Help Your Child Overcome Bedwetting

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As a pediatric nurse practitioner in the urology clinic at Children’s Hospital Los Angeles, one of the more common non-surgical issues I see is bedwetting. This is a very frustrating issue for many children and families. Parents often have to wash sheets and bedding on a daily basis and many children struggle with feelings of embarrassment or frustration. It sometimes inhibits their ability to feel like regular kids because the fear of wetting the bed prevents them from participating in normal kid activities like sleepovers or going to sleep away camp. For my first RN Remedies blog post, I will be shedding light on this common childhood issue, letting you know when it’s time to see the doctor and provide suggestions on how to help your child combat this problem.

The good news is that your child will likely outgrow this. Bedwetting is generally more of a nuisance rather than a sigh of a serious health problem.

Help Your Child Overcome BedwettingWhat is Bedwetting?

The definition of bedwetting is pretty straightforward. It’s when a child unintentionally goes to the bathroom in their bed beyond the age of normal control. It affects more boys than girls and starts to appear in kids’ sleep behavior around five years old. If your child is bedwetting, they are not alone. Over seven million children in the U.S. wet their bed at night. There are two categories of bedwetting:

  1. Primary bedwetting: These are children who have wet the bed since infancy. They have never had a dry period. These children may wet the bed only a few nights per week or every night. Bedwetting has always been an issue.
  2. Secondary bedwetting: These are children who have had a dry period of at least six months prior to beginning to wet the bed again. Secondary bedwetting requires a visit to the pediatrician, as it can be an indicator of a more serious problem such as a urinary tract infection (UTI), renal bladder anomaly, anxiety or stress, abuse or constipation. Secondary bedwetting is less common than primary bedwetting.

What Causes Bedwetting?

While not the only cause, genetics plays a role in the incidence of bedwetting. For example, 77 percent of bedwetting occurs if both parents wet the bed as children and only 44 percent if one parent wet the bed. The age of the parent when they grew out of this issue as a child, may give an idea as to what age their child may outgrow bedwetting. Other causes of bedwetting:

  • Deep sleepers: Children who wet the bed are often very deep sleepers and fail to wake up when their body needs to empty their bladder.
  • Delay in maturity: Some children may have a small bladder capacity or the nervous system is immature, which does not prevent the bladder from emptying at night.
  • Disruption of circadian rhythm: Abnormal antidiuretic hormone (ADH) release, which is a hormone that controls fluid balance in the body, causes disruption of a child’s circadian rhythm at night. As a result, some children produce more urine at night.

You Can Help Your Child  

  • First, talk to your child’s pediatrician about this issue. Your child’s pediatrician will help rule out an underlying medical concern and may recommend a visit to the urologist.
  • Do not punish or scold your child. Give them encouragement and positive reinforcement, such as giving them a gold star sticker for each dry night.
  • Make sure your child stays well hydrated throughout the day. Children that don’t have much to drink during the day will become fluid overloaded in the evening or at night causing them to produce a lot of urine at bedtime.
  • Restrict all fluids after dinnertime. A two hour gap or more is recommended between the last drink and bedtime.
  • Avoid foods that irritate the  bladder, such as citrus fruit, caffeine or carbonated drinks. In particular, restrict these after lunch time.
  • Make sure your child goes to the bathroom (pees) before bedtime. I tell my patients to make this a nightly ritual just like brushing teeth. Also, ask children to “double void” each time they use the toilet, meaning that they try to pee a little more after they have finished to make sure they are emptying the bladder completely. Many children rush through peeing and don’t empty completely finish because they want to quickly return to playing.
  • Make sure your child isn’t constipated. When the intestine is full of stool, this puts pressure on the bladder and may lead to a lack of control.
  • Sometimes doctors can prescribe medications to help children stop wetting the bed. Talk to your pediatrician or an urologist about the issue. The important thing to realize is that these medications just stop the body from producing urine overnight so they do not treat bedwetting.
  • Use a bedwetting alarm. The alarms are about 70 to 80 percent effective. The alarm is clipped on the pajama and a cord is attached to the child’s underwear. When the sensor in the underwear senses even a tiny drop of urine they begin to alarm and vibrate, waking the child up. When this happens, the child must get up, finish urinating in the bathroom, and reattach the alarm. The goal is to help your child’s brain recognize what is going to happen before it happens. Eventually the goal is for the child to wake up before they start urinating. These alarms can be purchased online by searching “bedwetting alarm,” without a prescription.

Remember to not give up. When I see parents in clinic they often share that they already tried restricting fluids, setting alarms and making star charts. Sometimes it just helps to talk with someone about this issue, such as an urologist to see if we can provide further insight. It’s important to remind kids that they are not alone and not to be afraid to talk to their parents or pediatrician about wetting the bed. I tell my patients that there are likely other children in their class that experience the same problem, except no one openly talks about it. At our hospital, no one is going to judge them. We’re here to help.