Our five fingers are not the same, and so are our children. When it comes to peeing, toilet training practices vary from child to another as does their control to master their bladder through the night. For some children, it could be very challenging, for others not. When can we diagnose bed-wetting as a problem called nocturnal enuresis is a question we’re going to tackle throughout this article. Hint: They have to be at least 5 years old.

In Sigmund Freud’s Three Essays on the Theory of Sexuality (1949), bed-wetting has been linked to having sexual fantasies, highlighting the action as the child having nocturnal emissions. This view was developed in the 20th Century by insinuating that bed-wetting was a sign of emotional disturbance and a psychological reaction emanating from emotional conditions in the home and a deficient mother-child relationship.

Another view by Pediatrician Benjamin Spock (1946) explained that bed-wetting was simply a sign of general anxieties that were a result of tenseness in a child’s feelings. Those anxieties could be moving into a new house, feeling pressured at school, stressed over a birthday party, sibling rivalry, birth of a new sibling, etc.

To break the myth, a study conducted by Friman and colleagues (1998) administered a child behavior problems questionnaire to parents with three groups of children; those with bed-wetting, those with behavioral clinical problems, and those with no problems (control group). The results showed no comorbidity between children who have a history of bed-wetting and a significant behavioral problem, but rather a physiological explanation.

So why do children wet their beds? Two reviews highlight that children who have a history of frequent bed-wetting, have a problem with higher than normal urine production and a dysfunction in their bladder and muscles controlling bladder release. Another reason could be difficulties with sleep arousal (deep sleep), once again stressing the physiological reasoning behind the problem (Hupp & Jewell, 2015).

It’s worth mentioning, however, that even though bed-wetting is not necessarily caused by underlying emotional problems, other studies show that it could have an opposite effect, meaning it can cause some stress in a child.

A study conducted by Schrober et al. (2004) looked into the impact of monosymptomatic nocturnal enuresis (MSNE) on how the child perceives the quality of attachment to a caregiver as well as the caregiver’s outlook of dissociative behavior. It showed that MSNE can negatively impact how a child perceives attachment. However, the caregivers did not report any dissociative behavior in nocturnal enuresis children. Thus, enuresis could play a role in the early attachment and intimacy between a child and their caregiver.

It’s important to be aware that sometimes a child’s quest for intimacy is through bed-wetting as it highlights an early pleasurable somatic sensation and fills the longing of the good old days. When the child wets their bed, it brings them back the feeling of warmth when they were cared for and felt loved. It could also be a method of attention-seeking (a cry for help) to the caregiver the child shows in a way of regression. If not paid attention to the real reason behind the situation, it could potentially turn into a repetitive cycle that could lead to problems later on in life (Stein, 1998).

In normal cases, the parent should make sure the child doesn’t drink much fluid before bedtime, encourage bathroom stops, teach the child how to go to the bathroom at night, etc. In case they wet their bed, it is recommended not to wake the child up immediately as it will disrupt their sleep, but rather help them wash in the morning and make them know it is okay. If the child is 5 years or older, it is necessary to understand the reason behind bed-wetting. If diagnosed by a doctor with nocturnal enuresis, a urine alarm (small sensor attached to the child’s underwear) is the most research-supported intervention for it as it works as some kind of conditioning (Hupp and Jewell, 2015).

Bed-wetting is a sign of emotional problem: Myth or fact? A myth until you stop paying attention to it, then it becomes a fact.

References

Freud, S. (1949). Three Essays on the Theory of Sexuality. London: Imago.

Friman, P.C., Handwerk, M. L., Swearer, S. M., et al. (1998). Do children with primary nocturnal enuresis have clinically significant problems? Archives of Pediatrics and Adolescent Medicine, 152, 537-539. doi:10.1001/archpedi. 152.6.537.

Hupp, S., & Jewell, J. D. (2015). Great myths of child development. John Wiley & Sons, Incorporated.

Schrober, J.M., Lipman R., Haltigan J.D., Kuhn P.J. (2004) The impact of monosymptomatic nocturnal enuresis on attachment parameters. Scandinavian Journal of Urology and Nephrology. 38:1, 47-52, DOI: 10.1080/00365590310001665

Spock, B. (1946). The Common Sense Book of Baby and Child Care. New York, NY:Duell, Sloan and Pearce.

Stein, S.M. (1998). Enuresis, Early Attachment and Intimacy. British Journal of Psychotherapy, 15: 167-176. https://doi.org/10.1111/j.1752-0118.1998.tb00440.x