Not long ago, I got a call from a mom of a 7-year-old boy, who was desperate to help her son with the one parenting issue that felt completely out of her control: bedwetting. I could hear the anxiety in her voice from the moment I answered the phone, and by mid-way through the conversation she was in tears.
Although her son was using the toilet by age 3, he never made it through the night without wetting the bed. She felt like she had tried everything. She made sticker charts when he was 5, but he never earned the stickers. She had him choose a “big” reward to work for when he was 6, but he lost interest after a few weeks. Then he turned 7 and the invitations for sleepovers started, but he was too embarrassed to go.
This mom wanted to empower her son to work through this. She did everything she could think of that seemed like some version of “positive reinforcement”. Still, it always seemed to end in tears. The problem, of course, was that her son had no control over his nighttime bedwetting. He couldn’t make it stop by wishing for an expensive Lego set or earning stickers for an ice cream cone.
In the end, I helped this mom dial back the pressure on “fixing” the problem. Together, she and her son decided that he just wasn’t ready for sleepovers yet. They stopped hyper-focusing on his bedwetting, visited his pediatrician for a check-up, and shifted their focus to his strengths.
Enuresis is the medical term for bedwetting. It can happen during the day (diurnal) or at night (nocturnal) and enuresis is considered “primary” when the child never fully masters using the toilet (meaning he or she never stayed dry at night). Secondary enuresis occurs when a child was able to stay dry for a period of time but then wets again. There are several factors that can contribute to bedwetting, and genetics does play a role.
According to the American Academy of Pediatrics, nocturnal enuresis affects 5 million children over age 6, and it occurs more frequently in boys than girls. It is estimated that 5 to 10 percent of these cases resolve without any treatment.
While it is certainly comforting to parents to hear that bedwetting is fairly common, and to know that products like pull-ups can help kids stay dry while they sleep, parents do need to tread carefully when dealing with bedwetting. Sure, changing the sheets every morning (or even during the night) is a lot of work and can leave parents feeling frustrated, but kids experience a range of emotions when confronting bedwetting. Some might seem completely unaffected by it, but others experience guilt, worry, and frustration. It can negatively impact their self-esteem and self-confidence. Bedwetting can cause kids to develop negative core beliefs, such as “I’ll always be a baby. I can’t do this.” And, these beliefs can stay with them for years to come.
Parental attitude plays a big role in how kids cope with bedwetting. If parents pour on the pressure it can negatively impact the self-confidence of the child and result in anxiety. It’s important to avoid the following parenting pitfalls when it comes to bedwetting:
1. Using a system of charts and rewards. Many well-meaning parents turn to charts and rewards to combat bedwetting. The theory is that the rewards “motivate” the child to finally conquer that bedwetting issue. It’s positive reinforcement, right? Wrong. The problem here is that children can’t control enuresis. It isn’t the result of laziness or defiant behaviour. Enuresis is most likely genetic, or it could be related to a sleep disorder or some other medical condition, but it isn’t within the child’s control. Charts and rewards are a setup for failure when it comes to enuresis. When children fail to meet the expectations night after night and spend their days staring at an empty sticker chart, they feel helpless, sad, and anxious.
2. Making kids responsible for clean-up duties. Some kids will pull off their sheets off the bed each morning and put them in the wash, because taking some control is part of coping with something that feels so very out of control. However, forcing kids to clean up each day can feel like a punishment. For some kids, it can really impact their self-esteem. It’s important to remember that bedwetting is not intentional. Your child is probably just as upset about it as you are. Working together to remake the bed while reassuring your child can help calm your child and decrease some of the stress, just be sure to make it a positive moment of bonding between parent and child.
3. Punishing children for wetting the bed. Taking away TV or video games won’t help your child stop wetting the bed. Neither will canceling play dates or making your 7-year-old do the laundry on his own. The child is not at fault in this. Punishment will only result in feelings of hopelessness and other negative emotions.
4. Criticizing (or shaming) children when nighttime accidents happen. We have to watch our words and comments around our children. Sarcasm is hurtful and difficult for children to decipher. Use of sarcasm shames children and leaves them feeling anxious and alone. Sometimes parents criticize kids out of exhaustion and frustration. In these instances, the language is often very clear and kids experience low self-esteem as a result. Other times, parents mutter criticism under their breath as they cope with their own feelings about difficult parenting challenges. Make no mistake, children hear those whispers and develop negative core beliefs as a result.
Parenting isn’t always easy. In fact, it probably feels like new challenges arise around every milestone. Enuresis can increase the stress level of parents and stress does trickle down to kids. It requires patience and support, and kids are likely to experience negative emotions as they get older and struggle to stay dry at night.
If your child is over age 6 and still struggling to stay dry, it’s worth a trip to the pediatrician for a check-up. While many cases of enuresis do resolve without any treatment, it can help both parents and kids to have some support along the journey.