- The total amount of liquid that a child needs varies depending on their age, size, activity levels and environment. Hot weather, getting lots of exercise and being overweight all mean children need to drink more.
- Good drinking habits are important for concentration levels. It also helps to promote good bladder health, helps to prevent urinary tract infections (UTI) and constipation.
- If your child doesn’t like drinking plain water, then dilute squash or fruit juice is fine. Read more of our tips for getting your child to drink more.
- Feeling thirsty can’t be relied on as a sign that children need to drink. This is because their thirst ‘cue’ may not be well developed. Or, they have reduced awareness of this sensation particularly if they have an additional need. Get more tips on toileting and children's sensory needs.
How often should children wee?
- School aged children (5 and over) should empty their bladders between 4 and 7 times a day, or every 2/2.5 hours approx.
- Younger children need to wee more frequently. Their smaller bladders hold about 120mls of urine at 3 years and this increases in capacity by about 30mls a year. However, their kidneys produce urine at the same rate as older children’s kidneys (about 60mls an hour).
- It's common for children under 5 to get the message that their bladder needs emptying at a later stage. This means they need to use the toilet more often and at shorter notice.
- As children get older, and if their bladder is working well, they become aware of the need to pass urine before the bladder is full, giving them more time use the toilet at convenient intervals; such as at school break time.
Common bladder problems
Wee accidents are very common when children are potty training. However, if leaks are still happening over the age of 5 years, you should book an appointment with a doctor so it can be looked into.
There are different types of urinary incontinence:
- Doing lots of small wees (frequency) and/or needing to rush to the toilet (urgency). This is often called ‘bladder overactivity’.
- Daytime wetting – damp pants or full bladder empty
- Finding it hard to relax on the toilet and fully empty their bladder
- Structural problems with the bladder usually from birth, such as bladder exstrophy or if the ureters connect to the bladder in the wrong place.
- Other conditions such as Spina Bifida which affect a small number of children from birth. This means the messages between the bladder and brain don’t work properly so children don’t recognise the need to wee. Get more information on complex bladder conditions and how they can be managed.
- Night time accidents (bedwetting) are common in children who also have daytime problems. If your child wets the bed and also has accidents in the daytime, this need to be investigated and treated first.
Causes of children’s incontinence
Here are some of the different things that can affect the way a child’s bladder works:
- Most bladder issues in children will be caused by a functional problem. This means everything in your child’s bladder is in the right place and should be able to work properly.
- Underlying constipation is a common cause of bladder issues and needs to be ruled out. A full bowel can affect the space that the bladder needs to fill and empty properly. Read our factsheet Advice for Children with Constipation for information on how to treat poo problems.
- A urinary tract infection (UTI) can make peeing painful and urine smell. UTIs are common in children who have underlying constipation.
- Children with additional needs such as autism are more likely to be affected by constipation which can then cause problems with their bladder. They may also find it difficult to recognise thirst due to a sensory processing difference.
- Wee accidents are very common when children are potty training and learning how to manage their bladder. They usually clear up once your child goes to school.
- If children don’t drink enough, their wee can become concentrated. This can irritate their bladder and make it empty when it shouldn’t.
- Certain drinks can also irritate the bladder such as blackcurrant and drinks containing caffeine (cola, energy drinks, hot chocolate etc).
- Putting off going to toilet when you need to go (‘holding on’) makes it more likely an accident will happen.
How to treat incontinence in children
If you think your child has a bladder problem, book an appointment with your GP. They should assess your child and discuss possible treatment.
- The doctor should examine your child and ask questions to find out if the bladder problems could be caused by an underlying condition. This is rare, but it is important to check.
- Most bladder conditions can be sorted out by following some simple steps which are often described as ‘bladder training.’
- It is important to remember that children don’t have accidents on purpose. They’re not caused by laziness or naughtiness.
- Try to praise your child for any efforts they make to becoming dry, such as increasing the amount they drink each day.
Take a look at our factsheet Advice for Children with Daytime Bladder Problems for more information on the causes, treatments and bladder training tips.
How to spot an overactive bladder
The bladder is supposed to stay soft and stretchy whilst it’s filling and until you get to the toilet. However, some children have an overactive or ‘twitchy’ bladder.
- A child's bladder signals that it's time to do a wee before the bladder is full. This means the bladder muscles contract before they are ready to empty.
- Because of this, you child will go to the toilet more often than other kids their age. They may find it hard to hold on until they get there and even leak urine on the way to the toilet.
- Children often do a ‘wee dance’ or hold themselves as an automatic response to the messages from the bladder, without realising this is what is happening.
What is the main cause of overactive bladder?
Bladder overactivity is one of the most common causes of daytime bladder and wetting problems in children. It can happen for a number of different reasons including:
- Being constipated. A full bowel can squash the bladder and make it hard to fill and hold on to wee. Constipation can then cause frequency, urgency and bladder infections.
- Not drinking enough. If you are not drinking enough your wee will be dark yellow in colour and very strong. Strong wee can irritate the lining of the bladder and make the twitching worse.
- The wrong drinks. Fizzy drinks and drinks with caffeine in them irritate the lining of the bladder. Tea, coffee, cola, hot chocolate and energy drinks all contain caffeine. If the bladder lining is irritated then the bladder twitching will get worse. This means your child will need to go to the toilet more often and have more wetting accidents.
- Not getting to the toilet in time. If you 'hold on' for too long, instead of going to the toilet when you feel you need to wee you are more likely to have a wetting accident.
- Urinary tract infections (UTI) can make you need to go to the toilet more often than usual and have to get there quickly.
Can an overactive bladder be cured?
Yes, bladder overactivity can be treated successfully and the bladder can start working normally.
There are several treatment options depending on the cause of the overactivity. Some of these may be used in combination.
- Before your child has a bladder assessment, it's helpful to keep a wee diary. Use our intake/output chart to record your child's weeing pattern and log much they’re drinking.
- If your child has any underlying constipation, this must be treated first.
- Medications called anticholinergics can be prescribed if there’s a lot of frequency and urgency. They work by reducing sensitivity in the bladder, stopping it twitching and help it to relax.Your doctor or bladder specialist will explain more about how they work, the different types and what the side effects can be.
- There are behavioural interventions to help with urinary incontinence. These include bladder retraining, pelvic floor exercises and biofeedback training. Your doctor can give you more information on these treatments.
Children’s UTI symptoms
Urinary tract infections can also cause bladder frequency and urgency. This means your child is more likely to need the toilet in a rush and not always get there on time.
The signs your child could have an infection in their bladder include:
- Doing lots of small wees more often than usual
- Needing to rush to the toilet urgently
- Daytime accidents and bedwetting
- Their wee might be smelly and/or cloudy
- Your child may complain of tummy ache or stingy wee. They may also have a high temperature.
- They may not seem ill however, so you wouldn’t guess your child had a UTI.
How to treat children’s UTI
If you think your child has a UTI, book an appointment with your doctor or nurse. There is a simple urine test that can be done to confirm an infection.
If an infection is found, they may need to take antibiotics to clear it up.
Some children need to stay on antibiotics until well after the UTI is better to help stop the infection coming back. A healthcare professional can explain more about this and do further tests if they think it’s necessary.
It’s really important to make sure your child changes their pants if they’re wet. Sore, damp skin can make UTIs more likely.