A more common issue than most parents imagine, bedwetting amongst school-age children can lead to great anxiety for the whole family. Hilary Pereira offers some solutions

On average, children are dry at night by around age four or five. If, however, your school-age child is still not dry at night, he's in good company: plenty of children simply take longer to achieve this particular milestone than others.

'The speed at which children achieve night-time dryness does vary, often starting with one or two dry nights a week and building up slowly over a number of months,' says a helpline advisor for ERIC (Education and Resources for Improving Childhood Continence). It's not always easy to pinpoint the reason why some children acquire night-time control later than others, but it is not due to laziness or lack of willpower.

'We made several attempts to get Joshua out of night-time nappies but he was still in them by age five,' says his mum, Lindsay Harper, 32, from Basildon. 'For about three months after we finally abandoned nappies he wet the bed every night, but then he started having the odd dry night, and by his sixth birthday he'd been dry for about a month. It was stressful having a problem none of my friends seemed to understand, but our health visitor gave me plenty of information to reassure me that Joshua was perfectly normal. I hadn't realised it could be a genetic problem, and it turned out that Joshua's dad had also been late to get dry. The key is to remain as positive as you can, and to treat the issue consistently.'

There are plenty of things you can do to make your lives easier until your child eventually grows out of bedwetting, and it helps to understand why the situation occurs in the first place.

How common is bedwetting?
Bedwetting (also known as 'nocturnal enuresis') is more common than many parents think, affecting around one in seven children aged five and one in 20 children aged ten. Without any treatment, the problem usually resolves itself gradually over a number of years, with less wet nights each year. Most children who are still wetting at age 10 have never had a dry night; a few may have regressed after weeks or months of being dry.

Why children wet the bed
A small bladder Some children simply have a smaller bladder capacity than others, and this - combined with last-minute pre-bedtime drinks - can result in bedwetting accidents. About one child in seven who has the problem will also have a sibling or parent who was late to become dry at night. 'The bladder may also be "overactive", giving an urgent signal to empty before it is full,' says the ERIC advisor.
What you can do 'To increase bladder capacity and encourage good function, ensure that your child has 6-8 glasses of water or water-based drinks throughout the day,' stresses the advisor from ERIC. However, during the last couple of hours before bedtime, limit drinks to water or diluted juice only, as there are certain ingredients in other drinks that may exacerbate the problem. Encourage your child to empty his bladder just before you tuck him in.

Hormones It's believed that the production of a hormone that inhibits the amount of urine made throughout the night is greater in some children than others. Those children who don't produce as much of this hormone, known as vasopressin, will make more urine and be more prone to bedwetting - especially as they may also be less aware of having a full bladder than others.
What you can do This problem usually resolves itself as children mature. Again, it's wise to limit drinks close to bedtime, and make sure that your child visits the loo just before sleeping.

Food and drink choices Some food and drinks contain caffeine, which is a known diuretic (encouraging the production of urine). These include chocolate and caffeinated cola.
What you can do Avoid giving your child anything containing caffeine within an hour of bedtime. You can buy decaffeinated cola, which is a better choice healthwise anyway.

Constipation If your child is constipated, this can have a knock-on effect on the sensitivity of his bladder, as any obstruction in the rectum can 'irritate' the bladder.
What you can do Prevent or ease constipation by increasing the amount of roughage in your child's diet. This includes unpeeled fruit and vegetables and wholemeal or wholegrain foods, such as brown rice, wholegrain bread and wholewheat pasta. Encourage your child to drink more fluids during the daytime - but decrease the amount you offer him towards bedtime.

Ways of treating bedwetting
'You may want to seek professional help from your GP or enuresis clinic if your child is aged six or seven or above,' says ERIC's advisor. 'They will be able to make a full assessment, advise on treatment options and support you and your child throughout treatment.' Speak to your GP, school nurse or health visitor, or contact ERIC. Meanwhile, there are ways of making life easier all round whilst your child's bladder matures sufficiently for him to stay dry at night.

Lifting Taking your child out of bed a couple of hours after he has fallen asleep (known as 'lifting') is one way of preventing wetting, but whether it works for you and your child or not will depend largely on his response to being woken: some children will stagger to the loo half-asleep, but others will protest loudly and have their sleep badly disrupted. Lifting is most effective in children who have started to have the occasional dry night, as they are already beginning to awaken when the bladder is full. ERIC's advisor stresses: 'If parents choose to try lifting, they should vary the time each night and ensure that their child is fully awake.'

Bedwetting alarms (usually used only from age seven) These consist of a sensor pad worn on the pants or placed under the bedsheet, and an alarm that goes off when the bed is wet. It's important that both parent and child respond to the alarm, rather than leaving the child to cope alone. 'Most children who wet the bed appear to sleep deeply, but we now know that it is less to do with the depth of sleep and more to do with the ability to arouse from sleep to go to the toilet or to hold on until morning,' says an ERIC spokesperson. 'The alarm helps this process; in fact, research has shown that enuresis alarms have been proven to be the most effective form of treatment, with a success rate of around 80 per cent, but they do need commitment and perseverence from both child and parents. On average, treatment will take about three months.' You can hire alarms from some children's hospital departments or buy them from support groups such as ERIC.

Drug treatments An anti-diuretic drug, known as Desmopressin, is sometimes prescribed for children who wet the bed. This is taken last thing before bed and works by suppressing the amount of urine produced overnight. It can be taken as a nasal spray or orally and works well in most children, although not all. The majority will have a brief relapse when treatment is stopped. It may be worth asking your GP about using this treatment as a stop-gap whilst your child's bladder matures. It can be particularly useful for sleepovers or trips away from home.

Reward schemes You'll need your child's cooperation to overcome bedwetting, and some parents find that a reward scheme helps. 'It's important to reward positive actions that your child takes, such as drinking frequently throughout the day, helping to change the bed or taking responsibility for going to the loo last thing at night,' says ERIC's advisor. 'Rewarding a child only for a dry night can be demoralising.'

Holly Ward, 34, from mid-Glamorgan, found this incentive worked well with her daughter Heather: 'I set up a sticker chart for Heather, even though she was nearly seven at the time. She'd been reluctant to help change her bed up until then, but with her favourite Bratz stickers as motivation we got there in the end!'

It's important to remain low-key about the situation, and not to humiliate or pressurise your child. This is where the emotional link comes in: a child who is ridiculed or punished for wetting the bed will feel inadequate and may suffer socially, too, as he'll probably resist sleepovers. This is demotivating, when what your child really needs is motivation to get up to go to the loo.

Overcome night-time fears Make it easier for your child to find his way to the toilet in the night by leaving a light on for him: he may have unspoken fears of the dark that are preventing him from getting up.

It's practical and sensible to invest in a waterproof mattress protector and a good supply of extra bedding to make midnight bed-changing easier. Also, temporary measures such as night-time absorbent pants can help ease the situation for both you and your child.

Further advice
ERIC (Education and Resources for Improving Childhood Continence), 34 Old School House, Britannia Road, Kingswood, Bristol, BS15 8DB, tel: 0117 960 3060 or visit the website Provides support and information and sells a range of products including alarms, mattress and bedding covers, waterproof duvets and mattresses.

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