A good friend recently shared a victory. Her 6-year-old son slept through the night for two weeks straight, without needing a pull-up diaper for protection. Her family had spent their year on the move, traveling frequently between their North Seattle home and China, where they settled last summer. Stephanie's relief at their "dry night" was obvious. She had expected Darren would have been fully potty trained long ago. (Both Stephanie's and Darren's names have been changed to protect their privacy.)
In medical terms, nighttime bed-wetting is known as nocturnal enuresis. And for many children and parents, it means guilt, embarrassment and even feelings of personal disappointment.
Given Darren's age, Stephanie likely need not have worried these past few years. Pedriatic experts say that 10 percent of 6-year-olds experience nocturnal enuresis and that half of those children will naturally grow out of it by age 10. Two-thirds of the children who wet their beds are boys.
If your child wets the bed, the first thing to remember is that he or she is not doing it on purpose or out of laziness In fact, many parents dealing with this may feel a sense of deja vu, because there is a genetic tendency toward enuresis. One report found that in families where both parents had enuresis, 77 percent of their children will also have the condition. In families where only one parent had enuresis, 44 percent of children are affected.
Gaining bladder control is a normal developmental process that takes longer in some people. So, like other developmental areas, some kids may take longer to achieve nighttime dryness than others. In rare cases, there is a medical reason for the enuresis, such as a child not producing enough antidiuretic hormone (ADH).
There is debate within the medical field about children wetting the bed because they sleep so soundly. One theory is that a child's upper airway may be obstructed, so the enuresis may be a symptom of a sleep disorder. In one study cited in the journal published by The American Academy of Family Physicians, surgical removal of the tonsils, adenoids or both diminished nighttime bedwetting in 76 percent of patients.
And if bed-wetting starts again after a child has been dry for some time (secondary nocturnal enuresis), a urine test may be performed to eliminate a urinary or kidney infection or possibly type 2 diabetes.
Roberta Winch, M.D., a pediatrician at Virginia Mason Medical Center in Seattle, believes a parent doesn't need to seek help until the child is at least 7 years old. "Start positive, with motivation, such as star charts as a reward for dry nights," Winch suggests. "And consider behavioral modification, too. Don't let the child have a huge glass of water before bedtime."
Instead, reduce fluid intake to 2 ounces in the two hours before bed. Cutting back on caffeinated beverages is also important, as caffeine is a natural diuretic.
Many pediatricians regard enuresis alarms as the most effective means of controlling bedwetting. "They give the child a feeling of empowerment and responsibility, so they are the ones in charge," Winch says. A variety of models are available in stores and online. Generally, a buzzer is activated when a sensor placed in the child's underwear reacts immediately to the first few drops of moisture, teaching the child to stop of the flow of urine.
Some children also respond to being awakened a half hour after they go to sleep so that they can urinate, thus reducing the likelihood of an accident.
In limited situations, such as a camp or sleepover, medication can be used to temporarily control bed-wetting. Not usually prescribed to children younger than 8, the drugs work to increase the child's bladder capacity. One of the most commonly prescribed FDA-approved medications is desmopressin (DDAVP). Homeopathic remedies such as "Be-Dry" are also available.
Megan Schmidt, R.Ph., MBA, a pharmacist with 16 years experience in Seattle and Eastside pharmacies and clinics, says she has seen more parents filling prescriptions for enuresis medication. She suspects the biggest change relates to the increasing number of camps and sleepover parties: "It is the level of children's socialization now that may make things different than before." She recommends that you have a trial run at home with the medicine before sending it with your child.
In most cases, children who wet the bed will make the developmental jump to dry nights spontaneously. As parents, we can support and motivate. But most of all, we should exercise a little patience.
Hilary Benson lives in the Seattle area.
- Seven Steps to Nighttime Dryness: A Practical Guide for Parents of Children with Bedwetting. Renee Mercer CPNP (Paperback), 2004
- Waking Up Dry: A Guide to Help Children Overcome Bedwetting. Howard J Bennett, MD FAAP (Paperback) 2005