Bedwetting and Toilet Problems: What Actually Helps a Foster Child

A wet bed at three in the morning, on your second night with a child you hardly know yet, is one of the things people worry about privately before they enquire. It is also one of the most ordinary things in fostering, and very little of it is about behaviour. Here is what the current guidance says, which bits of the handed-down advice are wrong, and how we support carers through it.

Please note: general information about children’s health, not advice about a particular child. Always speak to your GP and your supervising social worker. Guidance quoted here was checked on 6 November 2026 against the NHS bedwetting pages and NICE guideline CG111, Bedwetting in under 19s.

Start by treating it as a health question

ERIC, the charity that runs the national helpline for children’s continence, puts it at one child in nine across the UK, over 1.5 million of them. About three children in an average primary class. Nothing rare, then. Just private, which is why nobody at the school gate mentions it.

NICE is blunt about the rest. Its first recommendation tells professionals to explain that “bedwetting is not the child or young person’s fault and that punitive measures should not be used”. The NHS agrees: punishing it makes it worse. No child wets the bed at you. Treat it as a choice and a six-week problem becomes a two-year one, because a child who feels ashamed stops telling you.

Why it happens, and why the cause decides the plan

There is no single reason, which matters, because the right response depends on which one you are dealing with. The NHS lists not feeling the need to pee while asleep, producing too much urine overnight, and stress at home or school, with constipation or occasionally diabetes behind some cases. For a child who has just come into care, add a few more:

• where the child is in their development, rather than what their birthday says
• nobody having taught them yet, which is not the same thing as being behind
• sensory differences, such as an aversion to the feel of toilet paper
• having been left in dirty clothes before, so being wet does not register as a problem
• constipation that has been building for months and has never been treated

A seven-year-old nobody has ever shown how to use a toilet is not a seven-year-old with a medical problem. Different children, different plans, and guessing between them costs months. Ask the GP to rule out the physical causes early, and tell your supervising social worker what you see, because some of it will connect to history you have not been given. Our guide to trauma and attachment explains why a child’s body keeps reacting long after the danger has gone.

Three things worth unlearning

Bedwetting advice gets handed from carer to carer, and some of it runs against NICE.

• Do not cut back fluids. NICE says adequate daily fluid intake is important in managing bedwetting, and sets out how much by age. A thirsty child concentrates their urine, which irritates the bladder. Drink normally through the day, and skip the caffeine, because cola and tea make a child pee more.
• Do not lift or wake them. NICE says neither waking nor lifting will promote long-term dryness. Carrying a half-asleep six-year-old to the loo at midnight buys you a dry sheet and teaches the child nothing. An alarm the child sets and gets up to themselves is different, and can work.
• Reward the effort, not the dry night. NICE says rewards should go to agreed behaviour rather than dry nights: drinking enough, going before bed, helping change the sheets. Never take back a reward already earned. A sticker chart for dry nights pays a child for something outside their control, so a wet morning becomes a punishment you never meant to give.

The practical kit is dull and changes everything. Waterproof covers on mattress and duvet, spare bedding in the child’s own room so a 3am change takes four minutes instead of twenty, and a quiet way of doing it that does not wake the house. Our piece on preparing to welcome a child has the rest, and our guide to sleep and bedtimes covers the night-time side.

Soiling is almost always constipation

This is the one carers most often read as defiance, and it almost never is. The NHS explains that soiling usually happens when a child is so constipated that a large, hard stool becomes stuck at the end of the gut, and fresh stool leaks past it. Worth remembering on a bad morning: “they are not doing it on purpose and may not even realise it’s happening.”

Treatment is slow. The NHS warns that prescribed laxatives can take a few months to work and that soiling may get worse before it gets better, which helps in week three when you are wondering whether anything is happening. The routine does the rest: a sit after meals, five minutes, feet flat on a step rather than dangling, something to look at that lives only in the bathroom. If laxatives are prescribed, check you have delegated authority to give them.

Smearing is harder to talk about and gets carers very low. It usually has a cause, which may be medical, sensory, or about wanting adults to keep their distance. Stay neutral in your face and your voice, because a reaction is sometimes the point. Clean the child briefly with wipes rather than running a long bath, which some children treat as a reward. Our article on therapeutic parenting and PACE is the best thing we have written on staying calm through something you find revolting.

At school, you are asking for an adjustment, not a favour

Carers are often too polite with schools about this, and children pay for it by holding on all day. Bladder and Bowel UK, whose school guidance was reviewed in June 2024, says policies restricting access to the toilet or to drinking water may be in breach of legislation, because they have a disproportionate negative effect on learners with disabilities or health conditions. The School Toilet Charter asks for unrestricted access whenever the need arises, so no school should have a blanket rule against going during lessons.

The same guidance is firm on something worse: “It is not acceptable to refuse admission or exclude a child who has not achieved continence or continues to need support with this area of care.” Ask for an individual healthcare plan, reviewed each year, and for a private, well-kept toilet rather than the main block. Keep a bag at school with spare clothes and wipes. One decision is the child’s: plenty would rather their teacher knew and their classmates did not. Our guide to supporting a child’s education covers raising it through the designated teacher.

Who to tell, and what to write down

The GP comes first for anything physical, and the NHS asks you to go back if a child who has been dry for more than six months starts wetting again. There is a formal route as well. Statutory guidance on the health of children in care requires a health plan ready for the first review of their care plan, which must happen within 20 working days of them coming into care, with assessments twice a year under five and annually from five. Toileting belongs in that plan, in writing.

Keep your own daily record factual: what happened and when, not what you think it says about the child. A fortnight of plain notes about drinks and what the stools looked like is the most useful thing you can hand a GP or a continence nurse. There is a safeguarding side too. Helping a child wash and change means more intimate care than usual, which raises their vulnerability and your exposure to an allegation. Agree it with your supervising social worker, write it into your safer care agreement, and stick to what is written.

You won’t have to do this alone

Every Greater London Fostering carer has a supervising social worker who knows the children in their home, and out-of-hours support for the nights when you need a person rather than a leaflet. We will help you get the GP appointment and the referral to your local bladder and bowel service. GLF pay is one weekly fee covering allowance and reward: as at November 2026, 479.50 pounds a week for a child under 11 and 507.50 pounds for a child aged 11 or over, per child while they live with you, with an enhanced fee of roughly 100 to 200 pounds a week more for higher-needs placements. Ofsted inspected us in July 2025 and rated us Outstanding in all three judgements.

Outside the agency, ERIC runs a free helpline on 0808 801 0343, open Tuesday to Thursday, 10am to 1pm, for anyone caring for a child with a wee or poo problem. The people answering it have heard all of this before. You can also read about the support our carers get.

Frequently asked questions

Does bedwetting mean something has happened to the child?

Not on its own. It is common enough that you cannot read a history off it, and the NHS lists ordinary physical reasons first. Upheaval can set it off, and a child who was dry and then is not should see a GP. But do not build a theory about a child’s past out of a wet sheet.

How long does it take to get better?

More slowly than anyone would like. Simple bedwetting often settles within a few months once the routine is right and any constipation is treated. Constipation itself takes longer, and the NHS says laxatives can take months to work. If nothing has shifted after three or four weeks, go back to the GP.

Who pays for pads and bedding?

Your weekly fostering payment covers day-to-day costs like bedding and washing, and your supervising social worker will go through it beforehand. Some local continence services supply products too, though what is available differs from borough to borough, so ask your GP what your area provides.

Should I say no to a child who has toilet problems?

You can say no to anything, and you should never agree to something you are not ready for. But it is a poor reason to rule a child out. It is common, usually treatable, and one of the areas where a little training and a decent routine change things fastest. Several of our carers would call it the easiest part of their first year.