DEAR DOCTOR K:

My 4-year-old daughter wets her bed at night. I know this happens to a lot of kids, but I wonder if I should be worried. How should I handle it, and what can I do to make it stop?

DEAR READER:

You're right -- many young kids do wet the bed for a time. Bed-wetting is pretty normal for infants and young children, and usually doesn't indicate a medical problem.

Many kids going through toilet training can stay dry during the day, but they may wet the bed at night for several more months to a few years. Bed-wetting is not considered a problem until around school age, meaning 5 or 6 years old.

Why is it happening? Most likely, your daughter wets the bed when her body makes more urine than her bladder can hold. But the feeling doesn't wake her up in the way it does for adults. We're not sure why. The brain and nerve system are still developing. Possibly the nerve signals from the bladder don't yet register in the brain.

You should never punish your daughter for wetting the bed. It's important to remember that she isn't doing it on purpose.

Try these suggestions to help with nighttime toilet training (they can also be used for kids of any age who wet the bed):

-- Encourage drinking during the day. She'll make more urine, which may help stretch her bladder to hold more urine at night.

-- In the last two hours before bedtime, limit beverages and foods that melt into liquids, such as Popsicles.

-- Always remind your daughter to go to the bathroom before going to bed.

-- Remind her to get up to go to the bathroom in the middle of the night when she has to.

-- Make it easy for her to find the bathroom at night. Put a bright light in the bathroom and in the hallway.

-- Use real cloth underwear, not pull-ups or diapers. Feeling wetness and discomfort may help motivate her to stay dry.

If your daughter is still having problems at age 6 or older, call your doctor to discuss further testing and treatment. Several medical conditions can cause bed-wetting. For example, diabetes can cause excess urine. Urinary tract infections cause a frequent urge to urinate. Seizures during sleep (or when awake) can cause loss of bladder control. Pinworms irritate the vagina, which in turn encourages urinary tract infections.

It has long been thought that psychological problems might cause bed-wetting. It's my understanding from talking to experts on the subject that this theory is not based on much solid evidence. Nevertheless, it may be true in some kids.

Watch for these "red flag" signs in a child who is wetting the bed: a return of wetting the bed after having been dry at night for some time; fever or pain when urinating; or urinating or drinking more than usual. Any of these raises the possibility of an important medical problem.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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