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"Hi Jody,

Our 6 year old girl wears Pull-ups® every night due to bed wetting. We’re not sure what’s causing the bed wetting. Last year a doctor said it’s not unusual and to wait a year and see what happens – now the year's up and there’s no change.

She’s had some issues with separation from her mother, but knows her mother prefers her 4 year old brother. Her father is in the picture somewhat but she’s not close to him. She likes being with us, but is uncertain what the future holds. So there may be psychological as well as physical reasons for the wetting.

Do you have any information on bed wetting, or any suggestions on how we handle it? We try to handle it in a factual way, and don’t get upset with her about it."

Hi Dan,

Most children's elimination systems are not fully mature until the end of the "transitional phase", which is about age 4. By this point. most children can be expected to be fully potty trained day and night.

After that age, there are several factors which can contribute to bedwetting, so you have to do a process of elimination.

Start with things you can control and track (like liquid intake before bedtime, going to the bathroom before bed, and waking up to go in the middle of the night, etc.)

If this does not take care of the problem, then it may be a physiological problem, such as being a deep sleeper, or having a physical problem holding the waste.

Usually the way to tell the difference between these two problems is to look at whether or not the accidents only happen at night or if they also happen during the day.

If accidents only happen at night, chances are the child is a deep sleeper. One option for deep sleepers is a sensor you can get for children to wear at night that sets off a little alarm if they start to wet the bed.

If accidents happen day and night, and the child is age 6 or older, then there may be a physiological issue. For example, if the child at one time was trained and has suddenly started having accidents, it may be a urinary tract infection or some other temporary condition. If it's always been a problem than it could be a problem with organ development or something more long-term, permanent or genetic. A doctor would have to evaluate and diagnose children for any of these problems.

Because of the inconvenience, shame, and frustration involved, bedwetting is not usually an intentional misbehavior or a psychological problem. However, if all the above possibilities have been accounted for and ruled out, and there is some traumatic or upsetting event that could be associated with the onset of the problem, then a psychological basis for the problem might be present.

At this point, in your case, I agree with your pediatrician. Here is an article from the web for you to check out:

http://www.aacap.org/cs/root/facts_for_families/bedwetting

I hope this was helpful and that I see you again in one of my foster parent training programs.

Take care,
Jody

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