Bed-wetting in Children
Approximately 15% of all elementary school age children wet their bed, and continued bed-wetting (enuresis
meaning urinary incontinence, especially during sleep) past 5 years old. Nighttime bed-wetting, clinically
diagnosed as primary nocturnal enuresis, is a common problem affecting an estimated 5 to 7 million children
in the United States.

All children with wetting problems, especially those who wet during the day, need a medical evaluation that
includes testing for infections or other physical problems. Most children wet only at night, and only about 1
out of 20 has a medical condition that requires treatment. bed-wetting prevents the child from spending the
night away from home, and these children usually want to stop bed-wetting.

Most children begin to stay dry at night around three years old. About 66% of children who wet their bed
are boys. These children are not lazy, and they have to be told that bed-wetting is not their fault. Parents
often feel responsible for their child’s bed-wetting. This is seldom the case, and parents need to be at ease
not feel guilty.

Reasons for bed-wetting

Waiting for the condition to go away on its own is a misconception some parents have about bed-wetting.
About 1 out of every 8 children who wets the bed will be dry a year later on their own. It can take more
than 3 years for bed-wetting to stop without treatment. Waiting for a child to outgrow the problem is not
usually a good idea, because the child’s self-esteem will suffer. bed-wetting is hereditary and has been
confirmed by the identification of a gene marker.

Effective treatments are now available. Physicians emphasize that bed-wetting is not a disease, but a
symptom, and a rather common one. In most cases, it is due to the development of the child's bladder
control being slower than normal. Parents should remember that children rarely wet on purpose, and usually
feel ashamed about the incident. Instead of making the child feel bad or embarrassed, parents need to
support the child and communicate the belief that he/she will soon be able to stay dry overnight.

Helpful Tips for bed-wetting:

•        Restrict liquids before bedtime
•        Make sure the child uses the bathroom before bedtime
•        Compliment the child on dry mornings
•        Refrain from disciplining for bed-wetting
•        Wake the child during the night to empty their bladder

Facts about bed-wetting:

•        About 15 percent of children wet the bed past 3 years old
•        More boys than girls wet their beds
•        bed-wetting does run in families
•        Generally bed-wetting ends by puberty
•        The majority of bed-wetters do not have emotional problems

Possible Causes for Bed-wetting

bed-wetting may sometimes be related to a sleep disorder. bed-wetting may also be the result of the child's
worries and emotions that need attention. There are different types of emotional reasons for bed-wetting.
For example, when a young child begins bed-wetting after several months or years of dryness during the
night, this may represent new fears or insecurities. bed-wetting may follow changes or events which make
the child feel vulnerable such as moving to a new home, parents divorce, losing a loved one, or the arrival of
a new baby in the home. Sometimes bed-wetting occurs after a period of dryness because the child's
original toilet training was too demanding.

Low Functional Bladder Capacity

Another common cause in children with bed-wetting is due to a small functional bladder capacity. These
children have a reduced amount of sensation of the need to urinate and feel more urgency. Some of these
children may also display daytime symptoms. When a child's functional bladder capacity is low they are less
able to hold a normal amount of urine at night. Some evidence suggests that some bed-wetting children also
produce less anti-diuretic (a hormone that reduces making urine) during sleep. This causes the child to
create more urine at night.

Bed-wetting and Deep Sleep

Many people believe that children wet the bed because they are deep sleepers. This theory is not supported
by research. Most children are deep sleepers, and children with bed-wetting do not differ from other
children in how deeply they sleep. Wetting episodes can occur during any stage of sleep.

Bed-wetting Allergies

Food allergies are rarely related to bed-wetting. Children taking medications for allergies may wet more
frequently when taking medications. As a general rule, caffeine, which is in many foods, such as soda and
chocolate, should be avoided whenever possible. A small percentage of children are sensitive to foods that
contribute to nighttime bed-wetting. A number of children benefit from eliminating foods such as citrus.

Emotional Distress Due to Bed-wetting

Bed-wetting is disturbing to children and parents. Emotional grief is most often the result of bed-wetting, not
the cause. Children who have been dry at night for a year or more and then start bed-wetting again may be
different. Among these children (about 20% of bed-wetters), emotional distress may be a cause of bed-
wetting.

Physical Learning and Bed-wetting

Some children who wet the bed have not learned how to control the muscles they to use for bladder control
during sleep. They cannot make the physical response during sleep, and they cannot wake up in the night to
go to the bathroom. These reactions can be learned with appropriate training.

Medication and Treatments for bed-wetting

Speak with your child’s pediatrician who will ask you to complete a history of your child's daytime and
nighttime bathroom and dietary habits. Then a physical exam will be preformed and perhaps a urine test
(called a urinalysis) to rule out problems in the urinary tract and bladder. A treatment approach is then
developed based upon the child's particular situation. The best treatment program combines education,
behavioral modification with a bed-wetting alarm, cautious use of medications, dietary changes and positive
reinforcement that is individualized for each child and their family.

In general, medication treatments produce a temporary decrease in wetting frequency so long as the child
takes the medication. When the child stops taking medications, the bed-wetting returns. Medications rarely
“cure” bed-wetting. Medications may provide a temporary solution to the problem and allow children to
control bed-wetting for short periods of time.

Urine Alarm Treatment

This treatment can be administered by parents under professional supervision. A battery powered alarm
device used by the child is activated when the child wets. If the sound fails to wake the child, the parents
have to wake the child. Repeatedly waking a child immediately after the beginning of urination teaches the
child to control muscles even during sleep. The treatment takes 12 to 16 weeks.

Parents and children need to cooperate to complete the training. The most common causes of failure with
this treatment are not waking the child every time the alarm sounds and not continuing the treatment for the
full period. The opportunity for success is very high with this equipment (called bell and pad) if it is used
under a therapist’s supervision.

Behavior therapy with a urine alarm is the best treatment for plain bed-wetting. Many years of research
supports this claim. A permanent solution to bed-wetting can be expected for about 5 of every 10 children
treated with a urine alarm. Available evidence shows that children treated with a urine alarm improve in their
self-esteem and peer relations. There are no known negative side effects of urine alarm treatment.
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