4 1/2 year old boy, potty training problems

My son is now 4 1/2 and has been wetting the bed regularly for about 6 months.  We don't allow him to drink water after 7 pm ,we wake him in the middle of the night to take him to the restroom and he still urinates in his bed.  He will also wet his pants and not show any emotion about it.  Apart of me wants to think that he is just so active that he chooses to not go, but another part of me is starting to wonder if he may have something medical going on.  He did well as a 3 year old with only occasional accidents. Are there any suggestions on how to handle his lack of effort to go regularly to the restroom?

[Kevin Kennedy, Ph.D.]

It makes sense to establishe an incentive system that rewards him each time he uses the potty. You can stop waking him at night. It does not help and it is not good to be interrupting his sleep. There is no harm in having him evaluated by a pediatric urologist, though the information you offered does not indicate any problems in that regard.