Q&A: Helping your child beat the bedwetting blues

Question: What causes a child to wet the bed? Our son is well past the age of potty training, yet I still have to change his bedding several times a week. I've lost my patience with him more than once, and I can tell he's hurt by it. Is there a solution to this problem?

Answer:

Gaining consistent control of bladder and bowel functions during daytime hours is a significant milestone for a toddler or preschooler. For many children, keeping the bed dry at night is a more elusive goal, one that might not be reached until quite a bit later in life. You may be surprised to learn that by age five at least 10 to 20 per cent of children still have issues with bedwetting. In some cases this problem persists for years. In such instances, there's often a family history of enuresis (the involuntary passage of urine into the bed or clothes at least once or twice per month in a child who is at least five years of age).

It's not their fault

Children who wet the bed at night well into their grade-school years often take an emotional beating (and in some sad cases a physical beating) for it. One of the greatest difficulties faced by bedwetting children is a parent with unrealistic expectations that every child should be completely dry, day and night, by the age of three. What makes this especially unfortunate is that the behaviour is not under the child's conscious control. That's why rewards, reprimands, humiliation and punishment are ineffective and have no place whatsoever in dealing with bedwetting. The problem is one of physiological maturity – nothing more, nothing less. Accordingly, the best solution in nearly all cases is patience, continued use of diapers or training pants, lots of reassurance and a few more birthdays.

To deal with bedwetting effectively and supportively, it is important that parents understand some basic realities of nighttime bladder function in children. Only about one per cent of children with enuresis will be found upon medical examination to have an underlying disease or disorder such as a urinary tract infection, diabetes, significant constipation, a congenital abnormality of the urinary tract or a disturbance in the central nervous system. We'd recommend that you see your pediatrician before ruling out these remote possibilities.

Enuresis and other factors

In the other 99 per cent of children with enuresis, the problem may involve one or more of the following (note: clinicians are not in complete agreement about the relative importance of each of these factors):

• Delayed maturation. During infancy, the bladder automatically empties six to eight times per day when a certain volume of urine is present. As a child matures, this emptying reflex is inhibited by the central nervous system. In general, control is achieved earlier by girls than by boys.
  
  
• Small functional bladder capacity. A normal child can usually voluntarily hold urine in an amount of ounces equal to his age in years plus two. If a child cannot hold at least the same number of ounces as his age, this decreased capacity may contribute to enuresis.
  
  
• Increased formation of urine during the night. Normally, a hormone called vasopressin suppresses urine production during sleep. Some bedwetters apparently do not secrete more vasopressin during the night and thus produce more urine than their non-bedwetting peers.
  
  
• Difficulty awakening when the bladder is full. Many parents have observed that bedwetters are difficult to awaken and seem "able to sleep through anything."
  
  
• A family history of enuresis. Since so many of the factors contributing to bedwetting have an inherent physiological basis, it should not be surprising that this problem often runs in families.

The following measures may help a child with enuresis:

• Encourage fluid intake during the day, but discourage drinking liquids within two hours of bedtime. If your child wants a drink before bed, limit it to one or two ounces.
  
  
• Have your child empty his bladder just before bed.
  
  
• Encourage your child to get up during the night to urinate. Leaving the light on in the bathroom or providing a potty-chair near the bed can help.
  
  
• To a degree that is appropriate for his age, let him participate in the cleanup process. This should be presented not as punishment but as a matter-of-fact routine.
  
  
• Protect the mattress with a plastic cover.
  
  
• Offer praise when the child has a dry night or gets up to use the toilet.
  
  
• Avoid expressing dissatisfaction, dismay or anger when he is wet in the morning.
  
  
• Bedwetting "alarms" may be helpful for a child who is eight or older. Retail prices for such devices range from $70.00 to $120.00.
  
  
• In certain cases, drug therapy may be appropriate. Two medications have been recognized as potentially helpful in controlling bedwetting – Imipramine and Desmopressin. The use of either requires a doctor's prescription and a thorough understanding of potential benefits, risks, and proper use. For further information, you should arrange a consultation with your physician.