What causes bed-wetting, how to deal with its emotional toll, plus how to help your child wake up clean and dry

Yaakov is my fourth, so when it came time to potty train him, I wasn’t worried,” says Malka. “I had my method down pat. Dedicate a few days solely to establishing daytime training, then move on to night training. After a few accidents and a few weeks, the task is complete. People warned me that boys sometimes have a harder time with potty training, but I didn’t think much of it.”

The first part of the process went relatively smoothly for Yaakov, though it did take longer than Malka’s daughters. Then came night training.

Despite months of trying, Yaakov couldn’t stay dry through the night. “I figured he just wasn’t ready, so we took a break,” Malka says. She tried again six months later, but none of her methods worked. A year later, they made a third attempt but were just as unsuccessful.

Is Something Wrong?

When nighttime potty training doesn’t go as planned, it can unnerve (and exhaust) even the most experienced of mothers: “Why isn’t this working? Is this normal? Is there something wrong with my child?”

Pediatrician Dr. Jenny Berkovich, who regularly sees bed-wetting patients, is a voice of calm for frantic parents. “Technically, most kids should be able to stay dry through the night starting at age five. But it’s very common to see kids much older than that still requiring pull-ups at night,” she says. “In fact, it’s estimated that 10-15 percent of seven-year-old children still struggle with bed-wetting. The condition is twice as common in boys as in girls.”

What a pediatrician or pediatric neurologist will try to identify during an initial consultation is which type of bed-wetting the child is struggling with. The first type is called primary nocturnal enuresis, which describes a child who has never had proper control at night and consistently wets the bed. The second type is called secondary nocturnal enuresis, which is when a child who previously did have control suddenly starts wetting the bed again. Secondary nocturnal enuresis is often due to a specific cause, such as diabetes, urinary tract infections, trauma, or stress.

“The most common cause of primary nocturnal enuresis is ‘normal variance’ — meaning nothing is actually wrong, and the child just needs more time to become fully dry at night,” says Dr. Berkovich. “It’s not clear why some kids reach this stage earlier, but we do see bed-wetting run in families. I often find that when one or both parents struggled with this issue as children, their kids may experience bed-wetting for the same period of time.”

The role that genetics play in bed-wetting is backed by studies. If one parent suffered from recurring bed-wetting as a child, the risk of their child struggling with it is 40 percent. The chance of bed-wetting goes up to 70 percent if both parents struggled with bed-wetting.