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Intermittent and uncontrolled loss of urine is common among children but requires medical attention when it persists beyond age 5 years. Mostly functional in origin, urinary incontinence is caused by a complex inter-relationship of biopsychosocial factors, and evidence shows that mental health problems and adverse childhood experiences (ACEs) are common in children and adolescents with urinary incontinence. Mental health problems and ACEs (including abuse, neglect, and household dysfunction) could be both causes and consequences of paediatric urinary incontinence, but research is needed to understand causal pathways. Treatment guidelines increasingly recognise the need to integrate assessment of psychosocial factors and mental health support into clinical care pathways for children affected by urinary incontinence. Parental and societal beliefs, cultural norms, availability of sanitation facilities, economic constraints, and policy-level gaps affect the management of paediatric urinary incontinence. Early assessment and treatment are needed to prevent urinary incontinence from becoming chronic and negatively impacting on children's quality of life, wellbeing, and education.