The Modern Parent's Guide to Coping with Bedwetting
January 23, 2009
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Ann Douglas
PARENTCENTRAL.CA
Toronto pediatrician Mark Feldman, MD, has a cut-to-the-chase kind of way of putting bedwetting in context for worried parents.
"It's a laundry problem."
Feldman, who is Chair of the Canadian Paediatric Society's Community Pediatrics Committee, as well as a pediatrician at St Joseph's Health Centre and the Hospital for Sick Children, is not trying to minimize what can be a very frustrating problem for parents and kids alike. What he's trying to do is spread the word that, in most cases, the best approach to take with bedwetting is to let Mother Nature work her magic.
Of course, that doesn't apply to every situation, which is why it's important for every parent to know the facts about bedwetting.
So what do we know about bedwetting?
For starters, there are two types of bedwetting: primary nocturnal enuresis (not having experienced six consecutive months worth of dry nights) and secondary nocturnal enuresis (starting to wet the bed again after being dry through the night for at least six consecutive months worth of dry nights).
Primary nocturnal enuresis affects up to 20 per cent of 5 year olds and 10 per cent of 10 years, with 2.4 per cent of school-aged children wetting the bed on a nightly basis. The incidence of bedwetting decreases by 15 per cent per year of age without treatment. By age 15, just 1 to 2 per cent of adolescents are still experiencing problems with bedwetting.
There's a strong genetic connection to primary nocturnal enuresis. If a child has one parent who took a long time to be dry all night, that child has a 45 percent chance of experiencing the same issue. If both parents followed the same pattern, those odds are greater than 70 percent.
Other factors that have been linked to primary nocturnal enuresis include excessive nighttime urine production, experiencing a large percentage of REM (dream) sleep (this makes it difficult for the brain to tune into the bladder's nighttime signals), bladder dysfunction (for example, an unusually small bladder capacity), constipation (which can crowd the bladder), developmental delays, neurological dysfunction, and attention deficit hyperactivity disorder (ADHD).
The other type of bedwetting – secondary nocturnal is typically caused by urinary tract infections, diabetes mellitus, or emotional stress. In some cases, an underlying fear (like a fear of monsters in the closet) can cause a child to wait to long before getting out of bed to use the bathroom in the middle of the night. In this latter case, something as simple as a nightlight in the hall (or a child-safe flashlight on the night-table) can banish the boogey man and the wet sheets at the same time.
When does bedwetting become a problem?
When someone decides it's a problem. Typically, parents opt to consult a doctor if the child is still wetting the bed at 7 or 8 years of age. The child may be becoming upset or embarrassed about the bedwetting issue, or the parents may be becoming concerned that the child may need treatment. The doctor will conduct a physical exam (to eliminate any underlying medical causes for the bedwetting) and take a medical history (to differentiate between primary and secondary bedwetting) . He'll then make a diagnosis and discuss treatment options with the parent (with "give it time" often being the recommendation).
Other treatment options that may be presented as options, depending on the child's desire to address the issue, include:
A bedwetting alarm (sometimes referred to as a moisture alarm): the alarm is activated when the child begins to urinate. According to Feldman, the alarms are notorious for waking up other family members as opposed to the child for whom they are intended. The Canadian Paediatric Society only recommends use of bedwetting alarms "for older, motivated children from motivated families for whom more simple measures are unsuccessful." It also notes that families should never have to spend more than about $80 for an alarm.
Desmopressin (DDVAP), a synthetic hormone that concentrates urine and that is taken in tablet form. Note: The nasal spray version of this medication can no longer be prescribed to young children because it is faster acting that the tablet formulation and some cases of electrolyte imbalance leading to water intoxication were reported. This particular medication should not be taken on an ongoing basis but rather reserved for sleepovers and school trips (e.g., occasions when the child is particularly anxious about staying dry).
So what can you do in the meantime, other than waiting for Mother Nature to do her part?
Be patient and provide reassurance. If you maintain a matter-of-fact attitude towards the situation, letting your child know that some kids' bodies simply take longer to figure out how to stay dry all night, your child is less likely to feel embarrassed or ashamed. According to Feldman, research has shown that overdoing it with the praise, rewards, and sticker charts can actually backfire, putting pressure on her to do something about a problem that's biological, not behavioral.
Want more bedwetting help?
Peruse the rest of our bedwetting section
Bedwetting defined
Bedwetting treatments explained
Coping tips for sleepovers, car trips, family travel and more
Bedwetting: A self-esteem issue
Bedwetting causes — the modern parent's guide
Bedwetting drugs may cause serious side effects
Want more bedwetting help?
Peruse the rest of our bedwetting section
Bedwetting defined
Bedwetting treatments explained
Coping tips for sleepovers, car trips, family travel and more
Bedwetting: A self-esteem issue
Bedwetting drugs may cause serious side effects