Bedwetting

    Q: When should a child be able to go the whole night without wetting the bed?

    There is no magic age. Eneuresis, or bedwetting, actually is common into the elementary years, according to pediatrician Diane Matsumoto, M.D., of TLC Pediatrics in Phoenix.

    Bedwetting affects 40 percent of 3-year-olds, 10 percent of 6-year-olds and three percent of 12-year-olds. It generally involves a “developmental problem with the bladder” that children eventually outgrow, usually by age 8 or 10, Matsumoto says.

    Bedwetting occurs more often in boys than girls. It’s also more common in children who have close family members who were bedwetters.

    Don’t be embarrassed for your child or make your child feel ashamed of wetting the bed. A gentle, understanding approach can go a long way toward helping your child weather this stage of development.

    Most doctors don’t even treat bedwetting in the early elementary years. Often, kids that age just can’t hold urine for an entire evening. Others are such deep sleepers they rarely awaken, even when their bladders are full.

    Children who are still wetting the bed at age 10, however, are likely to be extremely self-conscious about it. At this point, interventions to curb bedwetting can help boost a child’s self-esteem, Matsumoto says. Pediatricians and parents may choose to intervene even sooner for a younger child who’s already attending sleepovers with friends and feels embarrassed about nighttime wetting. Strategies include:

    • Limiting fluid intake for several hours before bedtime, limiting caffeine intake in the evening (because caffeinated drinks increase frequency of urination) and encouraging children to use the bathroom before getting into bed.
    • Waking children periodically throughout the night to take them to the bathroom.
    • Bedtime pep talks or morning-after tracking charts to motivate children to stay dry at night. Though some experts recommend these approaches, Matsumoto says she’s “less than enthusiastic” because few studies support them.
    • Protective clothing, like padded GoodNites ® underwear.
    • Moisture alarms children wear at night, which make a loud sound at the first sign of wetness so children know to get out of bed and head for the bathroom. These alarms work within six weeks for about 70 percent of the children who try them, according to Matsumoto.
    • Medications like Desmopressin Acetate (DDAVP), a man-made version of the chemical that controls urine production. It won’t cure bedwetting, but it will lessen the problem. It’s available in two forms — pills and nasal spray — and can be used every night or just as needed for slumber parties and sleepover trips. Like Imipramine and other medications used to treat bedwetting, it is available by prescription only.

    Once your child grows old enough to be concerned, discuss bedwetting openly, as you would any other aspect of development, suggests Phoenix psychologist Lorna Gale Cheifetz, Ph.D. Take a matter- of-fact approach. A child who already has chores like cleaning his or her room, or helping with family laundry, can help with wet bedding too. Treat it like any self-care or housekeeping chore kids are expected to do as they mature. Never use changing sheets or laundering bedding as a form of punishment. It won’t stop the bedwetting but can eat away at self-esteem.

    If your child has been dry at night for several months but suddenly resumes bedwetting, consult your child’s doctor about likely causes, which can range from an overactive bladder or bladder infection to constipation or sleep apnea, http://affectivebrain.com/?attachment_id=5775. Red flags to watch for include daytime wetting, constipation or urination that comes in a dribble rather than a stream. A history of urinary tract infections or ongoing wetting in the absence of a family history of bedwetting may also signal a problem. Watch for unexplained high fevers, frequent urination (more than every three hours) and other signs of infection. Bedwetting is sometimes, though not often, caused by kidney or bowel disease.

    Bedwetting rarely represents an emotional problem, but experts note that some children do resort to nighttime or daytime wetting during times of stress. It’s best to let your child’s doctor make the call. “New onset of bedwetting is never okay,” says Matsumoto.

    When routine measures fail to decrease nighttime wetting, or when daytime wetting occurs, your child may need a more thorough examination by a urologist, according to Scott Berkman, M.D., of Urology Associates of Phoenix. A specialist may recommend an ultrasound or other tests to check for unusual anatomy, although Berkman notes “it’s rare to find abnormalities.”

    In some cases, says Berkman, a thorough work-up uncovers problems with bladder function that can be addressed through biofeedback designed to help people train their bladders to function more effectively.

    To learn more about bedwetting, visit the National Kidney Foundation website, kidney.org, which features information for parents, children, teens and medical professionals.