Bedwetting

    Children can occasionally wet the bed up to age 7 and, as long as the child has no other problems, it is considered to be normal. If a child has not had problems with urinating or stooling and then begins to have new problems going to the bathroom, especially if he has new symptoms such as back pain or abdominal pain, he needs to be seen by his caregiver.  Constipation is a common reason for urination problems like bedwetting (See “Constipation – Tummy Pain” article).

     Experts in enuresis (bedwetting) tell us that bedwetting has nothing to do with sleep patterns. However, parents continue to say that their children who wet the bed are very sound sleepers and can’t be awakened. Sometimes, not even the wet bed wakes them up. The children will often say that they dreamed that they had to go to the bathroom. They made sure that they were on a toilet and started to urinate only to find that they were still in bed. This makes bedwetting frustrating for both parents and children. The child may also feel embarrassment because bedwetting can be viewed (especially by siblings) as “being a baby”. I usually start conversations about bedwetting by telling the child he doesn’t have a wetting problem, he has a sleep problem. It seems easier for them to accept that they just don’t wake up to go the bathroom. I have also found that bedwetting at an older age runs strongly in families. I ask which adult in the family was a very sound sleeper and wet the bed when they were older. It helps the child to know that an adult he respects had the same problem. There should be no guilt, shame, anger, blame or punishment when dealing with bedwetting.

     When the parents and the child recognize that an over-tired child who has had a lot to drink in the evening is likely to wet the bed, it gives everyone ways to avoid bedwetting. Limiting liquids before bed is the start. Because any liquid containing sugar or caffeine seems to increase bedwetting, give the child water rather than milk or juice in the evening. When you limit late afternoon and evening fluids, allow the child increased fluids earlier in the day.  Don’t limit fluids when the child is ill. If the child has been allowed to get over-tired, expect a wet bed and plan for it.  Have a change of sheets near the bed to minimize the hassle of changing in the middle of the night. Experts recommend against pull-ups because they feel the child doesn’t learn anything by using them, but I think that, especially on a night when the probability is high that the child will wet the bed, pull-ups are OK, as long as the child is not upset or embarrassed by them.

     Charts that keep track of wet and dry nights can help motivate the child, as long as the child is the one who is responsible for the chart and can do it the way he wants to. The more the child is involved with deciding how to stay dry, the more success for everyone. Treats and small rewards can help a little, but children soon get bored with them. Waking the child up to urinate when the parents go to bed can also help bedwetting, but its not a long-term fix.

     Bedwetting alarms work but only if parents understand how they work. They are a learning tool and learning takes time. At first, the child doesn’t even wake up with the alarm. The parent should wake the child, tell him to finish urinating in the toilet and get him back into a dry bed. Once the child learns to wake up with the alarm, he begins to learn to wake up with the sensation of urinating. Then he learns to wake up just before he urinates when his bladder is full. Given enough time and patience, 66% of children using the alarm get dry and 50% of them stay dry. That’s a better success rate than any other treatment.

     Desmopressin is a prescription-only medication that can give a child a dry night or a dry weekend whenever he needs it. It is good for sleepovers or weeks at camp but shouldn’t be used as a long-term treatment for bedwetting because of its side effects.

     Most important is that the parents and the child approach bedwetting as a temporary inconvenience that can be managed and will ultimately resolve itself. Positive attitude and patience with celebration of dry nights and minimal disappointment on wet nights will help everyone.