Bed-wetting (nocturnal enuresis) in children: An evidence-based guide

Is bed-wetting in children — also known as “sleep enuresis” — a sign of illness? Does it indicate a child is lazy or defiant? Trying to get attention? Suffering from behavior problems?

Wet bed sheets in a child's bed, copyright 2019 Parenting Science

The answer — in most cases — is no. Kids who wet the bed aren’t lazy. Stress can contribute to enuresis, but most children who wet the bed don’t have behavior problems. And while bed-wetting can be caused by urinary tract infections and constipation, kids with these conditions tend to experience incontinence both night and day. If a child’s only symptom is bed-wetting, disease is an unlikely cause.

Instead, researchers think the most important causes of bed-wetting are related to the physiology of nighttime urine control. A child’s bladder might be overactive. The child might produce too much urine during the night. Or the child might sleep too deeply to awaken when he or she needs to urinate.

How should families respond to bed-wetting? Getting informed is the best first step. Here’s a guide to common questions, and an evidence-based guide for coping with enuresis.

At what age should we expect children to stop wetting the bed?

We aren’t born with full bladder control. It takes time to develop. So bed-wetting is a normal part of early childhood. When does this change? 

Studies suggest that most young children stop wetting the bed between the ages of 4 and 5. But some kids may achieve nighttime dryness even earlier. And a hefty percentage of 5-year-olds — around 20% — may still experience bed-wetting at least once per week (Kawauchi et al 2001; Butler et al 2005; Jansson et al 2005). 

By convention, researchers typically define nocturnal enuresis as wetting the bed in individuals who are at least 5 years old (Franco et al 2013). But we shouldn’t let this rule of thumb mislead us. It’s not unusual for a 5-year-old to wet the bed on a regular basis.

How common is bed-wetting after the age of 5?

One reasonable guess is that approximately 15-20% of kids in the early grades of primary school — 6- and 7-year olds — still wet the bed from time to time. As kids get older, the numbers diminish, so that by puberty the percentage of individuals wetting the bed is probably less than 5%.

But it’s important to understand: Studies have reported a wide range of estimates — from rates under 3% to rates exceeding 24%. And while some of the variation may reflect real differences between the groups being studied, a lot depends on what researchers count as bed-wetting.

For instance, some studies have counted anyone who wets the bed at least twice per month. Others have counted only those individuals who wet the bed at least twice per week. And as Richard Butler has shown, it makes a big difference.

In a study of more than 8200 British children (aged 7.5 years), Butler and his colleagues decided to measure bed-wetting both ways. While just 2.6% of kids wet the bed at least twice per week, more than 15% of children wet the bed at least twice per month (Butler et al 2005).

In another study, researchers reviewed the medical records of more than 1100 American children between the ages of 8 and 11. The researchers counted kids as having enuresis if either of these statements were true:

  • a child was wetting the bed at least twice per week, or
  • a child experienced bed-wetting as infrequently as once per month, but in combination with symptoms of “clinically significant distress or impairment.”

Using these standards, the researchers determined that about 4.5% of kids had a bed-wetting problem (Shreeram et al 2009).

So there isn’t any one statistic that sums it all up. But however researchers measure enuresis, it’s clear that bed-wetting isn’t a rare or unusual problem.

Bed-wetting has been documented all over the world — in Africa, the Americas, Asia, Australia, Europe, and the Middle East (e.g., Fockema et al 2012; Vasconcelos et al 2017; Tai et al 2007; Sureshkumar et al 2009; Butler and Heron 2008; Mohammadi et al 2019). And it persists even among adults.

For example, in surveys conducted in Hong Kong and South Korea, approximately 2.5% of respondents between the ages of 16 and 40 reported have at least occasional symptoms of nocturnal enuresis (Yeung et al 2004; Baek et al 2013).

What causes bed-wetting?

Researchers recognize a number of possible causes. The most common include:

  • reduced bladder capacity, and/or an overactive bladder 
  • too much urine production at night (caused by a developmental delay in a child’s nighttime release of anti-diuretic hormones)
  • failure to awaken in response to the sensation of a full bladder
  • urinary tract infection
  • constipation
  • obstructive sleep apnea

But doctors will look for different causes depending on a patient’s history.

Bed-wetting in children who used to be dry

Some children achieve nighttime dryness during early childhood, and then develop a problem later. Doctors call this secondary nocturnal enuresis (SNE) — bed-wetting in a child who was previously dry for at least 6 months.

When this kind of back-peddling happens, pediatricians want to make sure the child doesn’t suffer from a new medical condition — like a urinary tract infection or constipation.

Urinary tract infections can create a persistent urge to urinate. Constipation can put pressure on the bladder, so that the bladder’s capacity is greatly diminished (Caldwell et al 2005).

Secondary nocturnal enuresis (SNE) has also been linked with stress (Caldwell et al 2005), anorexia (Kanbur et al 2010; Kanbur et al 2011), and the onset of type 1 diabetes (Roche et al 2005).

Bed-wetting in children who have never achieved nighttime dryness

This is called primary noctural enuresis (PNE), and it too can be linked with urinary tract infections, constipation, and stress (Robson et al 2005). 

But researchers think that most cases are caused developmental factors relating to bladder function and/or sleep.

For instance, when it comes to bladder function, there is evidence that some kids have bladders that operate at reduced capacity during the night (Borg et al 2018).

Other children may have overactive bladders that leak before they are full (Nevéus 2019; Mattsson 2019). 

And there’s reason to think that some kids experience lower nighttime levels of vasopressin, a hormone that tends to suppress the production of urine. As a result, their bladders fill up faster —  increasing the risk of bed-wetting (Wille 1994; Angeli et al 2023). 

What about sleep? How might sleep patterns affect bed-wetting?

First, there’s a theory about arousal thresholds — how hard it is to wake someone up.

When kids don’t get enough sleep, their brains often try to compensate by sleeping more deeply when the opportunity arises. And deep sleep can increase the risk of bed-wetting. Kids aren’t awakened by the sensations of a full bladder (Mattsson et al 2019).

So maybe some kids are wetting the bed because they suffer from too much disrupted sleep.

Evidence in favor of this explanation comes from study that monitored children overnight using sleep polysomnography. The kids with enuresis experienced more fragmented sleep patterns, and they appeared to be harder to arouse (Soster et al 2017).

Furthermore, another study — combining physiological measures and parental sleep diaries — reported that children with nocturnal enuresis tended to experience more night wakings and daytime tiredness (Cohen-Zrubavel et al 2011).

In addition, researchers noticed that approximately 50% of children’s night wakings had been triggered by an episode of bed-wetting. Kids either woke up spontaneously after wetting the bed, or their parents woke them up (Cohen-Zrubavel et al 2011).

It’s possible, then, that bed-wetting — and the way families respond to bed-wetting — could create a vicious cycle. Kids become sleep-deprived, which leads them to sleep so deeply that they wet the bed. Then the bed-wetting episodes trigger further sleep disruptions and sleep deprivation.

There’s also reason to think that bed-wetting can be caused by obstructive sleep apnea.

Enuresis is more common in children who suffer from breathing abnormalities, like obstructive sleep apnea (Brown et al 2009; Kovacevic et al 2014; Jönson et al 2017; Wada et al 2018; Bascom et al 2019). And this link makes sense, because sleep-disordered breathing is known to cause hormonal changes that result in greater nighttime urine production (Umlauf and Chasens 2003). 

So maybe some children experience bed-wetting as a side effect of their breathing problems. In support of this idea, researchers report that surgical treatments for severe sleep apnea are often followed by improvements in bed-wetting. Some kids stop wetting the bed after having their adenoids and tonsils removed (Jeyakumar et al 2012; Ding et al 2017).

Another possibility is that an underlying developmental factor triggers both sleep troubles and bed-wetting.

Researchers report that kids with nocturnal enuresis don’t just awaken more often. They also experience more restless limb movements (Dhondt et al 2014; Dhondt et al 2015). So maybe there is something awry with the brain systems that control all of these phenomena — sleep, nighttime muscle movements, and urination (Dhondt et al 2014; Dhondt et al 2015).

Is bed-wetting “psychological” — the symptom of a psychiatric disorder?

No. There is evidence that kids with behavior problems are more likely to experience urinary incontinence. But most children who wet the bed don’t have these behavior problems.

For instance, children diagnosed with oppositional defiant disorder, or ODD, may be at higher risk for having bladder control problems, including nighttime enuresis. But most children who wet the bed don’t have any symptoms of ODD (von Gontard et al 2015).

Similarly, kids diagnosed with ADHD (attention deficit hyperactivity disorder) are more likely to suffer from nocturnal enuresis (Shreeram et al 2009; Yang et al 2022). Yet once again, most kids who wet the bed do not have ADHD.

So bed-wetting, by itself, is not a sign that your child suffers from any underlying behavioral or emotional problems. 

That doesn’t mean that psychological factors are irrelevant. As noted above, stress may be a contributing factor in some cases of bed-wetting. It’s also clear that bed-wetting can cause distress. Kids with chronic bed-wetting problems suffer are more likely to suffer from low self-esteem (e.g., Collier et al  2002; Kanaheswari et al 2012; Grzeda et al 2017a).

But the old idea that bed-wetting is “psychological” has been debunked. Read more about it in my Parenting Science article, “Bed-wetting in scientific perspective.”

Does bed-wetting run in families?

Decades of research indicates that nocturnal enuresis has a genetic component (Breinbjerg et al 2023). For instance, if you have a twin sibling who wets the bed, your chances of sharing this problem depends on the degree of genetic relatedness. Monozygotic twins (who share virtually 100% of their DNA) are nearly twice as likely to show concordance as dizygotic twins (who share only about 50% of their DNA).

In addition, mothers who report having to urinate frequently during the night are more likely to have kids who wet the bed (Montaldo et al 2010). And kids are more likely to suffer from severe enuresis if they have one or more parent with a history of bed-wetting (von Gontard et al 2011).

Researchers speculate that certain traits — like the amount of urine produced at night, or the tendency to sleep deeply — might be controlled by our genes (Schaumburg et al 2008; Wang 2007).

What about toilet training practices? Do they play any role in the development of enuresis? 

It’s possible. In particular, the early use of an approach called “elimination communication” (EC) has been linked with lower rates of bed-wetting.

In a survey of more than 18,000 parents, researchers in China found that children were less likely to experience nocturnal enuresis if they had begun elimination communication before the age of 6 months (Wang et al 2019).

Elimination communication demands that caregivers play close attention to their infants’ signals. When it seems likely that a baby is ready to urinate, the caregiver holds the baby’s bare bottom over a toilet and encourages the baby to void. You can read more about this technique here.


Treatments: What are the best ways to deal with bed-wetting?

As noted above, it’s important to treat any underlying diseases, infections, and sources of stress. But for most kids with primary nocturnal enuresis, these steps aren’t likely to solve the problem. Currently, the therapies with the best evidence in their favor are:

  • bed-wetting alarms, and
  • desmopressin, a synthetic version of the anti-diuretic hormone, vasopressin.

Bed-wetting alarms use the same technology as diaper alarms. A moisture sensor is attached to the child’s underpants. When the child urinates, a sound awakens him. Desmopression, when it prescribed by a physician, is taken before bedtime, and suppresses urine production overnight. How do these therapies compare?

Alarms are more disruptive to use, but they seem more effective in the long run.

In studies testing the effectiveness of alarms, kids slept with bed wetting alarms every night for 12 weeks, and approximately half the kids stopped wetting the bed (Glazener et al 2005).

The alarms seemed to work even better when training programs included an “overlearning” component, which means giving kids extra fluids before bedtime so that they have more opportunities to wake up and urinate  (Glazener et al 2005).

Research indicates that desmopressin can yield similar results, with one important difference: Kids who use alarms are more likely to stay dry after treatment has concluded (Song et al 2019; Peng et al 2018).

Thus, studies favor the use of alarms — if you can tolerate the fuss. Alarms are more disruptive, and for this reason, many families that try alarms give up on them.

Can you improve bed-wetting in children by restricting their caffeine intake?

Caffiene is a well-known diuretic, and it’s found in foods like cocoa, coffee, and cola. Is is possible that some kids are experiencing bed-wetting as a side effect of consuming these foods? A recent, controlled study suggests that this is possible.

Researchers recruited more than 500 bed-wetting participants (ranging in age between 6 and 15 years), and randomly assigned each individual to follow one of two regimens: Daily consumption of 90-110 mg of caffeine, or daily consumption of less than 30 mg of caffeine. After a month, some kids in both groups had stopped wetting the bed at night. But this outcome was much more common among the kids who had consumed less caffeine (Rezakhaniha et al 2023). The takeaway? If your child is currently consuming caffeine, this approach may be worth a try.

What about simply waking your kid up at night to go to the bathroom?

This tactic, called “lifting,” was tested in a randomized experiment on 4- and 5-year-olds, and there was a reduction in nocturnal enuresis symptoms after six months (van Dommelen et al 2009). 

But more recently, researchers reported less encouraging news. In a study tracking more than 1250 bed-wetting children from the age of 7.5 years, lifting was not linked with long-term improvements. On the contrary, kids subjected to lifting were more likely to be wetting the bed two years later (Grzeda et al 2017b).

Lifting may be problematic because parents can’t know for sure when a sleeping child needs to urinate. As a result, kids may be awakened when their bladders aren’t full — making it harder for children to learn to associate the sensations of a full bladder with a nighttime bathroom visit.

We need more research to be certain. Meanwhile, the available evidence suggests that lifting is less effective than alarms (Caldwell et al 2013), and possibly counterproductive.

Do punishments work?

Kids suffering from nocturnal enuresis don’t wet the bed on purpose. It’s unfair to blame or punish them for bed wetting. And it appears to make things worse.

As noted above, kids who wet the bed may struggle with feelings of embarrassment, shame, or poor self-image about their condition (Collier et al  2002; Kanaheswari et al 2012; Grzeda et al 2017). And these emotional stresses could make it harder for children to develop bladder control (Glazier et al 2005). So the last thing you want to do is actively punish kids. It’s adding fuel to the fire.

For example, in a study conducted in Egypt, parental punishment for bed-wetting was linked with more frequent nighttime accidents, and kids who were punished experienced more severe psychological distress (Al-Zaben et al 2015).

Similarly, in a British study, parents who expressed displeasure in response to early bed wetting episodes were more likely to have kids who still wet the bed at age 7 ½ (Butler 2005). And in studies conducted in Italy and the Netherlands, kids were less likely to improve if their parents punished them for nighttime accidents (Ferrara et al 2016; van der Wal et al 1996). 

Should parents try to motivate kids with rewards?

To date, there is little evidence that rewards are effective (Glazener et al 2005; van Dommelen et al 2009). In fact, in one study, researchers found that offering rewards to 7.5-year-olds actually increased the risk of bed-wetting two years later (Grzeda et al 2017b).

So I’m skeptical, and concerned about the message it might send. When parents offer rewards to kids for staying dry at night, the implication is that bed-wetting is under conscious control, but it’s not. Kids wet the bed while they are asleep. And I’d wager that most kids want us to understand. They are already motivated. They don’t need bribes. If they could wake themselves up, they would do it.


More information about the myths of bed-wetting

For more information about nocturnal enuresis, check out the article, Bed-wetting in scientific perspective: Destructive myths and misconceptions.


References: Enuresis in children

Abramovitch IB, and Abramovitch HH. 1989. Enuresis in cross-cultural perspective: a comparison of training for elimination control in three Israeli ethnic groups. J Soc Psychol. 129(1):47-56.

Al-Zaben FN and Sehlo MG. 2015. Punishment for bedwetting is associated with child depression and reduced quality of life. Child Abuse Negl. 43:22-9.

Angeli M, Bitsori M, Rouva G, Galanakis E. 2023. The role of the autonomic nervous system in nocturnal enuresis. J Pediatr Urol. 19(1):6-18.

Baek M, Park K, Lee HE, Kang JH, Suh HJ, Kim JH, Lee SD, Pai KS, Han SW, Park YH, Kim KD; Korean Children’s Continence and Enuresis Society. 2013. A nationwide epidemiological study of nocturnal enuresis in Korean adolescents and adults: population based cross sectional study. J Korean Med Sci. 28(7):1065-70.

Bascom A, McMaster MA, Alexander RT, MacLean JE. 2019. Nocturnal enuresis in children is associated with differences in autonomic control. Sleep. 42(3). pii: zsy239

Borg B, Kamperis K, Olsen LH, Rittig S. 2018. Evidence of reduced bladder capacity during nighttime in children with monosymptomatic nocturnal enuresis. J Pediatr Urol. 14(2):160.e1-160.e6.

Breinbjerg A, Jørgensen CS, Borg B, Rittig S, Kamperis K, Christensen JH. 2023. The genetics of incontinence: A scoping review. Clin Genet. 104(1):22-62.

Butler RJ, Golding J, Heron J; ALSPAC Study Team. 2005. Nocturnal enuresis: a survey of parental coping strategies at 7 1/2 years. Child Care Health Dev. 31(6):659-67.

Butler RJ and Heron J. 2008. The prevalence of infrequent bedwetting and nocturnal enuresis in childhood. A large British cohort. Scand J Urol Nephrol. 42(3):257-64.

Caldwell PH, Nankivell G, Sureshkumar P. 2013. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. (7):CD003637.

Caldwell PH, Edgar D, Hodson E, Craig JC. 2005. 4. Bedwetting and toileting problems in children. Med J Aust. 182(4):190-5.

Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A. 2011. Sleep and sleepiness in children with nocturnal enuresis. Sleep. 34(2):191-4.

Collier J, Butler RJ, Redsell SA, and Evans JH. 2002. An investigation of the impact of nocturnal enuresis on children’s self-concept. Scand J Urol Nephrol. 36(3):204-8.

Dhondt K, Baert E, Van Herzeele C, Raes A, Groen LA, Hoebeke P, Vande Walle J. 2014. Sleep fragmentation and increased periodic limb movements are more common in children with nocturnal enuresis. Acta Paediatr. 103(6):e268-72.

Dhondt K, Van Herzeele C, Roels SP, Raes A, Groen LA, Hoebeke P, Walle JV. 2015. Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol. 2015 Jul;30(7):1157-62.

Ding H, Wang M, Hu K, Kang J, Tang S, Lu W, Xu L. 2017. Adenotonsillectomy can decrease enuresis and sympathetic nervous activity in children with obstructive sleep apnea syndrome. J Pediatr Urol. 13(1):41.e1-41.e8.

Erdem E, Lin A, Kogan BA, Feustel PJ. 2006. Association of elimination dysfunction and body mass index. J Pediatr Urol. 2(4):364-7.

Ferrara P, Dell’Aquila L, Perrone G, Spina G, Miconi F, Rapaccini V, Del Vescovo E, Di Lazzaro V, Verrotti A. 2016. A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children. Int Neurourol J. 20(4):311-315

Fockema MW, Candy GP, Kruger D, and Haffejee M. 2012. Enuresis in South African children: prevalence, associated factors and parental perception of treatment. BJU Int.110(11 Pt C):E1114-20.

Franco I, von Gontard A, De Gennaro M. 2013. International Children’s Continence Society. Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children’s Continence Society. J Pediatr Urol 9:234-43.

Glazener CM, Evans JH, Peto RE. 2005. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 18;(2):CD002911.

Grzeda MT, Heron J, von Gontard A, Joinson C. 2017a. Effects of urinary incontinence on psychosocial outcomes in adolescence. Eur Child Adolesc Psychiatry. 26(6):649-658.

Grzeda MT, Heron J, Tilling K, Wright A, Joinson C. 2017b. Examining the effectiveness of parental strategies to overcome bedwetting: an observational cohort study. BMJ Open. 7(7):e016749.

Gümüş B, Vurgun N, Lekili M, Işcan A, Müezzinoğlu T, and Büyuksu C. 1999. Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey.Acta Paediatr. 1999 Dec;88(12):1369-72.

Hashem M, Morteza A, Mohammad K, and Ahmad-Ali N. 2013. Prevalence of nocturnal enuresis in school aged children: the role of personal and parents related socio-economic and educational factors. Iran J Pediatr. 23(1):59-64.

Jansson UB, Hanson M, Sillén U, Hellström AL. 2005. Voiding pattern and acquisition of bladder control from birth to age 6 years–a longitudinal study. J Urol. 174(1):289-93.

Jeyakumar A, Rahman SI, Armbrecht ES, Mitchell R. 2012. The association between sleep-disordered breathing and enuresis in children. Laryngoscope. 122(8):1873-7.

Joinson C, Grzeda MT, von Gontard A, Heron J. 2019. A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence. Eur Child Adolesc Psychiatry. 28(1):123-130.

Joinson C, Sullivan S, von Gontard A, Heron J. 2016. Early childhood psychological factors and risk for bedwetting at school age in a UK cohort. Eur Child Adolesc Psychiatry. 25(5):519-28.

Joinson C, Sullivan S, von Gontard A, Heron J. 2016. Stressful Events in Early Childhood and Developmental Trajectories of Bedwetting at School Age. J Pediatr Psychol. 41(9):1002-10.

Jönson Ring I, Markström A, Bazargani F, Nevéus T. 2017. Sleep disordered breathing in enuretic children and controls. J Pediatr Urol. 13(6):620.e1-620.e6.

Kanbur N, Pinhas L, Lorenzo A, Farhat W, Licht C, and Katzman DK. 2010. Nocturnal enuresis in adolescents with anorexia nervosa: Prevalence, potential causes, and pathophysiology. Int J Eat Disord.

Kanbur N, Pinhas L, Lorenzo A, Farhat W, Licht C, Katzman DK.2011. Nocturnal enuresis in adolescents with anorexia nervosa: prevalence, potential causes, and pathophysiology. Int J Eat Disord. 44(4):349-55.

Kanaheswari Y, Poulsaeman V and Chandran V. 2012. Self-esteem in 6- to 16-year-olds with monosymptomatic nocturnal enuresis. J Paediatr Child Health. 48(10):E178-82.

Kawauchi A, Tanaka Y, Yamao Y, Inaba M, Kanazawa M, Ukimura O, Mizutani Y and Miki T. 2001. Follow-up study of bedwetting from 3 to 5 years of age. Urology. 58(5):772–776.

Kovacevic L, Wolfe-Christensen C, Lu H, Toton M, Mirkovic J, Thottam PJ, Abdulhamid I, Madgy D2, Lakshmanan Y. 2014. Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing? J Urol 191(5 Suppl):1592-6.

Lin J, Rodrigues Masruha M, Prieto Peres MF, Cianciarullo Minett TS, de Souza Vitalle MS, Amado Scerni D, and Pereira Vilanova LC. 2012. Nocturnal enuresis antecedent is common in adolescents with migraine. Eur Neurol. 2012;67(6):354-9.

Longstaffe S, Moffatt ME, and Whalen JC. 2000. Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics. 105(4 Pt 2):935-40.

Mattsson S, Persson D, Glad Mattsson G, Lindström S. 2019. Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis. J Pediatr Urol. 15(3):229.e1-229.e8

Mohammadi M, VaisiRaiegani AA, Jalali R, Ghobadi A, Salari N. 2019. The Prevalence of Nocturnal Enuresis among Iranian Children: A Systematic Review and Meta-Analysis. Urol J. 2019 Aug 17. doi: 10.22037/uj.v0i0.5194.

Montaldo P, Tafuro L, Narciso V, Apicella A, Iervolino LR, Del Gado R. 2010. Correlations between enuresis in children and nocturia in mothers. Scand J Urol Nephrol. 44(2):101-5.

National Clinical Guideline Centre (UK). 2010. Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. NICE Clinical Guidelines, No. 111. London: Royal College of Physicians (UK).

Nevéus T. 2019. The amount of urine voided in bed by children with enuresis. J Pediatr Urol. 15(1):31.e1-31.e5.

Pashapour N, Golmahammadlou S, and Mahmoodzadeh H. 2008. Nocturnal enuresis and its treatment among primary-school children in Oromieh, Islamic Republic of Iran. East Mediterr Health J. 14(2):376-80.

Peng CC, Yang SS, Austin PF, Chang SJ. 2018. Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis. Sci Rep. 8(1):16755.

Rezakhaniha S, Rezakhaniha B, Siroosbakht S. 2023. Limited caffeine consumption as first-line treatment in managing primary monosymptomatic enuresis in children: how effective is it? A randomised clinical trial. BMJ Paediatr Open. 7(1):e001899.

Roche EF, Menon A, Gill D, Hoey H. 2005. Clinical presentation of type 1 diabetes. Pediatr Diabetes. 6(2):75-8.

Schaumburg HL, Kapilin U, Blåsvaer C, Eiberg H, von Gontard A, Djurhuus JC, and Rittig S. 2008. Hereditary phenotypes in nocturnal enuresis. BJU Int.102(7):816-21.

Shreeram S, He JP, Kalaydjian A, Brothers S, and Merikangas KR. 2009. Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry. 48(1):35-41.

Song P, Huang C, Wang Y, Wang Q, Zhu W, Yue Y, Wang W, Feng J, He X, Cui L, Wan T, Wen J. 2019. Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis. BJU Int. 123(3):388-400.

Soster LA, Alves RC, Fagundes SN, Lebl A, Garzon E, Koch VH, Ferri R, Bruni O. 2017. Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis. J Clin Sleep Med. 13(10):1163-1170

Spee-van der Wekke J, Hirasing RA, Meulmeester JF, Radder JJ. 1998. Childhood nocturnal enuresis in The Netherlands. Urology. 51(6):1022-6.

Sullivan S, Joinson C, Heron J. 2015. Factors Predicting Atypical Development of Nighttime Bladder Control. J Dev Behav Pediatr. 36(9):724-33

Sureshkumar P, Jones M, Caldwell PH, Craig JC. 2009. Risk factors for nocturnal enuresis in school-age children. J Urol. 182(6):2893-9.

Tai HL, Chang YJ, Chang SC, Chen GD, Chang CP, Chou MC. 2007. The epidemiology and factors associated with nocturnal enuresis and its severity in primary school children in Taiwan. Acta Paediatr. 96(2):242-5.

Umlauf MG and Chasens ER. 2003. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev. 7(5):403-11.

Wang QW, Wen JG, Zhang RL, Yang HY, Su J, Liu K, Zhu QH, Zhang P. 2007. Family and segregation studies: 411 Chinese children with primary nocturnal enuresis. Pediatr Int. 49(5):618-22.

Wille S, Anveden I. 1995. Social and behavioural perspectives in enuretics, former enuretics and non-enuretic controls. Acta Paediatr. 84(1):37-40.

Vasconcelos MMA, East P, Blanco E, Lukacz ES, Caballero G, Lozoff B, Gahagan S. 2017. Early Behavioral Risks of Childhood and Adolescent Daytime Urinary Incontinence and Nocturnal Enuresis. J Dev Behav Pediatr. 38(9):736-742.

von Gontard A, Heron J, Joinson C. 2011. Family history of nocturnal enuresis and urinary incontinence: results from a large epidemiological study. J Urol. 185(6):2303-6.

von Gontard A, Niemczyk J, Thomé-Granz S, Nowack J, Moritz AM, Equit M. 2015. Incontinence and parent-reported oppositional defiant disorder symptoms in young children–a population-based study. Pediatr Nephrol. 30(7):1147-55.

Wada H, Kimura M, Tajima T, Shirahama R, Suzuki Y, Suzuki Y, Hayashi T, Maruyama K, Endo M, Sakamoto N, Ikeda A, Gozal D, Tanigawa T. 2018. Nocturnal enuresis and sleep disordered breathing in primary school children: Potential implications. Pediatr Pulmonol. 53(11):1541-1548.

Wang QW, Wen JG, Zhang RL, Yang HY, Su J, Liu K, Zhu QH, Zhang P. 2007. Family and segregation studies: 411 Chinese children with primary nocturnal enuresis. Pediatr Int. 49(5):618-22.

Wang XZ, Wen YB, Shang XP, Wang YH, Li YW, Li TF, Li SL, Yang J, Liu YJ, Lou XP, Zhou W, Li X, Zhang JJ, Song CP, Jorgensen CS, Rittig S, Bauer S, Mosiello G, Wang QW, Wen JG. 2019. The influence of delay elimination communication on the prevalence of primary nocturnal enuresis-a survey from Mainland China. Neurourol Urodyn. 38(5):1423-1429.

Yang TK, Huang WY, Guo YJ, Chen YF, Chang HC, Huang KH. 2022. Prevalence of Lower Urinary Tract Symptoms in Children with Attention-Deficit/Hyperactivity Disorder: Comparison of Hospital and Population-Based Cohorts of 13,000 Patients. J Clin Med. 11(21):6393.

Yeung CK, Sihoe JD, Sit FK, Bower W, Sreedhar B, Lau J. 2004. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int. 93(3):341-5.

Zhang A, Li S, Zhang Y, Jiang F, Jin X, Ma J. 2019. Nocturnal enuresis in obese children: a nation-wide epidemiological study from China. Sci Rep. 9(1):8414.

Content of “Bed-wetting (sleep enuresis) in children” last modified 9/2023

Portions of this text appeared in a previous Parenting Science article, “Bed-wetting in children” (2010), posted at the same URL, as well as in a version published in 2019.

Image of wet bedsheets and toy owl copyright 2019 Parenting Science

Content last modified 8/2023

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