Bed-Wetting: What’s Normal, What’s Not, and What Actually Works

For many caregivers, bed-wetting can feel like an ongoing mystery—why does it happen? When should we be concerned? And most importantly, can it be “taught” away?

As BCBAs, we know that behavior is influenced by reinforcement, learning history, and environmental factors. But when it comes to bed-wetting, developmental readiness plays the biggest role. It’s not just about behavior—it’s about biology. So, let’s dive into what we actually know about bed-wetting, what we don’t, and what we need to stop doing immediately.

Bed-Wetting: The Developmental Science

The first thing to understand is that bed-wetting (or nocturnal enuresis) is developmentally appropriate up until the age of 7. While it may feel frustrating for families dealing with frequent sheet changes, it is not necessarily a sign that something is "wrong."

Why? Because staying dry at night requires a mature connection between the brain and bladder. The body must:

✅ Recognize a full bladder while asleep
✅ Have the neurological maturity to wake up in response to that signal
✅ Be able to hold urine for the entire night

Some children develop this ability earlier than others, but hormonal regulation, bladder size, and deep sleep cycles all influence nighttime continence. In other words, no amount of sticker charts, reinforcers, or prompts will speed up a brain that simply isn’t there yet.

When Is Bed-Wetting a Problem?

Occasional bed-wetting up to age 7? Not a concern.
Frequent bed-wetting after age 7? Time to assess.

After age 7, persistent bed-wetting may indicate:

🔹 Delayed bladder maturation – The connection between brain and bladder hasn’t fully developed yet.
🔹 Low levels of antidiuretic hormone (ADH) – This hormone signals the kidneys to slow urine production at night. Some children produce less ADH, resulting in a full bladder while asleep.
🔹 Genetic predisposition – If one or both parents experienced bed-wetting beyond age 7, the child is more likely to follow the same timeline.
🔹 Medical concerns – In rare cases, bed-wetting may be linked to conditions like sleep apnea, chronic constipation, or bladder dysfunction.

What Doesn’t Work (aka, Let’s Stop Doing This)

🚫 Waking the child up to go to the bathroom while they’re still asleep.
This popular strategy—often called “lifting” or “dream peeing”—seems like a logical fix, but it teaches the brain to urinate at that time rather than developing true bladder control. It’s also difficult to fade over time.

🚫 Punishment or shame.
Bed-wetting is involuntary. Kids are not “choosing” to wet the bed, and consequences like verbalizing disappointment, restricting fluids, or making them clean up can lead to distress without improving the situation.

🚫 Over-reliance on pull-ups beyond an appropriate age.
For some children, wearing a pull-up at night becomes a reinforcing factor—if they don’t feel wet, their brain doesn’t register a reason to wake up. While protective bedding is fine, caregivers should work toward dry nights rather than prolonged dependence on disposable solutions.

What Might Help

✔️ Limiting fluids before bedtime (without causing distress)
✔️ Encouraging regular daytime bathroom habits to strengthen bladder control
✔️ Using a bed-wetting alarm (for children over 7) to create an association between a full bladder and wakefulness
✔️ Making gradual changes and tracking progress

The Takeaway

Bed-wetting isn’t a behavior to “fix.” It’s a developmental process that can’t be forced but can be supported. The best thing we can do as BCBAs is provide education, reassurance, and guidance to families—helping them distinguish between what’s expected, what needs assessment, and what interventions might actually work.

Want to expand your expertise on sleep and related nighttime concerns? The Sleep Collective is enrolling now! Learn evidence-based, ethical sleep interventions that empower families and improve outcomes for autistic learners.

Ready to dive deeper? Let’s talk about how sleep certification can elevate your practice and make you a go-to resource in the field.