Bedwetting/Enuresis
By Dr. Brown
Wetting the bed more than once a week after age 6 (enuresis) has many causes. Often there is a family history. In some families night time dryness can be as late as the teen years! Up to 20% of 5 year olds wet, diminishing by 15% each year. There are medical causes such as diabetes mellitus (sugar diabetes), urinary tract infections, constipation, and "stress". The most common reason is maturational; some are dry at three years of age, others not until the teen years.
There are two types of enuresis, primary and secondary. Primary enuresis means that a child has never been dry at night for at least 6 months. This kind of bedwetting is usually because a child is not developmentally ready to stay dry all night. A child is just not able yet to control urination. Waking up because of a full bladder and being able to hold urine while asleep takes longer for some children to achieve. Secondary enuresis means that a child had previously been dry at night for at least 6 months and the bedwetting started again. Secondary enuresis may be related to a medical problem like a urinary tract infection or stress. We should probably check your child if he or she develops secondary enuresis
There are other things that make a child more likely to wet the bed at night. First of all is genetics. Children are more likely to wet the bed if one or both of their parents, especially fathers, wet the bed when they were children. Constipation can also contribute to bedwetting. A large amount of stool may press upon the bladder, resulting in more frequent urination. Many medical problems, such as diabetes and abnormalities of the urinary system, can lead to enuresis. Children who also have “accidents” during the day are more likely to have a medical issue.
HOW SHOULD YOU RESPOND TO YOUR CHILD’S BEDWETTING?
First of all, realize that your child has no control over his wetting the bed at night. Thus, don’t punish your child for wet nights. If your child is under the age of 7 years, in most cases it is better to wait and see if he outgrows it.
However, if your child is older than age 7 years, if bedwetting is impacting his or your family’s life, or it is upsetting to your child, there are a number of things that you can try to stop or decrease the likelihood of bedwetting:
Simple Suggestions: There are several suggestions to make your life and your child's less stressful:
1. Minimize fluids in the evening. Do not give fluids or juicy foods within 90 minutes of bedtime.
2. Consistent Bed Time. Being over tired is a disaster. When the child goes to bed tired he or she will sleep much deeper and therefore will not wake when the bladder feels full. Bed wetters usually sleep very soundly and being over tired worsens this.
3. Good bladder health during the day can make a difference at night. Make sure your child goes to the bathroom every 2 to 3 hours during the day. He shouldn’t avoid going to the bathroom while at school, as many children do. Increasing fluids during the day is also good, as it helps a child learn to “hold” his urine during the day.
4. Bladder training, in which you have your child drink increasing amounts of fluid and wait longer and longer to urinate. This can help with wetting the bed.
5. Constipation. Being constipated may confuse the body's sensation for fullness down in the area of the baldder. Try to keep your child's bowels loose.
6. Sticker charts and reward systems can help encourage your child to stay dry at night. But realize that your child is not being deliberately difficult or belligerent if he continues to wet the bed.
7. Magic sheets. To avoid the middle of the night change the bed hassle, put on two layers of cotton sheets and two layers of rubber sheets: a rubber sheet first then a sheet then another rubber sheet and finally another sheet. When the child wets, you can pull back the top sheet and blanket and simply remove the wet layers and pull the top layers back on. This process takes one minute in the middle of the night and saves much frustration for families.
8. Enuresis Alarms.These devices have a sensor that goes into your child's underwear and will sound an alarm when wetness is present. Often, the alarm will sound waking the rest of the family and not the deep sleeping child. If this is the case, train your child to recognize the sound of the alarm by experimenting with the device during the daytime. Some who are ready to train can become dry in a few nights while others may take up to a few months. This system trains the mind to respond to a full bladder in a bio-feedback manner. Sometimes children will regress and begin th wet again - you may need to use the device again for a few to several nights to retrain the mind to wake for a full bladder. You can research these devices on the internet, however a great place to go is the bedwetting store:
www.bedwettingstore.com
Wetting the bed more than once a week after age 6 (enuresis) has many causes. Often there is a family history. In some families night time dryness can be as late as the teen years! Up to 20% of 5 year olds wet, diminishing by 15% each year. There are medical causes such as diabetes mellitus (sugar diabetes), urinary tract infections, constipation, and "stress". The most common reason is maturational; some are dry at three years of age, others not until the teen years.
There are two types of enuresis, primary and secondary. Primary enuresis means that a child has never been dry at night for at least 6 months. This kind of bedwetting is usually because a child is not developmentally ready to stay dry all night. A child is just not able yet to control urination. Waking up because of a full bladder and being able to hold urine while asleep takes longer for some children to achieve. Secondary enuresis means that a child had previously been dry at night for at least 6 months and the bedwetting started again. Secondary enuresis may be related to a medical problem like a urinary tract infection or stress. We should probably check your child if he or she develops secondary enuresis
There are other things that make a child more likely to wet the bed at night. First of all is genetics. Children are more likely to wet the bed if one or both of their parents, especially fathers, wet the bed when they were children. Constipation can also contribute to bedwetting. A large amount of stool may press upon the bladder, resulting in more frequent urination. Many medical problems, such as diabetes and abnormalities of the urinary system, can lead to enuresis. Children who also have “accidents” during the day are more likely to have a medical issue.
HOW SHOULD YOU RESPOND TO YOUR CHILD’S BEDWETTING?
First of all, realize that your child has no control over his wetting the bed at night. Thus, don’t punish your child for wet nights. If your child is under the age of 7 years, in most cases it is better to wait and see if he outgrows it.
However, if your child is older than age 7 years, if bedwetting is impacting his or your family’s life, or it is upsetting to your child, there are a number of things that you can try to stop or decrease the likelihood of bedwetting:
Simple Suggestions: There are several suggestions to make your life and your child's less stressful:
1. Minimize fluids in the evening. Do not give fluids or juicy foods within 90 minutes of bedtime.
2. Consistent Bed Time. Being over tired is a disaster. When the child goes to bed tired he or she will sleep much deeper and therefore will not wake when the bladder feels full. Bed wetters usually sleep very soundly and being over tired worsens this.
3. Good bladder health during the day can make a difference at night. Make sure your child goes to the bathroom every 2 to 3 hours during the day. He shouldn’t avoid going to the bathroom while at school, as many children do. Increasing fluids during the day is also good, as it helps a child learn to “hold” his urine during the day.
4. Bladder training, in which you have your child drink increasing amounts of fluid and wait longer and longer to urinate. This can help with wetting the bed.
5. Constipation. Being constipated may confuse the body's sensation for fullness down in the area of the baldder. Try to keep your child's bowels loose.
6. Sticker charts and reward systems can help encourage your child to stay dry at night. But realize that your child is not being deliberately difficult or belligerent if he continues to wet the bed.
7. Magic sheets. To avoid the middle of the night change the bed hassle, put on two layers of cotton sheets and two layers of rubber sheets: a rubber sheet first then a sheet then another rubber sheet and finally another sheet. When the child wets, you can pull back the top sheet and blanket and simply remove the wet layers and pull the top layers back on. This process takes one minute in the middle of the night and saves much frustration for families.
8. Enuresis Alarms.These devices have a sensor that goes into your child's underwear and will sound an alarm when wetness is present. Often, the alarm will sound waking the rest of the family and not the deep sleeping child. If this is the case, train your child to recognize the sound of the alarm by experimenting with the device during the daytime. Some who are ready to train can become dry in a few nights while others may take up to a few months. This system trains the mind to respond to a full bladder in a bio-feedback manner. Sometimes children will regress and begin th wet again - you may need to use the device again for a few to several nights to retrain the mind to wake for a full bladder. You can research these devices on the internet, however a great place to go is the bedwetting store:
www.bedwettingstore.com