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Are you concerned about bedwetting?

February 05, 2014

It makes me sad as a pediatrician to see families who stress over children who wet the bed. This is usually a normal, natural issue that goes away in time, yet it can really hurt children who are treated like it is their fault.

Bedwetting, or primary nocturnal enuresis, affects one in five normal kindergarteners, and naturally resolves at a rate of 15 percent per year. Unlike potty training, which is learned behavior that children can control, nighttime dryness is a part of sleep. Children cannot decide to wake up to pee or to “hold it” at night. This is something that the sleeping brain needs to learn, and it happens at different times in different children. Not all bedwetting is that simple; there are some symptoms that should lead you to your pediatrician. There are also some things that parents can do to help children with bed-wetting. The most important thing to remember is to be patient and kind.

When should I worry if my child wets the bed?

Primary nocturnal enuresis is what we call it when a child has never been consistently dry at night. If your child has been dry for some time and starts to wet the bed again, this is called secondary nocturnal enuresis, and might represent a medical problem. Urinary tract infection, obstructive sleep apnea, and even diabetes, can present itself with bedwetting. If your child starts to wet the bed after having been dry before, you should visit your pediatrician. Children with chronic constipation, daytime accidents, or burning with urination, with or without bedwetting, should also be evaluated by their doctor.

We make her stop drinking at dinnertime, use the potty at bedtime, and we even wake her up to pee when we go to bed but she STILL wets the bed!!!

Children who have learned to use the potty during the day but who continue to wet the bed at night are usually very sound sleepers. These are the children who would sleep through an earthquake, so it is not hard to imagine them sleeping through emptying their bladder. Our kidneys constantly cleanse our blood and produce urine. That urine is stored in our bladders until we urinate. So whether we stop children from drinking or make them empty their bladder at bedtime, there will still be pee in that bladder at 3 a.m.  If the child is going to empty his bladder, just like sleepwalking or sleep talking, there will be a wet bed.

My friend told me to make them do the laundry when they wet the bed to make them stop.

There are actually pediatricians who recommend this! It may be that if a child is made to feel bad enough about bedwetting their sleeping mind will learn to stop. Personally, I think that this is just plain mean. It leaves lots of laundry, which makes everyone feel bad and frustrated. Other parents angrily make their bed-wetter feel bad about wearing diapers. I think that pull-ups are a great thing if they are seen as a convenient, temporary measure and not as a punishment. They are a practical way to prevent smelly, wet laundry, and they won’t be needed forever.

So do we just live with this and do nothing?

The short answer is, yes, you can do that. Your child will probably outgrow this.  However, if your child is bothered by her bedwetting, there are alarm systems that can teach her sleeping brain to wake up just enough not to pee in the night. There are even medications that can be prescribed if absolutely necessary. Bedwetting alarms have a sensor that triggers an alarm at the first sign of wetness. This teaches your child’s sleeping brain to rouse a little bit when she is about to pee and to “hold it.” This takes a motivated child, a committed parent (remember the child who sleeps through the earthquake? They sleep through the alarm at first too, so a parent must be an intermediate waker-upper for a while). Alarms take a few months to work, with a long-term cure rate of 70-80%.

So when does it end?

Again, about one in five kindergarteners wet the bed, and about 15 percent of children outgrow this every year. Genetics play a big role, so most children outgrow the problem at the same age that their bed-wetting relatives did. For most children, this is a normal, temporary issue, and it should be treated that way. There are many more important and difficult issues that we will face as parents, and this should not consume much emotional energy for us or for our children. Concerns? Talk to your pediatrician.

Above all, make sure that your child knows that you love him and that this is not a big deal!

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