Private bedwetting clinic in London, same-day paediatrics.

Why it happens

• the bladder produces more urine overnight than it can hold, because the hormone that concentrates urine at night has not matured
• a small or overactive bladder
• very deep sleep — the child does not rouse to a full bladder
• constipation, which is present in a large proportion and is the single most commonly missed factor
• It is strongly hereditary — if both parents wet the bed, the chance is high. Telling a child this often helps enormously.

Check the basics first

• Treat constipation — a loaded bowel presses on the bladder. Fixing this alone resolves a meaningful proportion of cases.
• Drink more during the day, not less. Restricting fluid shrinks bladder capacity and makes things worse. Aim for six to eight drinks spread through the day, most before 5pm.
• Cut fizzy and caffeinated drinks, including cola and chocolate drinks in the evening.
• Toilet before bed, and again just before the parents' bedtime if the child is easily roused.
• Easy night access — a night light, a clear path, and no fear of the dark or of stairs.
• Stop pull-ups at night once treatment starts, if the child agrees; they can mask progress.

Treatment

• A bedwetting alarm is first-line for children over about seven who are motivated. It sounds at the first drop and gradually trains the brain to wake or to hold on. It requires commitment from the whole household for one to three months, and someone needs to help the child wake at first.
• Desmopressin reduces overnight urine production. It works quickly, which makes it ideal for school trips and sleepovers, but wetting usually returns when it is stopped unless used as part of a longer plan. Fluid must be restricted for eight hours after the dose, and it should be omitted if the child is unwell or vomiting.
• Where these do not work, further assessment and specialist referral are appropriate.

Practical help

• Waterproof mattress protector, and a second one under the first with a sheet between — strip one layer at 3am rather than remaking a bed.
• Keep dry pyjamas and a towel by the bed so the child can manage independently.
• Involve the child in changing sheets without it being a punishment.
• For sleepovers and school trips, talk to the host or teacher in advance — and consider desmopressin.
• Reassure your child that many children in their year are in the same position and simply do not say so.