Bed-Wetting
Causes of Bed-Wetting
Toilet training a child takes a lot
of patience, time and understanding. Most children
do not become fully toilet trained until they are
between 2 and 4 years of age. Some will be able to
stay dry during the day. Others may not be able to
stay dry during the night until they are older. Nighttime
bed-wetting, called enuresis, is normal and very common
among preschoolers. It affects about 40 percent of
3-year-olds.
All of the causes of bed-wetting are not fully understood,
but the following are the main reasons a child wets
the bed:
• His bladder is not
yet developed enough to hold urine for a full night,
or
• He is not yet able to recognize when his
bladder is full, wake up and use the toilet
Often, a child who has been dry at
night will suddenly start bed-wetting again. When
this happens it is usually due to stress in the child's
life. Such stress could be due to a big change, such
as a new baby in the home, moving, or a divorce. Children
who are being physically or sexually abused may also
develop enuresis. If your child wets the bed after
having been dry at night in the past, your pediatrician
should do an evaluation. The bed-wetting may be a
sign that stress or a disease is causing the problem.
In trying to find the cause of your child's bed-wetting,
your pediatrician may ask you the following questions:
• Is there a family history
of bed-wetting?
• How often does your child urinate, and at
what times of the day?
• When does your child wet the bed? Is she
very active, upset or under unusual stress when
it happens?
• Does your child tend to wet the bed after
drinking carbonated beverages, caffeine, citrus
juices or a lot of water?
• Is there anything unusual about how your
child urinates or the way his urine looks?
If your pediatrician suspects a problem,
he may take a urine sample from your child to check
for signs of an infection or other problem. Your pediatrician
may also order tests, such as X-ray films of the kidneys
or bladder, if there are signs that wetting is due
to more than just delayed development of bladder control.
If the tests point to a problem that
may require surgery, your pediatrician may recommend
that you see a pediatric urologist who is specially
trained to treat children's urinary problems that
require surgery.
Some parents fear that their child's
bed-wetting is due to a disease or other physical
problem. Actually, only about 1 percent of bed-wetting
cases are related to diseases or defects such as:
• Bladder or kidney infections
• Diabetes
• Defects in the child's urinary system
With any of these cases, there will often be changes
in how much and how often your child urinates during
the day. Your child may also have discomfort while
urinating. Tell your pediatrician if you see any
of the following signs at any age:
• Unusual straining during urination, a very
small or narrow stream of urine, or dribbling that
is constant or happens just after urination
• Cloudy or pink urine, or bloodstains on
underpants or nightclothes
• Daytime as well as nighttime wetting
• Burning during urination
Most school-age children who wet their
beds have primary enuresis. This means they have never
developed nighttime bladder control. Instead, they
have had this condition since birth and often have
a family history of the problem. Children who are
older when they develop nighttime bladder control
often have at least one parent who had the same problem.
In most cases, these children become dry at about
the same age that their parent(s) did.
Tips for Managing Bed-Wetting
A small number of children who wet
the bed do not respond to any treatment. Fortunately,
as each year passes, bed-wetting will decrease as
the child's body matures. By the teen years almost
all children will have out-grown the problem. Only
one in 100 adults is troubled by persistent bed-wetting.
Until your older child outgrows bed-wetting,
it is important that you give him support and encouragement.
Be sensitive to your child's feelings about bed-wetting.
For instance, children may not want to spend the night
at a friend's house or go to summer camp. They may
be embarrassed or scared that their friends will find
out they wet the bed.
Make sure your child understands that
bed-wetting is not his fault and that it will get
better in time. Do not pressure your child to develop
nighttime bladder control before her body is ready
to do so. As hard as your child might try, the bed-wetting
is beyond her control, and she may only get frustrated
or depressed because she can not stop it.
Set a no teasing rule in your family.
Do not let family members, especially siblings, tease
a child who wets the bed. Explain to them that their
brother or sister does not wet the bed on purpose.
Do not make an issue of the bed-wetting every time
it occurs.
If your child has enuresis, discussing
it with your pediatrician can help you to understand
it better. Your pediatrician can also reassure you
that your child is normal and that he will eventually
outgrow bed-wetting.
Until that happens naturally, however, the following
steps might help the situation.
Take steps before bedtime.
Have your child use the toilet and avoid drinking
large amounts of fluid just before bedtime.
Use a bed-wetting alarm
device.
If your child reaches the age of 7
or 8 and is still not able to stay dry during the
night, an alarm device might help. When the device
senses urine, it sets off an alarm so that the child
can wake up to use the toilet. Use this device exactly
as directed so that it will detect the wetness right
away and sound the alarm. Be sure your child resets
the alarm before going back to sleep.
These alarms are available at most
pharmacies and cost about $50. Although they provide
a 60 percent to 90 percent cure rate, children often
relapse once they stop using them. Alarms tend to
be most helpful when children are starting to have
some dry nights and already have some bladder control
on their own.
Protect and change
the bed.
Until your child can stay dry during
the night, put a rubber or plastic cover between the
sheet and mattress. This protects the bed from getting
wet and smelling like urine.
Let your child help.
Encourage her to change the wet sheets
and covers. This teaches responsibility. At the same
time it can relieve your child of any embarrassment
from having family members know every time she wets
the bed. If others in the family do not have similar
chores, though, your child may see this as punishment.
In that case, it is not recommended.
Other treatments.
Some pediatricians recommend bladder
stretching exercises. With these, your child gradually
increases the time between daytime urinations so that
the bladder can slowly stretch to hold more urine.
Should you and your child decide together to try bladder-stretching
exercises, follow instructions from your pediatrician.
When no other form of treatment works,
your pediatrician may prescribe medication. The use
of medications to treat bed-wetting is in dispute.
Since primary enuresis stops as a child matures, some
pediatricians worry that using medication may have
more risks than benefits. Not only can medications
cause side effects, but they may not work.
Your pediatrician can talk with you
about the different medications that are available,
their possible side effects, and their success rates.
But keep this information in mind:
because bed-wetting is such a common problem, many
mail-order treatment programs and devices advertise
that they are the cure. Use caution; many of these
products make false claims and promises and may be
overly expensive. Your pediatrician is the best source
for advice, and you should ask before your child starts
any treatment program.
© COPYRIGHT AMERICAN ACADEMY
OF PEDIATRICS, ALL RIGHTS RESERVED.
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