Q. My son is still not completely toilet trained even though he is 4 and ½ years old . He is generally dry during the day but continues to wet his bed every night. My older son was toilet trained without any accidents after age 3. I have discussed this with my son’s pediatrician and he assures me that there is no physical problem and I should not be concerned at this point. I still cannot help but worry, however. My son also seems to be somewhat bothered by this. By what age should children be toilet trained?
A. Generally, children are completely toilet trained (dry through the day and night) by age 5. One out of every ten children, however, continues to wet the bed between the ages of 5 and 6. Most of these (between 67%-75%) are boys. Even 5 year olds who are toilet trained will have some accidents at night but typically not more than 1-2 per month.
If your doctor examined your child and has determined that there is no physical problem, it is best to set your mind at ease until your child is a little over the age of 5. Bladder control at night has a strong genetic component, so it may be helpful to do a survey of relatives on both sides of the family to determine if others had similar problems. It is very typical for male bed-wetters to have relatives on the paternal side of the family who were delayed in this respect.
The practical aspects of frequent bed-wetting can be distressing for both parent and child alike. Sheets on the bed need to be changed often and the child needs to be cleaned or bathed. Your son may be comparing his lack of night-time bladder control to that of his brother or friends which may make him feel bad.
The best way to handle this situation is to reassure you son that he will be able to stay dry during the night when he is older and that is not his fault. It may be quite helpful to ask your son what bothers him about the bed-wetting. Develop a matter-of-fact routine with the cleaning procedure.
If your son does not obtain bladder control by the time he is about 6 and there is no history of bed-wetting on either side of the family, you might consider attempting to facilitate the process. It is important to get a full physical examination to insure that there are no medical reasons for the problem before proceeding.
Once this is done, there are several behavioral plans that may be suitable for your child. There are several books written on bed-wetting that will give specific instructions. Alternatively, you may wish to consult a professional who has experience in dry-bed techniques.
Beware of common sense solutions however (limiting fluid intake before bed-time, waking the child after he/she has been asleep for a few hours) because research shows this to exacerbate rather than help the situation. (you would like your child to develop the sense of a full bladder to the extent that he/she can wake up independently. If the child had an empty bladder because of fluid restriction, this sense will not be developed. Likewise, if the child is relying on you to wake him/her, the ability to wake up independently will not be developed.)
A final word about bed-wetting. If your child has had a long period of being dry (4-6 months) and suddenly starts to wet the bed frequently, it is often a sign the child is experiencing some stress that needs to be examined. In this case, it is important to either remove the stressor or help the child adjust to it. Sometimes this requires professional help.
Note: This was a question answered by Dr. Cynthia Divino in her column for the Boulder Parent between the years 1991 and 1994. The articles have been updated and republished here to help the BIPR parenting community.