Why Do Children Wet the Bed According to Psychology?

Children wet the bed for both physical and psychological reasons. Find out what causes nocturnal enuresis and how to deal with it.
Why Do Children Wet the Bed According to Psychology?

Last update: 13 November, 2021

Toilet training is one of the biggest milestones in child development. Although it’s usually reached between two and four years of age, each child follows their own rhythm and this process can be lengthened in a variable way depending on the case. Even so, when the commonly established age is exceeded, we may be facing a problem that requires medical or psychological intervention. For this reason, today, we’re going to explain why children wet the bed.

Is there a problem when children wet the bed?

The phenomenon by which children wet the bed is called enuresis and can be of various kinds:

  • If the child has never achieved bladder control, we’re talking about primary enuresis.
  • On the other hand, if they’ve been able to properly retain urine for at least six months and suddenly lose this ability, we’re talking about secondary enuresis.
  • In addition, depending on the time of day in which urine leakage occurs, the child may have diurnal, nocturnal, or mixed enuresis.

In any case, identifying the underlying causes is essential in order to take action.

As we’ve commented, the acquisition of sphincter control is achieved at a variable age among children.

However, it follows a certain sequence: First they learn to control bowel evacuation (fecal continence), then they acquire daytime urinary control, and finally, nighttime urinary control. Therefore, it’s possible that a child may be without a diaper during the day and need to wear it at night.

In regard to the above, in order to consider that an infant who wets the bed has any condition, certain diagnostic criteria must be met:

  • Repeated passing of urine (either in bed or on clothing) often at least twice a week, for three consecutive months or more.
  • Significant discomfort in the child, deterioration of their social ties, or of their academic performance due to the loss of urine.
  • Chronological age of five years or older, or an equivalent degree of development.
  • Absence of a known medical condition that causes it, such as diabetes, spina bifida, or the use of certain substances (such as diuretics).
A toddler kneeling on the floor after wetting his pants.

Why do children wet the bed?

Although there’s some controversy about it, the most common belief is that primary and secondary enuresis respond to different causes. Therefore, in the first case, it’s usually linked to genetic or hereditary factors, and in the second case, psycho-affective factors take center stage.

Next, we will discuss the most common causes why children wet the bed.

1. Family history of enuresis

As we’ve already mentioned, enuresis can have a hereditary component.

Therefore, in children whose parents didn’t wet the bed, the average incidence is less than 15%, while in those with a family history, the risk is higher: 45% when one of the parents suffered enuresis in childhood and 77% when both parents did.

2. Physiological causes

Children who wet the bed have often been found to have a smaller bladder than their peers. This causes them to need to urinate more frequently during the day and are unable to hold onto it overnight.

In addition, these little ones may have difficulties delaying urgent urination. That is, they don’t have the ability to inhibit the contraction of the bladder detrusor muscle when they have the desire to urinate. Therefore, this prevents them from reaching the bathroom on time.

3. Deep sleep

When children wet the bed at night, they may have a very deep sleep. By not alternating as much with the more superficial stages of sleep, their threshold for waking up is high and they can’t perceive the need to urinate. Therefore, they don’t wake up and end up wetting the bed.

4. Hormonal factors

Contrary to what happens in other children, some little ones who wet the bed don’t produce antidiuretic hormone at night. This causes their kidneys to produce a high amount of urine during the night’s rest and this favors involuntary urination.

5. Psychological and emotional causes

Psychological and emotional factors can also play an important role in this problem, especially when it comes to secondary enuresis.

Children may revert to bedwetting when they face stages of transitions or major changes that involve high levels of stress.

For example, a divorce, the birth of a sibling, a move, or the death of a loved one. Likewise, when there are family or school conflicts that cause a certain degree of anguish and anxiety in the child.

A child sitting on the floor with his arms crossed looking upset.

What to do when children wet the bed?

It’s important to note that enuresis has an excellent future prognosis and that in the vast majority of cases, it resolves itself as the child grows. However, some cases can persist into adolescence.

Still, the family can apply some guidelines to help improve the situation:

  • Don’t humiliate, blame, or punish the child. Remember that nocturnal enuresis is involuntary and unconscious and therefore, the minor doesn’t seek to harm or bother us in this way. So be patient and understanding so as not to produce additional emotional damage.
  • After urine leakage, ask the little one to help you change the sheets. Not as punishment, but as a natural consequence of the process. In addition, this can help reduce the guilt of the minor, as they can collaborate with the resolution of the problem.
  • Make sure that the child doesn’t drink too many liquids at night and that they go to the bathroom before going to bed.
  • Another effective measure is to wake them up in the early morning and take them to urinate.
  • Reward and verbally reinforce them on the days when they wake up dry.

Finally, if the situation continues, it’s important to seek professional help. This way, certain organic causes can be ruled out or psychotherapeutic treatments can be applied to help the child overcome their difficulties.

Voluntary retention training, dry bed training, or the use of alarm devices are some of the most effective options.

Above all, the process must be approached with patience and understanding, as sooner or later your child will stop wetting the bed. In contrast, the emotional damage derived from possible humiliation can last for life.

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  • Lapeña, S., Rodríguez, L. M., Marugán, J. M., Palau, M. T., Reguero, S., Gutiérrez, M., … & San Martín, J. L. M. (1996). Enuresis nocturna primaria y secundaria.¿ Son entidades diferentes?. An Esp Pediatr44, 345-350.
  • Alfaro, A. D. (2002). Enuresis en la infancia. In Anales del Sistema Sanitario de Navarra (Vol. 25, pp. 63-72).