See why your child bedwets and how to treat it

Bedwetting is an issue that millions of families face every night. It is extremely common among young kids but can last into the teen years.

All the same, bedwetting can be very stressful for families. Kids can feel embarrassed and guilty about wetting the bed and anxious about spending the night at a friend's house or at camp. Parents often feel helpless to stop it.

Bedwetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence.

For infants and young children, urination is involuntary. Wetting is normal for them. Most children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first, while nighttime control comes later.

The age at which bladder control is expected varies considerably.

• Some parents expect dryness at a very early age, while others not until much later. Such a time line may reflect the culture and attitudes of the parents and caregivers.
• Factors that affect the age at which wetting is considered a problem include the following:
  • The child's gender: Bedwetting is more common in boys.
  • The child's development and maturity
  • The child's overall physical and emotional health. Chronic illness and/or emotional and physical abuse may predispose to bedwetting.

Bedwetting is a very common problem.

• Parents must realize that enuresis is involuntary. The child who wets the bed needs parental support and reassurance.

Bedwetting is a treatable condition.

• While children with this embarrassing problem and their parents once had few choices except waiting to "grow out of it," there are now treatments that work for many children.
• Several devices, treatments, and techniques have been developed to help these children stay dry at night. 

While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying disease. In fact, a true organic cause is identified in only a small percentage of children who wet the bed. However, this does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient.

Types of bedwetting: primary and secondary.

Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time.

Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).

In general, primary bedwetting probably indicates immaturity of the  nervous system. A bedwetting child does not recognize the sensation of the full bladder during sleep and thus does not awaken during sleep to urinate into the toilet.

The cause is likely due to one or a combination of the following:

• The child cannot yet hold urine for the entire night.
• The child does not waken when his or her bladder is full.
• The child produces a large amount of urine during the evening and night hours.
• The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents are familiar with the "potty dance" characterized by leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.

Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting. Common causes of secondary bedwetting includes urinary tract infections, diabetes, sleep patterns, neurological problems, excessive fluid intake, emotional problems aong others.

Bedwetting tends to run in families. Many children who wet the bed have a parent who did, too. Most of these children stop bedwetting on their own at about the same age the parent did

Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful.

• Reduce evening fluid intake. The child should try to not take excessive fluids, chocolate, carbonated drinks or citrus after 3 p.m. Routine fluids with dinner are appropriate.
• The child should urinate in the toilet before bedtime.
• Set a goal for the child of getting up at night to use the toilet. Instead of focusing on making it through the night dry, help the child understand that it is more important to wake up every night to use the toilet.
• Make sure the child has safe and easy access to the toilet. Clear the path from his or her bed to the toilet and install night-lights. Provide a portable toilet if necessary.
• Some believe that you should avoid using diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet. Others argue that pull-ups help the child feel more independent and confident. Many parents limit their use to camping trips or sleepovers.

The parents' attitude toward the bedwetting is all-important in motivating the child.

• Focus on the problem: bedwetting. Avoid blaming or punishing the child. The child cannot control the bedwetting, and blaming and punishing just make the problem worse.
• Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the bedwetting each time it happens.
• Enforce a "no teasing" rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the bedwetting in front of other family members.
• Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help him or her overcome the problem. If applicable, remind him that a close relative successfully dealt with this same issue.
• The child should be included in the clean-up process.

To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers.

Self-awakening programs are designed for children who are capable of getting up at night to use the toilet, but do not seem to understand its importance.

• One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night.
• Another strategy is daytime rehearsal. When the child feels the urge to urinate, he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet.

Parent-awakening programs can be used if self-awakening programs fail. These programs should only be used at the child's request. Interruption of sleep should be a last resort.

• The parent should awaken the child, typically at the parents' bedtime.
• The child must then locate the bathroom on his or her own for this to be productive. The child needs to be gradually conditioned to awaken easily with sound only.
• When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms.