Bed-wetting: What’s normal and how to manage it

04/15/2014 6:08 AM

08/08/2014 10:23 AM

As a parent, being aroused from a deep sleep to tend to a child who has wet the bed can be exhausting, especially if it’s an every night occurrence. But for the child who continues to wet the bed beyond what seems to be a reasonable age, the experience can be humiliating.

What’s normal?

Bed-wetting is very common in children younger than 5 because nighttime dryness is the last part of toilet learning that kids achieve. According to the American Academy of Pediatrics, 20 percent of 5-year-olds wet the bed. After age 5, about 15 percent of children continue to wet the bed (twice as many boys as girls), and by age 10, 5 percent still have frequent episodes.

Wet beds can frustrate parents. Worse, kids may worry there’s something wrong with them, and fear of wetting the bed at a sleepover can create social awkwardness.

Generally the treatment for bet wetting is time. The brain and bladder gradually learn to communicate with each other during sleep, but this takes longer in some children. If your child is older and continually wetting the bed, here is some information that may help.

What causes bed-wetting

• Slight delay in maturation of the nervous system. When the bladder is full, the sleeping brain sends that message to the bladder, which typically wakes the child. If your child’s nervous system is a bit underdeveloped, the message might not get through.
• Deep sleeping. Some children sleep so deeply, their brain doesn’t get the signal that their bladder is full.
•  Smaller functional bladder. The bladder has a smaller capacity to hold in the urine.
• Heredity. Bed-wetting runs in families, so it is likely there is genetic connection.

When to act

If your child continues to wet the bed after the age of 5, begin efforts to control the accidents. Keep a detailed diary of normal urination and wetting episodes, fluid and food intake, and sleep times. Limit liquids consumed a few hours before bedtime and encourage a trip to the bathroom just before going to bed.

Make sure your child, and the rest of the family, knows that bed-wetting is normal. Don’t allow anyone to tease the child about it.

Motivational therapies

After ensuring the child is on board, develop a plan to motivate him. Keep pajamas, sheet and towel close to the bed. If the child has an accident, he should go to the bathroom to finish voiding, put a towel over the bed’s wet area, change pajamas and go back to sleep. In the morning, he should assist with laundering the wet items.

A reward system can also be motivating. For example, seven dry nights may result in a reward previously agreed upon between you and the child. To build confidence during this process, offer help in uncomfortable situations, such as a sleepover, by providing training pants or other items to help your child feel confident he can manage the situation.

Alarms

A special bedtime alarm placed in the underwear senses drops of moisture and will go off, awaking the child so he can go to the bathroom and empty his bladder. The child typically remembers the full bladder sensation they felt when the alarm woke them and learns to recognize it. This method is typically reserved for children older than 7.

The Next Step

If efforts are not working after 12 to 14 weeks, it may be time to talk to your child’s doctor. Parents often hesitate to do this because they, or their child, are embarrassed but it’s important to rule out any medical cause.

Signs there may be a medical reason:

• More frequent urination
•  Increased thirst
• Complaints of burning with urination
•  Swelling of the feet or ankles
• Child starts wetting the bed after several weeks or months of being dry

Your child’s doctor will discuss bed wetting history, perform a physical exam and request a urinalysis to rule out infection or diabetes. If your doctor deems it necessary, medications are available that can help by decreasing the amount of urine produced overnight. These can be used short-term for things like summer camp or sleepovers or long-term. It’s important to have regular follow up with your child’s doctor to ensure the child still needs the medication.

Most children will eventually outgrow bed-wetting. Some may just need a little help to get over the hurdle. Remember to let your child know that bed-wetting is normal, that they are normal, and that they will eventually wake up dry.

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