Why are kids with ADHD more likely to wet the bed?

When your child wets the bed, it can be distressing for both of you. But it’s important to remember that bedwetting isn’t something kids do on purpose. And it’s especially common in kids with ADHD. 

In fact, bedwetting (nocturnal enuresis) — the accidental release of urine while sleeping — affects around 20 to 30 percent of kids with ADHD,opens in a new tab according to a consensus statement by the International Children’s Continence Society. It’s caused by a mix of factors, including developmental delays, a decreased ability to pay attention to bodily cues, sleep issues, and problems with executive function and impulse control. 

Bedwetting isn’t considered an issue until a child is 5 years old. About 20 percent of kids under age 5 wet the bed sometimes, and about 10 percent still do at age 7, according to the American Academy of Pediatricsopens in a new tab (AAP). But for kids with ADHD, wetting the bed after age 5 is more common. 

It’s not completely clear why ADHD and bedwetting in children often go hand in hand. We’ll take a look at what researchers know so far — and what parents can do to manage bedwetting incidents so that kids and families are better able to cope.

In most cases, bedwetting stems from multiple issues. Here are some of the most common links between ADHD and bedwetting:

To stay dry at night, kids need to develop the ability to sense that their bladder is full and then wake themselves up to go to the bathroom. This typically happens naturally as specific regions in a child’s brainopens in a new tab mature, usually by the age of 5. 

When development in these regions of the brain is delayed, a child is more likely to experience bedwetting. The same brain regions also help regulate attention, impulse control, and how deeply someone sleeps. In other words, delays in maturation of these shared regions may play an important role in both ADHD and bedwetting.

According to research published in the journal Frontiers in Psychiatryopens in a new tab, 82 percent of kids with ADHD experience insomnia and other sleep disturbances. Kids with ADHD are also more likely to experience circadian rhythm disruptions, which is when your body’s internal clock is out of sync. This can result in daytime sleepiness and nighttime wakefulness, and contribute to bedwetting. 

Many kids with ADHD also have anxiety. Anxiety itself doesn’t cause bedwetting, but it can contribute to the problem. For example, kids who are anxious may not want to use the bathroom at school or in other public places. They may also forget to use the bathroom before bed. 

Stress at home can be a factor that may contribute to bedwetting. Stress can come from things like divorce, illness, job loss, or moving to a new home. Bedwetting can also contribute to anxiety, particularly when children are old enough for sleepovers. 

As with any concerns, it’s important to listen to your child and try to understand how they’re feeling about these stressful situations. If your child is experiencing significant worries for any reason, don’t hesitate to share these concerns with their doctor.

Another ADHD and bedwetting connection? Impulse control. Challenges with executive functioning, emotional regulation, and impulse control are common symptoms of ADHD. These issues can contribute to bedwetting because kids with ADHD may have trouble recognizing bodily urges to urinate. They also may have issues with controlling their bladder while sleeping.

Daytime distractions, such as hyperfocusing on play or other activities, may be a factor in bedwetting. “It is possible that distractibility and difficulties with schedules in the day may lead some children with ADHD to not empty their bladders as consistently, which could contribute to increased likelihood of bedwetting,” explains Elizabeth Harstad, MD, MPH, a developmental-behavioral pediatrician.

Kids might also be prone to “accidents” during the day, so they may benefit from reminders to pause playing and use the bathroom.

While not common, certain prescribed ADHD medicationsopens in a new tab may affect a child’s urination patterns, according to the AAP. For example:

• Amphetamine stimulants can make it more difficult for a child to relax the muscles that allow urine to flow.

• Methylphenidate stimulants may change bladder pressure and increase the amount of urine the bladder can hold.

If you suspect that medication is having an effect on bedwetting, talk to your child’s health care provider before making any changes. Often, changing dosages or medication timing is enough to decrease unwanted side effects. And you can work with your child’s doctor on the best path forward. 

Children with ADHD often have other conditions that may be associated with bedwetting.opens in a new tab These include learning disorders and other behavioral or emotional concerns.

Another issue impacting bedwetting is deep sleep patterns that make it difficult to wake up, even with a full bladder. This may be more common in teenagers who experience bedwetting,opens in a new tab since deep sleep patterns are more likely to impact this age group.

Rarely, bedwetting can be a symptom of an underlying medical concern requiring attention. If your child has been completely toilet trained for six months or longer and suddenly begins wetting the bed or experiences other symptoms related to urination, you should speak with your child’s doctor. 

It’s completely understandable if you feel worried and upset about your child’s bedwetting. But remember — you’re not powerless in the situation. There are effective strategies you can consider to support your child and possibly decrease how often they wet the bed. Here are some tips to consider.

Harstad suggests having your child pee at night before bedtime and making this a nightly routine. You can also consider two bedtime bathroom visits — one at the start of the bedtime routine, and another right before turning out the lights. 

“If you suspect the bedwetting is happening in the later part of the night, you could try waking your child up a few hours into sleep to see if they will urinate in the toilet then,” Harstad says. “For some kids, this helps reduce bedwetting. For others, this can be challenging, so obviously don’t continue this if it isn’t helpful.”

You can encourage your child to drink frequently throughout the day, but less in the hours before bed. “Trying to limit liquid intake in the two hours before bed is a reasonable approach,” Harstad says.

But try not to emphasize the goal of reducing pee incidents. That can sometimes put undue pressure on kids. Instead, just work on establishing fluid intake routines that can help decrease bedwetting.

Bedwetting can cause feelings of guilt and shame, and it can affect self-esteem. It can also affect a child’s social life. For example, kids who wet the bed might feel uncomfortable at sleepovers or going away to sleepaway camp. 

It’s important to be kind and compassionate with your child. “It is recommended to try not to make your child feel bad about bedwetting as they probably don’t want to be doing it, and punishing or getting upset about it won’t usually help — and may make your child ashamed and feel bad about something they can’t control,” says Harstad. 

ADHD bedwetting alarms,opens in a new tab which use moisture sensors to detect wetness and remind your child to get up and pee during the night, can be an option for some kids. These alarms work about 50 to 70 percent of the time and are best for kids who are deep sleepers.

“If a child is around 7 to 8 years old and motivated to stop the bedwetting, you could talk with their doctor about trying a bedwetting alarm, which gives them a signal at the first sign of urination, to encourage them to fully wake up and go to the bathroom,” says Harstad. “However, if your child is a really deep sleeper or not too interested in reducing the bedwetting, then the bedwetting alarm may not be as helpful.”

Consistent routines in the day and evening can also help reduce bedwetting. The AAP suggests the following practices:opens in a new tab

• Encourage regular bladder emptying throughout the day, especially when you notice your child is getting distracted during activities.

• Use mattress covers routinely, and keep nighttime cleanups low-stress and routine.

• Talk regularly with teachers, relatives, and others who care for your child about ensuring that your child visits the bathroom regularly during the day.

Bedwetting can often be managed on your own by changing a few key routines and supporting your child’s emotional health and well-being. But sometimes you might need outside support. 

“In general, if you have significant concerns about your child’s bedwetting, it is always reasonable to talk about these concerns with your child’s doctor,” Harstad says.

She notes that if your child has been dry at night for six months or longer and then starts to wet the bed, “this would be a good time to see your child’s doctor to make sure that there are no medical or other things that are contributing.” 

According to the AAP, other symptomsopens in a new tab that may be cause for concern include burning or pain when your child pees, or cloudiness or blood in the urine. Sometimes medical conditions contribute to bedwetting, such as constipation, sleep apnea, and urinary tract infections (UTIs). It’s important to rule those out. But you don’t have to wait until something is wrong to reach out for help.

“If your child is really bothered by the bedwetting, it may be helpful to talk with the child’s doctor to get some strategies to try to help it,” Harstad emphasizes.

Thumbnail image credit: GeorgeRudy via Getty Images