Arkansas Children’s urology program was nationally ranked by the 2022-2023 U.S. News and World Report, along with six other pediatric specialties. The urology clinic, which had more than 7,800 visits in 2021 system wide, provides statewide care through Arkansas Children’s Hospital in Little Rock, Arkansas Children’s Northwest in Springdale and the ACH Jonesboro Clinic. Telehealth appointments are also available in Texarkana, Fort Smith, Springdale and Jonesboro. The clinic treats a variety of conditions, including anomalies of the kidneys and bladder, as well as urinary tract infections and incontinence.

Sally Puckett, an advanced practice registered nurse (APRN) specializing in urology for Arkansas Children’s in Little Rock, Jonesboro and Springdale, said that up until age 5, bedwetting, or not being able to control the bladder, is normal. Bedwetting is the most common type of incontinence seen in the urology department. Puckett typically sees patients that have accidents/bedwetting, urinary tract infections, hurting or pushing to pee and other genital conditions.

Puckett shared statistics about how common bedwetting at night can be as a child grows:

  • 20 percent of 5- to 6-year-olds wet the bed
  • 10 percent of 7-year-olds
  • 5 percent of 10-year-olds
  • 1-2 percent of 15-year-olds

According to the American Academy of Child and Adolescent Psychiatry, more boys than girls wet the bed, and bedwetting tends to run in families.

It’s important to note that parents and caregivers should not panic if a child is wetting the bed past age 5, as the common causes are treatable.

A few factors that might contribute to bedwetting beyond the typical age include:

  • Producing too much urine while sleeping.
  • A smaller capacity to hold urine.
  • Constipation causing less room for the bladder to expand and hold urine.
  • Sleep disorders like sleep apnea.

The AACAP stated some medications causing a child to sleep deeper can lead to bedwetting. It could be emotional-based if a child begins bedwetting after several months of no accidents. The AACAP points to causes like anxiety or significant life changes like divorce, death, bullying and a new baby. It's also common for children to experience accidents while they are awake. In some cases, there are structural body issues or neurological conditions that contribute to bedwetting, like some conditions of the spinal cord that cause a bladder to not work correctly.

If a child is bedwetting past age 5, it is better to take the child to a doctor sooner rather than later. If a child was fully potty-trained by 3 years old and starts bedwetting again at 4, it could be time to see the doctor.

Bedwetting can lead to embarrassment, low self-esteem and cause a child to skip out on social activities, like sleepovers and overnight camps. Parents and caregivers should let a child know they are doing nothing wrong and bedwetting is treatable. Punishments are unhelpful and can prolong bedwetting.

During an initial ACH urology appointment, Puckett explained she asks a lot of questions to determine the child's needs, as each treatment plan differs depending on the child. Sometimes appointments include urine tests to rule out infections or disorders, an X-ray to see how full the intestines are and a bladder scan. An appointment can also include a genital exam. Puckett said parents should prepare their child ahead of time, explaining they will stay in the room with them, and it is OK for a doctor to do the exam.

Treatment can sometimes include behavior modifications, medications and physical therapy to help with muscle control.

According to the AACAP, there are also devices like urine pad alarms that detect when a child is starting to pee, and an alarm activates to wake a child up.

Puckett pointed out a few simple tricks parents and caregivers can try at home:

  • Stop fluids about an hour before a child goes to sleep.
  • Make sure the child goes to the bathroom before bedtime.
  • Treat constipation.

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