I get a lot of questions about bedwetting. I often suspect parents are going to bring it up when I walk into the room for a well visit for a really healthy 8 year old boy and find both parents in the room. Dads worry about bedwetting (and so do moms) but apparently it is a large enough worry to take a half day off of work to come and talk about it with me. To be fair, working parents often take time off to bring their child in for a check up but it is rare when BOTH parents do so for a healthy child.
Why the worry about bedwetting? Some parents wonder if their child is lazy or has willfully rolled over and gone back to sleep when their full bladder comes a knockin’ at 2 am. Other parents wonder since they allowed their four year old to use pull ups at night, that he was never forced to learn. A few parents think there could be a bladder disorder or diabetes as the cause. In an attempt to solve the problem, parents have limited fluids after dinner, given their child a pep talk about getting up during the night if they feel the need to pee, and some have even set their own alarm or awoken their child when they go to bed to pee during the night. A few have tried dangling a big reward (like a new bike) if the child can stay dry and others have punished their child for these wet nights. All of these strategies have something in common: they don’t work.
What parents don’t understand is that this is a very common problem and their child is not to blame. Most kids complete potty training and stay dry throughout the day by age 3 1/2 to 4 years but nighttime dryness can take much longer to achieve. Did you know that 9% of boys and 6% of girls still have consistent bedwetting at age 7? These percentages decrease only slightly by age 10 and even at age 18 about 0.5% of people wet the bed at least twice a month. Some kids are later to achieve night dryness as a result of a genetic predispostion. Often one or both parents were bed wetters themselves and the age at which he or she outgrew it is a good gauge for when the child will. Sometimes the cause of bedwetting in school aged kids is a sleep disorder. If you child snores a lot during sleep, be sure to mention this to your doctor. Very rarely bedwetting is caused by a neurologic problem and is associated with constipation and clumsiness.
So what is a parent to do? First off, it is appropriate to bring your child to the doctor to confirm there is no physical cause for the problem. This is especially true if your child never had bedwetting issues and has suddenly started wetting the bed. Even if your child has never been dry at night, it is worth a trip to the pediatrician to make sure that your child’s problem is indeed run-of-the-mill bedwetting and nothing more.
Since an immaturity of the neurologic system is at the root of the problem, trying to train your child to stay dry at night before he/she is ready is futile. I liken it to trying to teach a 6 month old to walk. You can try all you like, putting him standing in front of a couch, showing him how to move his legs, but until his neurologic system is mature enough, the message won’t stick and you will just spend a lot of time frustrating both child and parent.
How then do you know when your child is ready? If you have a family history of bedwetting and know the age at which the relative achieved dryness, you can start trying about 6 months or at most a year ahead of that age. If you have no relatives who were bedwetters, look at your child’s pattern of dryness as a guide. If he has been wet every night of the week for years and suddenly you are getting a couple of dry nights each week, it is a good time to try. Other signs of readiness are a desire to be out of pullups at night and a strong motivation to learn and stay dry.
The best method for night training is to use a bedwetting alarm. These alarms awaken the child as soon as there is any wetness on the sensor (worn in underwear or as a pad on the bed) and over time the child slowly but surely starts to make the connection between the sensation that is occuring just before the alarm goes off and needing to pee and will eventually awaken without the alarm. This process can take several months to complete but is over 80% effective.
What about medications? DDAVP has been around for a decade or so and works by essentially turning off the kidneys so much less urine is made. The medication works for about half the kids and can be tried especially if your child is going to camp or a sleepover. It won’t solve the problem but can at least mask it temporarily. It is important to try the medication long before the event for which it is to be used to see what dose (if any) will work.
Eventually, your child will achieve consistent night dryness either through normal maturation or through the help of an alarm. Of course if all parents come to see that bedwetting is no big deal, I’ll have to create some new incentive to get both parents there for a check up!
Do a lot of laundry, invest in the new, thin pullups and get an alarm and each day will be your best!
Molly O’Shea, MD Birmingham Pediatrics + Wellness Center