Writer and broadcaster

My six year old still wears nappies. Published in The Guardian

Dear Annalisa

My son is six and a half and still wears a nappy at night. His development in other areas is average or above and he is a perfectly normal, happy child. He was dry during the day shortly after his third birthday and only has an occasional daytime accident when he has, for example, not gone for a wee before going somewhere without access to a toilet.

I have never made a big deal of it as I thought he would grow out of it and I didn’t want him to be embarrassed or ashamed. But as we’re heading for his seventh birthday, I wonder if I should make more of an effort. His nappy is heavy every morning. We had a go a year ago but I gave up after three nights of having to wake him so I could change the sheets. The wet bed hadn’t woken him.

His four-year-old brother has been dry day and night since shortly after his third birthday. I always felt that this was a physical-development issue and it would sort itself out naturally. But it hasn’t, and now I worry that by doing nothing I have allowed him to get into the habit of not having to monitor his bladder at night and just letting go. Have I made it worse?

T, via email

I can’t absolutely say it will sort itself out, but it’s extremely likely that it will. Becoming dry at night is a developmental process. It’s the last step before full continence and a variety of physiological and mental processes need to converge.

Different children are dry at different times, and, as you’ve seen with your own two sons, some children are dry during the day for ages. Boys are more likely than girls to wet the bed up to the age of 12 and 16% of five year olds, 14% of seven year olds, and 9% of nine year olds wet the bed. And those are only those we know about.

What you don’t say is if your son wants to be dry at night. If so then there is something you can do to help him (see later). If not, then I would say don’t worry. You’re doing all the right things: not telling him off if he wets the bed, putting him in a night nappy etc. There is no more point in trying to force a child who isn’t developmentally ready/willing, to be dry at night, than there is in forcing one to walk before he is able.

Were you and your husband late bed-wetters? If so, there can be a genetic preconditioning: a 45% chance if one parent was; 75% chance if you both were. Bed-wetting while asleep (nocturnal enuresis) can happen for a few reasons. Primary enuresis is when the child has never really been dry at night. Secondary enuresis is when a child has been dry at night for six months or more, but then starts wetting the bed. This is usually due to emotional reasons and is not what’s happening here.

The main reasons for the first sort are 1) lack of vasopressin – this is a largely night-time hormone that slows down the production of urine at night. 2) In some children, the bit of the brain that tells them that their bladder is full might not be fully mature yet and the signal that says “wake up I need to go” isn’t getting through at night (given you’ve said he sleeps through wetting, I tentatively think this might be the reason). And 3) some children just have an overactive bladder.

I spoke to eric (eric.org.uk, tel: 0845 370 8008), a childhood continence charity. It has loads of information on its website that I think you will find helpful and comforting. It said that the time to intervene was when a child wants to become dry. If – and I stress if – your son is at this stage then the first thing to try is a bed-wetting alarm, which will wake him if he starts to wet the bed. This conditions a child to wake earlier in the process. If your son is not bothered by his bed-wetting, I would try to relax and see what happens. If it doesn’t sort itself out then when he is motivated to be dry at night (and that will happen) then you can look at the bed wetting alarm. Eric has all the further information you need about everything I’ve mentioned here.


This article was first published in the Guardian Family section on 1 March 2013.