Eight-year-old Tommy is tired of waking up every morning in a wet bed. "He is frustrated and his mother is worried, but bedwetting is not something to panic about," says Dr. Vera Loening-Baucke, professor of pediatrics at The University of Iowa College of Medicine and staff physician at UI Hospitals and Clinics.

"Bedwetting is very common, but it is considered a problem when it occurs in boys over the age of 6 and in girls older than five," Loening-Baucke says. Bedwetting, called enuresis, is the involuntary discharge of urine during sleep. Bedweting affects 15-20% of 5-year olds, 7% of 7-year olds and 1-2% of adolescents and adults. Boys are twice as often affected than girls. Primary enuresis is bedwetting in a child who has always wet the bed. It is considered to be due to developmental delay. Rarely is a urologic, medical or neurological abnormality the cause in a child who has primary bedwetting and no daytime wetting. Secondary enuresis occurs in a child who has been dry for a period of time prior to the occurrence of bed wetting.

"Bedwetting can be frustrating to the child and parents, causing feelings of low self-esteem in the child. Just as in potty-training, never be angry with or punish a child for wetting the bed, he or she is not doing it deliberately," Loening-Baucke says.

Bedwetting may run in families. Research has shown that if the father wet the bed as a child, there is a 39 percent greater chance the child will wet the bed, and if the mother has a history of enuresis, there is a 23 percent greater chance. If both parents have a history of bedwetting, there is a 77 percent chance the child will also wet the bed.

"It has been suggested that some children may have a sleeping disorder that makes it difficult to awaken them. However, no scientific studies have explored this theory, " she adds, "and most children are deep sleepers, irrespective if they wet the bed or not."

In some children, nighttime urine formation is the cause of bedwetting. Normally, a hormone released at night reduces urine flow, but this hormone may be lacking in some children, Loening-Baucke explains.

Whatever the cause, parents have several options to help children with this problem, Loening-Baucke says. "Try restricting the amount of fluids the child drinks at night and make sure the child urinates before he or she goes to bed," Loening-Baucke says. "Self-monitoring, motivation and responsibility training with charting of successful nights should be the initial approach. Parents should try to determine the time of night bedwetting occurs. If parents know when it is likely to happen, they can awaken the child to urinate."

The next step is to use a conditioning device called a bed-wet alarm, Loening-Baucke says. "An alarm sounds when the child's pajamas are wet. The goal for the initial week is for the child to wake up when the alarm goes off, then the child will wake up earlier and earlier when the alarm goes off, making the puddle smaller and smaller, till the child will wake up prior to the alarm going off and prior to wetting the bed. Three out of four children will be dry after six months using the bed-wet alarm," Loening-Baucke says.

"If these options fail, your physician may suggest medication," she adds, "such as low does antidepressant with effect on bedwetting or a hormone medication to reduce the urine volume at night. The hormone treatment can be great for a sleep-over, for camping or travel."

The outcome is good, 15 percent of children spontaneously outgrow the bedwetting every year.

For more information about bedwetting, talk to your physician.