The Text of Your Heading

AAP Logo

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

  • Discuss your child's treatment program with appropriate school personnel.

  • Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.

  • Schools may be willing to fax completed follow-up rating scales to your doctor's office.

  • Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.

  • Ask your child how he or she feels on the medication.

  • Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

© 2020 American Academy of Pediatrics. All rights reserved. AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

Bedwetting and School-aged Children

What is bedwetting?

When children pee (urinate) in their sleep at night, this is called bedwetting or nocturnal (nighttime) enuresis .

Bedwetting is common when children are learning how to use the toilet. Many children are fully toilet trained (no longer wetting the bed at night) between 2 and 4 years of age. However, bedwetting may continue for some children. Bedwetting affects 1 out of 4 children who are 5 years of age, 1 in 5 children who are 7 years of age, and about 1 in 20 children who are 10 years of age. Also, it is 2 to 3 times more common in boys than girls (male or female sex assigned at birth).

Bedwetting is rarely a serious medical condition, and parents and caregivers can help their children manage different bedwetting concerns.

Causes

Here are some possible reasons why bedwetting occurs.

  • Family history of bedwetting. Most children who wet the bed have at least one parent who did it as a child.

  • Your child hasn’t developed the ability to hold their pee (urine). If the bladder signals the brain that it’s filling up with pee and the brain doesn’t send a message back to the bladder to relax and hold the pee until morning, bedwetting will happen.

  • Your child is a deep sleeper and doesn't wake up when they have to pee.

  • Your child's bladder is still too small to hold urine all night.

  • Your child has trouble passing poop (stool). This can put pressure on the bladder.

Keep in mind that children have no conscious control of their bladders when they are sleeping. Also, children may temporarily wet the bed at night when they have a minor illness or are going through changes or stress at home.

Exam and Tests

If you are concerned about your child’s bedwetting, or if your child is concerned, contact your child’s doctor. You may be asked the following questions about your child’s bedwetting:

  • Is there a family history of bedwetting?

  • How often and when does your child urinate during the day?

  • How are your child’s bowel movements?

  • Have there been any changes in your child’s home life, such as a new sibling, a move, or other family issues?

  • Does your child drink a lot of water or other liquids before bed?

  • Is there anything unusual about how your child urinates or the way the urine looks?

If needed, your child’s doctor will perform tests or refer you to a doctor who is specially trained to treat children’s kidney (pediatric nephrologist) or urinary conditions (pediatric urologist).

How to Manage Bedwetting

Bedwetting usually goes away as your child gets older. Here are ways to manage bedwetting.

  • Support and offer reassurance to your child. Let them know that

    • Wetting the bed is not their fault.

    • It won't last forever.

    • Other children wet their beds, but no one talks about it at school.

  • Set a no-teasing rule in your family. Let others know that it's not the child's fault.

  • Don't make bedwetting a big issue so your child won't either.

  • Protect the bed. Put a plastic cover under the sheets.

  • Have your child use the toilet just before bedtime.

  • Don't give your too many liquids before bed.

  • Wake your child up to use the toilet 1 or 2 hours after going to sleep. This may help them stay dry through the night.

  • Reward your child for dry nights. Try a star chart. Do not punish your child for wet nights.

  • Let your child help change wet sheets and covers. But don't force your child to do this because your child may think they are being punished.

Treatment

There are many treatment programs and devices that claim they can “cure” bedwetting. However, many of these products may make false claims and promises and may be expensive. Your child’s doctor is the best source for advice about bedwetting. Talk with your child’s doctor before starting any treatment program.

In addition to the tips mentioned in the previous section on how to manage bedwetting, doctors may suggest trying a bedwetting alarm or medicine.

  • A bedwetting alarm is a device that has a sensor that turns on an alarm when it gets wet. The alarm wakes the child so they can use the toilet. Over time, this helps a child stay dry at night. It can take weeks or months to work. Bedwetting alarms tend to work best for children who have some dry nights. Ask your child's doctor what kind of alarm would be best for your child.

  • There are some medicines for treating bedwetting in older children. They almost never cure bedwetting. But they can help your child go to a sleepover or camp. Ask your child's doctor if medicine could be an option for your child.

Visit HealthyChildren.org for more information.

Disclaimer

The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: Nov 17 2024 20:38 Version 0.1

Powered by RemedyConnect. Please read our disclaimer.

< Back to all behavior articles

Customize from Behavior Article v0.1 7/7/2025