It's understandable that night-time bedwetting (called childhood enuresis) can be frustrating and upsetting for both parents and children, especially if there's been a problem for some time. 

Added to this is the supply of confusing, free opinions about how the child's bedwetting problem "should" be addressed.  If you've been trying for dry beds for some time, you'll know by now there are no simple answers.

Training a child to be dry at night could be thought of as "more an art rather than a science" because there are so many factors to juggle! Children and their caregivers are all individuals with their own personalities and perceptions. Not all children develop at exactly the same rate. There are different styles of parenting - and brothers and sisters are involved too. 

Being sensitive to all these factors will help you negotiate what can sometimes be a tricky area of childhood development.

Here are some general guidelines which could help you to help your child become dry at night:

Accept the realities …

• Most children aren't reliably dry during the day until they're between 3 and 4 years old, and not dry on most nights until the age of 4.
• At the age of 5, there will be 5 or more children in a school class of 30 who are still wetting the bed at least twice a week.
• To be reliably dry at night the bladder has to hold on to a good amount of urine and the person must have the ability to wake up and go to the toilet before the bladder empties. 
• If a child is dry at night earlier than average, luck might be playing a part or these children may have mothers and fathers who were dry at a younger-than-average age. If both parents were bed-wetters, there's a 3 in 4 chance that their child will be a bed-wetter too.
• While the washing of bed-linen might seem unending, be patient – or appear to be!
  

Scan the situation for any barriers to improvement …

• Is there a fear of the dark or monsters lurking in the toilet, maybe a fear of falling in? Question the child sensitively. Aim to make the toilet "a happy place" (ie. the child is comfortable to be there and not a lonely place, plus the toilet is child-friendly to sit on).
• Is the toilet easily visible and accessible at night – perhaps a night-light?
• Are you yelling or appearing angry? Yelling won't solve anything: if the child's own bladder can't "yell" loudly enough to wake them, your anger at discovering another wet bed won't solve anything either - and it may cause bigger (emotional) problems.
• Are your child's drinking and toileting habits working well? Children need to drink plenty of water daily for best bladder function. Plenty of fluids (water is best) will encourage the bladder to learn to hold more urine. If the child is going to the toilet a lot during the day, maybe their bladder is not trained to hold larger volumes of urine. It's advisable to get some professional advice here – a simple bladder training program could help.
• It's normal for children to have occasional wetting accidents during the day until they're school age. A small number of school-age children wet during the day and night - a visit to the doctor is strongly recommended.
  

Some general tips that could help ...

• Be aware of your child's personality and what they can cope with.
• If the child wets day and night, help the child achieve day dryness before tackling the night-time bed-wetting.
• The child must want to be dry at night: their involvement and commitment is necessary. (ie. it's not enough that the parent wants them dry!)
• Don't restrict fluids in the evening unless drinking in the evening is excessive. Cutting down fluid in this way doesn't actually work and can make it worse by reducing the bladder's ability to expand and to hold bigger volumes of urine.
• Encourage water in the evening rather than fizzy drinks or drinks containing caffeine (like cola drinks) may irritate the bladder or produce extra night-time urine.
• Avoid routine wakening. Don't "lift" the child in this way because, while it might reduce the amount of wetting, it can delay the child achieving dryness independently.
• Beware incentive schemes! They're easy to blow out and manage poorly so that disappointments and setbacks arise.  Set achievable targets (eg. not total dryness straight away) and without overly generous rewards – praise is the best reward of all.
• Don't make cleaning up a punishment: it's important the child looks after themselves as much as possible, but with support. After all, self-reliance is part of the treatment. Involvement and responsibility in clean-up is something they can be proud of. It's not a punishment. 
• Encourage the child to drink lots of fluids during the day for healthy bladder activity – it won't make the bed-wetting worse. A child should drink whenever they feel thirsty. However, about 6-8 glasses of fluid a day is a rough guide, with more in hot weather and with higher exercise levels.  Set a good example and teach the child to love water.
• Keep a bedwetting/fluids diary. Perhaps involve the child in making it, and in what it shows. You can both better see the improvements together. 
• Be sensitive to the child's feelings: don't discuss a bedwetting problem with other people in front of the child.  
• If the child is upset by their ongoing bedwetting, this is a good enough reason alone to seek professional advice about the situation. 
  

How to prepare for sleepovers

• Don't be tempted to live in hope and let a bedwetting child "wing it"
  on their own. 
  
• The excitement, extra drinks, and generally strange routine of a sleepover can make them even more prone to an embarrassing accident. 
  
• Wearing a pair of absorbent pyjama pants discreetly under nightwear, and/or an absorbent product under the sheet are sensible precautions.

The child who's never been dry
It's extremely rare to find anything wrong.  The main cause is that the child has difficulty waking from sleep in response to that full bladder feeling: the messaging "wiring" between bladder and brain simply isn't fully developed yet.

Is their bed flooded, or a disposable product drenched - and more than once a night perhaps? In some of these children the kidneys produce a lot of night-time urine. This could be due to not having a natural rise in the level of the anti-diuretic hormone (ADH) which makes the kidneys slow down urine production overnight.

Using a bed-wetting alarm
If a child is aged 7 or over, it's worth trying an alarm. Sometimes, in a well-motivated child from about the age of 5, it can also be appropriate. There are two types of alarms: either a personal alarm with a small sensor, or a bell and pad/mat fitted to the bed.

An alarm program requires commitment, every night, by a caregiver, because the child has to be attended to and the alarm re-set each time it triggers. The child has to be closely involved in its use. You may have to initially wake the child when the alarm triggers. Learning to wake can be difficult for a child – be patient.  Properly used and with professional guidance, there's a 75 per cent success rate for permanent dryness.

The guidance and support of a continence consultant as your child's "bedwetting coach" is strongly recommended with an alarm program.

Relapsing: the child who was dry but is bed-wetting again
By the age of 10, about 8 out of 100 children will relapse. Usually these children are no different from those who have always wet the bed, but some specialists believe they're more likely to have a medical or psychological cause (perhaps a urine infection or a big emotional upset).

The children who are in the relapse group tend to be those who were an older than average age when they first controlled their bladder at night, ie. they'd already shown some sign of delay in developing the right "wiring". Check with the doctor so the child can be checked for infection or other physical or emotional problems.

Good bladder and bowel health
Like toilet training, achieving a dry bed is another step up the child's ladder to having good bladder and bowel habits as teenagers and adults. 

In the early stages, be aware that your own habits and attitudes as caregiver take hold, so –

• Explain the Whys of bed-wetting – show the child a diagram of their body's "waste management" system
• Explain the input/output process of drinking/kidneys/bladder/weeing
• Explain food intake (including the importance of the fibre in vegetables and fruit) and bowel function – and last but certainly not least ... 
• Be optimistic, positive and supportive always.
  

Overall
Ditch the perceptions that you're on your own in this (it's a very common problem), that your child is too slow becoming dry, that they're being naughty, that it's your fault, or that other people's children seem to become miraculously dry without any bother. 

However, if you've been coping with bedwetting for some time, it's wise to seek some professional advice. In seeking this, the clinician might simply provide some comfort that you're doing all you can, that your child is simply not ready, that there is nothing bad physically or emotionally that is upsetting this "natural process". But at the appropriate stage, a "bedwetting coach" (such as a GP or a paediatric continence nurse) is an excellent way to go.

* This information is drawn in part from The Dry Night, a free resource available from the National Continence Helpline