Bedwetting, also known as nocturnal enuresis, is common in childhood and most children will grow out of it as they age. We asked UC Davis pediatrician Lena van der List about causes, strategies and solutions that can help families beat the bedwetting blues.
In the majority of young children who experience bedwetting, the main issue is sleep arousal. The brain is not signaling to awaken when the bladder is full, and, at times, doesn’t even signal the child to wake up when wet. Frequently, these kids are extremely heavy sleepers. Kids may also produce more urine than expected at night (which is called nocturnal polyuria) or have small bladder capacity (with frequent small urinations throughout the day and night), which may increase their risk for bedwetting.
When you visit your doctor with a bedwetting concern, they may ask you questions like how long has it been going on? What time does it occur most nights? How much fluid and what types of fluid does your child drink in a day? Has your child had any previous “dry” periods? How often do they stool and what is it like? Do they ever have continence issues during the day?
Your child’s physician will perform an exam, which may include a genital exam and a neurologic exam. He or she may perform a urinalysis (where they ask your child to pee in a cup) to make sure there isn’t an infection or signs of diabetes, or extremely diluted urine.
Some physicians may ask you to keep a diary documenting all elimination (stools, day and night-time urination), fluids consumed, or even at times the volume of urine to help pinpoint the problem.
Well, the first criteria is that the child is motivated for it to stop. If the child is not bothered by the bedwetting, each of these proven methods is much less likely to work:
Bedwetting alarms are recommended by the International Children’s Continence Society. It is worn attached to the pajamas or underwear and will alert the child as soon as wetness or moisture is detected. At first, the alarm may not wake the child so parents need to play active roles in waking up their kid, walking him or her to the bathroom. Their child should help change the sheets before going back to bed.
The alarm needs to be used nightly and may take two to three months to work, but it has been shown to be very successful in up to two-thirds of children. It also costs about $60 and is typically not covered by insurance so this can be a barrier for some families. It is recommended that parents and kids continue to use the alarm until two weeks of consecutive dry nights!
The most commonly used medication for bedwetting is called desmopressin. It reduces the amount of urine produced overnight so it may be more beneficial in those kids that produce more urine at night. Studies have shown a 20-30% response. One side effect of the medication can be low sodium, so parents need to be aware of the signs, including confusion, weakness and even seizures.
One other bedwetting medication that is occasionally used is called imipramine. It belongs to a class of medications called tricyclics and is also used to treat depression. It is less frequently prescribed these days because if too much is taken, an overdose may occur. Before starting on this medication, the heart needs to be monitored with an EKG.
There are a few other medications that have been used, but they have a higher likelihood of side effects and are therefore not routinely recommended as a first line of treatment in kids.
Dry bed training is a more hands-on, parent-led approach.
One older study reported a great than 90% success rate with this method.
This is referred to as secondary nocturnal enuresis. This is often related to a psychological stressor like a divorce or the birth of a new sibling. Exploring what may be bothering your child is a good idea. But the above other medical diagnoses should also be considered.
As kids get older, typically closer to around 6-8 years old, they begin to get self-conscious and embarrassed by bedwetting. They may resist sleepovers. This can affect their self-esteem and friendships. It’s important that the child doesn’t feel like it’s their fault or something is wrong with them.
They should not be shamed. For example, never say “I can’t believe you did this again” or “You are costing us a lot of money having to wash your dirty sheets every night.” It’s important that bedwetting is not discussed in front of the child’s siblings or friends. Parents should reassure the child that it’s normal for his or her age. Act as an ally to the child and show that you’re going to tackle this as a team.
Parents may want to teach the child to do the laundry so they can wash their sheets and pajamas on their own. This should not be treated like a punishment; it is an opportunity for the child to have control over it and limit who knows about it. This also helps develop responsibility. If you approach it in this supportive and collaborative way, most kids will outgrow it.