Development of nighttime bladder control from 4 – 9 years: association with dimensions of parent rated child maturational level, child temperament and maternal psychopathology.

Carol Joinson, Jon Heron, Richard Butler, Tim Croudace


Background: This study investigates variability in acquisition of nighttime bladder control in a large, general population sample of children by defining a developmental typology through latent class analysis. Also examined is the association of bedwetting classes with risk factors in early childhood including maturational level, temperament and exposure to maternal psychopathology.

Methods: Data from a UK population sample of over 10,000 children from age 4-9 years were available from ALSPAC. Parents completed questionnaires asking about their child’s bedwetting (on five occasions during the assessment period) and maturational level (at 18 months), temperament (24 months), and maternal depressive / anxious psychopathology (21 months). Longitudinal phenotypes capturing population heterogeneity in nighttime bladder control were derived using latent class analysis. Associations with the risk factors were investigated using multinomial logistic regression.

Results: Five groups of children were identified with different patterns of development: 1) normative (69.9% of 10,818 sample); (2) delayed (8.4%); (3) severely delayed (9.3%); (4) persistent (8.6%), and (5) relapse (3.8%). Results indicated that the risk factors were associated with an increase in the odds of children experiencing problems either attaining nighttime bladder control or with relapse in bedwetting after a period of initial dryness.

Conclusions: Development of nighttime bladder control and onset of bedwetting problems are captured by this developmental typology approach, enabling factors that affect risk of bedwetting to be determined and targeted. Further investigation is required into risk factors relating to individuals and their environments that are associated with difficulties attaining or maintaining nighttime continence, including neurobiological and genetic factors.


bedwetting; nocturnal enuresis; latent class analysis; developmental typology; risk factors; prospective study; child development; ALSPAC.

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