Children and Bed-wetting

Although it is a nuisance for parents, bed-wetting is a normal part of childhood. Bed-wetting (known medically as nocturnal enuresis) is quite common in young children ages 5 and under, especially boys. It is estimated that up to 7 million U.S. children wet their beds on a regular basis and that one in five 5-year-olds is affected by the condition.

The causes of bed-wetting are not fully understood. When a baby's bladder fills with urine to a certain point, it automatically contracts and empties. As children develop, however, their brain begins to receive messages from the filling bladder and then sends messages back to the bladder to prevent automatic emptying until the child decides when to void. Most bed-wetting children do not wake up, even though their bladders are full. Some young children simply have a small bladder capacity, which leads to bed-wetting. Evidence also exists that the systems of some children who wet their beds may not have enough ADH, the antidiuretic hormone that enables the kidneys to retain more water, resulting in less urine filling the bladder during the night. Bed-wetting tends to run in families. Research suggests that if both parents have a history of bed-wetting, their child has a 70 percent chance of developing it. In about 1 percent of bed-wetting, the condition may be related to a urinary infection or other medical disorder, so parents of a bed-wetting child, particularly if the child had been dry at night for some time, should call their health care provider to discuss having the child's urine tested.

After daytime toilet training is complete, which usually occurs by age 4, many children have a brief period of bed-wetting. Luckily, most children outgrow bed-wetting after age 4 or 5 and stay dry at night. By age 10, only one child in 20 still has a bed-wetting problem. Because each child is different, however, it is difficult to estimate when he or she will stop wetting the bed. Only 1 to 2 percent of bed-wetting children continue to have the problem by the time they are 15.

It's important to understand that bed-wetting is not an emotional, learning or behavioral problem and that children do not wet the bed on purpose. For this reason, experts advise parents never to punish children for wetting the bed, any more than they would scold youngsters for developing a cold. Parents should also note that stress, such as the birth of a sibling, a divorce or other major changes, may cause children who have never had a bed-wetting problem or have been dry for a while to start bed-wetting.

A number of treatments can help children stay dry until they outgrow the problem. These include limiting fluids near bedtime, awakening the child at certain times during the night to void, and medications. Some treatments can help children overcome bed-wetting. One method involves using an alarm, a moisture-sensing device attached to the pajamas that wakes the child with a loud signal or vibrating alarm. The alarm helps the child learn to feel when the bladder is full and when wetting is just about to happen. One drawback to this method is that children who wet the bed do not always wake up to the alarm. Another treatment method is bladder training, which involves special exercises used to stretch or condition the bladder to control urination.

What to Do

To help reduce the number of times your child wets the bed, limit your child's intake of fluids, especially of caffeinated beverages such as colas, after dinner. Also, wake the child periodically through the night to go to the bathroom. If your child is still not able to stay dry overnight after age 6, talk to your child's doctor about this problem.  Depending on your child’s history, the doctor may want to rule out any underlying medical problems.

Use Medicine Effectively

Several medications are available to treat bed-wetting, but some may have side effects. The medications include a synthetic form of the hormone ADH, desmopressin (in nasal spray or pill form), which conserves body water and temporarily reduces urine output. Talk to your health care provider about whether a medication is needed and which is right for a child. A provider may recommend a combination of medications and other treatment methods.

Self-care Steps for Bed-Wetting

• Bring absorbent pants along on any overnight stays to absorb any wetness, as well as an extra pair of pajamas. Overnight disposable absorbent underpants are available for older children to carry them through the bedwetting period without the stigma of a diaper or a wet bed.

• Assure the child that millions of children suffer with the same condition and most outgrow the problem on their own.

• Do not allow family members, especially siblings, to tease a child who wets.

• Until the child can stay dry, put a rubber or plastic cover between the sheet and the mattress.

• Minimize the importance placed on bed-wetting episodes and privately praise the child's efforts to stay dry.

• Be sensitive to children's feelings about bed-wetting. Never punish or blame children for bed-wetting. Never pressure children to develop nighttime bladder control before their bodies are ready to do so.