rather than changing their entire set of sheets every time, you simply pull off the bed pad and replace it with a new one.

When should you see the doctor?

Talk to your child’s pediatrician if you’re concerned about your child’s bedwetting at any time or if:

• They’re still wetting the bed regularly after the age of seven.
• They were dry at night for several months and they start to wet the bed again (known as secondary bedwetting).
• They feel upset or distressed about wetting the bed.
• You or your child are worried about upcoming sleepovers or overnight camps.
• They’re also wetting themselves during the day, which could signal a medical issue or stress.
• They have other symptoms such as painful urination, constipation or snoring.

Bedwetting often resolves on its own, so arm yourself with waterproof tools and a good dose of patience!