Bedwetting

Bedwetting is a common and frustrating problem in many families. Many children continue to have occasional nighttime wetting up to age 5 yearsand a significant number may continue to experience bedwetting until the pre-teen years.
Statistics show that 1 in 4 children still have occasional bedwettingup to age 5 years, 1 in 5 up to age 7 years and 1 in 20 until age 10years. Children who have a problem with bedwetting frequently have a close family member who also experienced this issue.
Reasons for bedwetting include an immature nervous system so that the messages from a full bladder are not recognized or acted upon by the brain to wake the child in time to make it to the bathroom. Some children have a small bladder and must void more frequently than average.
Most children who wet the bed are described as very deep sleepers who are hard to awaken. Constipation may also play a role in bedwetting because stool in the colon may press on the bladder.
When a child is old enough to want to stop wetting the bed, to want to stop wearing pull-ups at night, and to take part in efforts to stop bedwetting, then the family can work together to try and help the child wake up dry.
Limiting water or other drinks during the last 2-3 hours before bedtime is sometimes but not always helpful. A more successful method maybe an alarm that is worn on the child's underwear or pajamas, which will alarm if the sensor becomes wet. This will hopefully awaken the child so he can go to the bathroom to finish urinating in the toilet. This method works by making the child more aware of the feeling of having a full bladder and, hopefully, will learn to awaken on his own when his bladder feels full.
There is also a medicine taken by mouth, called DDAVP or desmopressin, which works to decrease bedwetting. It is a synthetic form of a chemical made by the body, which decreases urine production at night. DDAVP is useful for times when a child is away at camp or at a sleepover, but it only helps the child remain dry while he is taking the medicine. Once the medicine is stopped, if the child's body has not matured to stop bedwetting on its own, the wetting will recur.
If a child has had a fairly long period of remaining dry at night- 6months or more- and starts bedwetting again, there may be other reasons for the relapse. A bladder infection, constipation, anxiety or a stressful event may be the cause. Therefore, if wetting starts back after a long dry period, a search must be made for the cause and an office visit should be scheduled to discuss the situation.
The most important thing to remember is that children do not wet the bed on purpose and are frequently very distressed and embarrassed when it occurs. The caregiver can provide support, acceptance and encouragement as the child tries to become dry at night.
For further information, a helpful source is Dr.Howard Bennett's book: Waking Up Dry: A Guide to Help Children Overcome Bedwetting.

by Elizabeth Kemp, MD, FAAP