Some children empty the bladder involuntarily and wet the bed at an age beyond which the sphincter control is normally developed. An occasional lapse by a child should not cause undue parental concern. When the bed wetting occurs frequently, it is defined as enuresis. The enuresis may be primary or secondary. In primary enuresis there is a delay in the maturation of neurological control of sphincters and such children have usually never been dry at night. There is often an organic basis for this e.g., mental subnormality. In secondary enuresis, the sphincter control is developed at the normal age and the child remains dry for several months after which the child again starts wetting bed at night. This may be due to excessively enthusiastic attempts at toilet training by the parents, emotional disturbances in the child or parent-child maladjustment. Enuresis may represent the subconscious desire of the child to gain care and attention of his parents as in earlier period of infancy or it may be a manifestation of subconscious resentment against the parents. Thus enuresis often has a psychological basis.
The behavior disturbances observed by the child psychologist may, however, be a result rather than cause of bed wetting and may be attributed to feeling of shame or guilt.

The children with nocturnal enuresis usually sleep very deeply at night and it may be difficult to arouse them. The signals from the digtended bladder indicating the need to empty the bladder do not reach the conscious level of their mind during sleep and this may cause involuntary emptying of the bladder.
Management. Organic causes such as juvenile diabetes mellitus, anomalies of the urinary tract, nephropathies and neurological illnesses should be excluded by suitable physical examination and investigations. Since the condition is generally harmless and self-limiting, the child and parents should be reassured. About 15 percent of children between the ages of 5 and 10 years are known to be enuretic. About 1 percent of normal children may continue to wet the bed till the age of 15 years. Every attempt should therefore, be made to minimize the emotional impact of enuresis on the child. The sympathetic over activity, which is associated with emotional disturbances and fear aggravate the condition. The parents are advised not to nag, criticize or reprimand the child for wetting the bed at night. The bed sheet, should be quietly changed next morning, without making the child conscious of it. The child should refrain from taking beverages such as tea, milk or sherbet after 5 o’clock in the evening. He should be habitually made to pass urine before retiring to bed. The parents should arouse him fully again after two or three hours of sleep and persuade him to walk unaided to the toilet to empty his bladder.
The bladder should be trained to retain urine for a longer time. This may be done by making the child drink large quantity of water during the day and persuading him to delay emptying of the bladder as long as possible.