What causes a child to wet the bed? Our 5-year-old soaks his sheets nearly every night, and it drives me crazy.

There are about 7 million kids in the United States who wet the bed nightly. They are a misunderstood lot. Many of their parents believe their bed-wetting is deliberate and that it can be eliminated by punishment. Others think these kids are just too lazy to go to the bathroom. These are wrong and unfortunate notions. Bed-wetting is often caused by medical factors such as a small bladder, physical immaturity or other physical conditions. That’s why you should begin by consulting a pediatrician or a urologist when bed-wetting starts. About 50 percent of the kids can be helped or cured by medication.

For other boys or girls, the problem is emotional in origin. Any change in the psychological environment of the home may produce midnight moisture. During summer camps conducted for young children, the directors routinely put plastic mattress covers on the beds of all the little visitors. The anxiety associated with being away from home apparently creates a high probability of bed-wetting during the first few nights, and it is particularly risky to be sleeping on the lower level of bunk beds.

There is a third factor that I feel is a frequent cause of enuresis. During a child’s toddler years, he may wet the bed simply because he’s too immature to maintain nighttime bladder control. Some parents, in an effort to head off another episode, begin getting these kids up at night to go to the potty. The youngster is still sound asleep, but he or she is told to “go tinkle” or whatever. After this conditioning has been established, the child who needs to urinate at night dreams of being told to “go.” Particularly when jostled or disturbed at night, the child can believe he or she is being ushered to the bathroom. I would recommend that parents of older bed wetters stop getting them up at night, even if the behavior continues for a while.

I get so angry at my kid for doing this. Every morning I have to strip and wash his bedding and pajamas. I told him last week that I would spank him if it happened again. Do you think that will help?

Most certainly not. Unless your child’s bed-wetting is an act of defiance occurring after he is awake, which I doubt, his enuresis is an involuntary act for which he is not responsible. Punishment under those circumstances is dangerous and unfair. Your son is humiliated by waking up wet anyway, and the older he gets, the more foolish he will feel about it.

The bed wetter needs reassurance and patience from parents, and they should be there for him or her. They would be wise to try to conceal the embarrassing problem from those who would laugh at him. Even good-natured humor within the family associated with bed wetting is often very painful.

Aside from medical help, what suggestions do you have for dealing with this problem?

There are other remedies that sometimes work, such as electronic devices that ring a bell and awaken the child when the urine completes an electrical circuit. This conditions a child to associate the feeling of needing to urinate with the bell that awakens him. I have seen some dramatic success stories where “hard-core” bed wetters were cured within a few weeks using such a device. Trying it certainly can’t hurt.

Until the problem is solved, I hope you can keep your frustrations at a minimum. A smile sometimes helps. I received a letter from a mother who wrote down her 3-year-old son’s bedtime prayer. He said, “”Now I lay me down to sleep. I close my eyes, I wet the bed.”