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Five-Year-Old Bed Wetter

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: My daughter is five years old. She used to be good about getting up in the middle of the night to go to the bathroom. But now she doesn't; she wets the bed every night. She doesn't drink after 7:30 pm. She also thinks it's funny afterwards. What should I do? It's driving me up the wall.

A: This is one of those situations where you have to try and sort out the motivation for her behavior. Given that she was able to get up in the past, but does not want to now, she likely has decided that it is not an important thing to her. (I'm presuming here that she has no other symptoms. If she has pain when she urinates, fever, or accidents during the day, you should see your doctor to make sure she doesn't have an infection or other problem.) It's also possible that she is just sleeping more deeply and has a difficult time waking.

In order to have her stop wetting at night, it has to become important to her again. One of the ways to do this is to have some sort of positive reinforcement for not wetting the bed. For example, you can create a system whereby, for every night that she doesn't wet the bed, she gets a sticker placed on the calendar for that day. When she has accumulated ten stickers, she is allowed to pick out a small toy or else is allowed to have a special treat (a trip or experience is preferable to food). Subsequently, when she accumulates twenty stickers, she gets another special treat or reward. You do not have to do this forever and usually after having a consistent response (that is, not wetting the bed) over a three to four week period, she will continue to do it out of habit.

In the situation you describe, however, I would be a little bit careful about using this approach, as it sounds like the bedwetting may be more of a control issue for your daughter. If that is the case, you may need to back off a little, and not let your daughter see that it bothers you. Simply help her change the PJs and sheets (definitely make sure that she is involved in the cleanup process, as this makes it less "funny") and don't make any negative comments, although an unemotional "Maybe when you're a big girl you'll stop wetting the bed" is okay. You absolutely want to avoid any type of punishment for her bedwetting, and always look for positive incentives for her to stop.

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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.


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