When Should I Worry if My Child Still Needs a Pull-Up at Night?

My 8-year-old is still in a pull-up at night. How concerned should I be?
—Kerri

The graph below shows the frequency of “nocturnal enuresis” — not waking to pee — in children by age.

These are average figures; wetting rates are higher in boys than girls.

Typically, after the age of about 7, it’s a good idea to have an evaluation if your child is still wetting at night. This is because there are some broader issues that could cause nighttime wetting, including some types of bladder dysfunction, constipation, or kidney problems. In most of these cases, you would also be seeing symptoms during the day, but there is value to checking. Usually this evaluation will involve some data collection, a urine sample, and counseling.

If there is nothing broader that is wrong, then this issue may just take time to resolve (as implied in the graph). How your pediatrician will manage it with you depends in part on how your family is reacting to this (as in: how challenging you are finding it). Interventions may involve taking away the pull-up, making sure your child pees before bed, and (possibly, longer-term) a wetting alarm. There is one medication that could be used, but it would be unlikely at this stage.