Bed wetting at 11

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Still Bedwetting at 10 Years Old

Q1. My son is 10 years old, turning 11 in October. He wets the bed just about every night. He currently takes DDAVP tablets before bed and does not drink fluids after 6:30 pm. I just can’t get him to stop wetting the bed. I read a news study that said heart hormones are sometimes elevated in children who wet the bed. How can I find out if this is the issue and, if it is, will this help me to find a better treatment?

It sounds like you have tried a lot of different techniques to help your son with his bedwetting (also called nocturnal enuresis). First, I just want to emphasize how common an issue bedwetting is in children, especially males. About 5 percent of children aged 10 to 11 years old will have issues with nocturnal enuresis. There can be a variety of causes, including a small bladder, an immature bladder that does not always empty appropriately, a family history that makes bedwetting more likely, deep sleeping, stress, and increased urine production at night that may be related to abnormal secretion of hormones that affect urine volume.

I believe the “heart hormone” that you have heard about is atrial natriuretic peptide, a hormone involved in the body’s fluid regulation that is secreted from the heart. Studies I have read have not supported initial thoughts that children with nocturnal enuresis have abnormal amounts of atrial natriuretic peptide. It is not currently recommended as a treatment for children with primary nocturnal enuresis.

Certainly, by the age of 10, I do recommend treatment for those with bedwetting issues because it can be very embarrassing for children this age to attend sleepovers or camp. DDAVP (desmopressin) has been shown to be effective in almost 50 percent of patients who have nocturnal enuresis; however, there is a very high relapse rate when the medication stops. DDAVP works by decreasing the production of urine. It is usually given right before a child goes to bed. It seems that your son has not responded to DDAVP, which is not uncommon! Surprisingly, the most effective treatment for bedwetting is actually “bedwetting alarms,” or underwear that can detect urination. These “alarms” help approximately 70 percent of patients, with a low relapse rate. I would certainly recommend that you try a bedwetting alarm before you try a new medication. Your child’s pediatrician can give you specific instructions about how to best use the alarm to modify bedwetting behavior.

If your son is still having significant issues with bedwetting, I would recommend he see a pediatric urologist. Your son’s primary care doctor can be a great resource in helping you develop a plan for your son’s treatment. I would definitely involve him in whatever decisions you make.

Q2. My daughter is 7, and she wets her bed about three times a month. Is this normal? What can I do to help?

— Maria, New Hampshire

Bedwetting is a common childhood problem. The medical term for it is nocturnal enuresis. Most children are toilet trained by the time they are 5 years old, however, approximately 3 percent of girls your daughter’s age will have occasional nocturnal enuresis. If your daughter has no other symptoms, such as an increase in amount, frequency, urge, or pain with urination, and if she has always had difficulty with wetting the bed, she has a benign type of nocturnal enuresis.

The exact cause of this type of nocturnal enuresis is not known. It can be embarrassing and cause anxiety for both children and parents, especially as children get older and want to have or attend sleepovers. Nocturnal enuresis does seem to run in families. It may be due to deep sleep, a small bladder, delayed control of the urination system, or some psychological component.

Although diapers may seem like a tempting solution, it’s important that your daughter learns how to better control the problem. There are several strategies you can try to help reduce the frequency of these episodes. I recommend starting with a conversation to explain nocturnal enuresis to your daughter, so that she understands what is occurring and does not feel guilty or unusual for having this issue. There are good handouts on the topic that can help you with this discussion. Other things you may want to try include:

  • Limiting your daughter’s food and fluid intake close to bedtime (but not during the rest of the day).
  • Completely removing any caffeinated beverages like iced teas or sodas from her diet.
  • Developing a routine in which your daughter uses the bathroom right before she goes to sleep to fully empty her bladder.
  • You or your daughter can keep a diary to try to track her bedwetting improvements.
  • Have her help clean up if she has an accident, however, do not treat this as a punishment! Praise both dry nights and thorough cleaning up of accidents. Avoid criticism and teasing by other family members!

These simple measures help to improve symptoms in most patients, although only about a quarter of patients are “cured” by these measures. If your daughter continues to have nocturnal enuresis, there are other options, such as special “bedwetting alarms” or underwear that can detect urination, hypnotherapy, and medications.

Rarely, bedwetting may be caused by a urinary tract infection or can be a sign of a more significant issue. This is unlikely if the problem only occurs at night and on an occasional basis. A number of behavioral and medical treatments exist for benign nocturnal enuresis that does not get better on its own, or by using the simple measures mentioned above. Consult your child’s pediatrician if your daughter is having any other symptoms associated with her nocturnal enuresis or for more details about treatment options.

Learn more in the Everyday Health Kids’ Health Center.

Our son wet the bed for 10 years. Here’s what eventually worked …

No matter how prepared you think you are as a parent, there is always that one phase in your children’s upbringing that will stand out to you later as the most challenging period you had to parent through.

It might be behavioural – tantrums, lying and biting and the like. It might be social – the child who says she has no friends, or the child who’s being bullied. It might be emotional or developmental. Whatever it is, it will find you googling solutions and rereading passages of parenting books you thought you had long left behind.

For our son, it was definitely developmental. He was a demon bedwetter and the campaign waged to get him dry through the night lasted nearly 10 solid years.

To be fair, his genes had a lot to do with his bedwetting ways – I was a bedwetter until about six or seven years old (old enough that I can still remember trying to change my own sheets in the middle of the night) and my husband was a bedwetter, too. As was one of his brothers and one of his sons from his first marriage. So our poor son really didn’t stand a chance – he was surrounded by a family tree of bedwetters.

And so knowing this, I thought I was prepared to do what needed doing for our bedwetting boy. Except I wasn’t.

For almost 10 years this mum tried to help her son stop wetting his bed. Source: iStock

The early years

After patting myself on the back when our boy spontaneously toilet trained himself on his second birthday, I thought that perhaps, PERHAPS night training wasn’t going to be such a big deal after all.

Fast forward through three years of being greeted each morning by a sodden, at-capacity Pull-Up. We never, not once, glimpsed a future where the occasional dry night might occur. Sometimes our growing boy would completely drown his Pull-Up and wake with a flooded bed AND sodden pants.

Starting school

At age five, and about to embark on his first year of Big School, we thought we needed to move things along a bit and made the decision to retire the Pull-Ups . The hope was that after a week or so of cold, wet, midnight awakenings, his body would start to get the idea.

The reality was that he was such a deep sleeper that nothing, NOTHING woke him up. We’d go in to check on him before going to bed and there he would be – fast asleep in sodden pyjamas on a sodden mattress amongst sodden sheets. Quite happy and quite deeply asleep.

Waking him to pee

So we started down the path of intervention – waking him at 10:30pm to go to the toilet. Sometimes we would get there too late and the bed would be wet already. Sometimes we would ‘wake’ him and walk him to the loo. In truth, we steered a sleeping boy to the bathroom and pointed him in the direction of the toilet. Yes, he peed but no, he never learned to wake on his own.

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The following years

And so the grind really began – every six months or so, we would get energised and try something new, always sure that with him being that little bit older, surely something would work. We tried:

  • the bell and mat
  • the pants alarm
  • restricting fluids
  • rewards (for the record, these are completely pointless. There is no way to offer rewards to a boy who is simply a super-deep sleeper)
  • waking him at night.

And none of them worked. Yes, he did improve slightly – less multiple bedwettings in a single night. But ultimately he was a bedwetter.

By the time he was moving into Year 5 and 6 at school, the bedwetting was starting to become a problem that was larger than what we were tackling at home. There were sleepovers he didn’t want to go to (or DID want to go to but wasn’t willing to risk going to), and there were school camps that he had to go to. We spoke to lovely and very understanding teachers but ultimately, we had to hand over our leaky son and hope that he could discreetly manage it all on his own for a week.

Enter medication

By this time, we had progressed to the Bedwetting Clinic at Sydney Children’s Hospital, Westmead and the medication Minirin as the hoped-for solution. A drug that drastically reduces the amount of urine made overnight, even this wasn’t the total cure and for us, was not totally reliable. So we were still taking him to the loo at 10:30pm each night.

Are we going to have a bedwetting adult?

And so into high school and more missed sleepovers and more stressful school camps. Our son continued on with the Minirin and 10:30pm peeing sessions and slowly, ever so slowly, we started to see a dry night every so often. Then it was a dry night once a week and then every couple of days and then, finally, he was dry. Really dry.

And it only took 10 years to get there. Ten years and three new mattresses, five new pillows, four new doonas and loads of washing to numerous to count.

In the end, I believe that he simply grew out of it. I suspect that nothing we did helped or hindered. He just needed to be 13 years old to get through the night without wetting the bed.

Bedwetting

Nocturnal enuresis is the medical term for bedwetting, which is involuntary urination during sleep. Bedwetting is quite common but it can be embarrassing for children. They may feel isolated and unable to talk to others about it. They may avoid certain social situations, such as overnight camps and slumber parties. They may be the target of bullying or even blamed for being wet even though they cannot help it. Bedwetting may cause problems such as decreased self-esteem and psychological distress for the child and the family.

How common is bedwetting?

Bedwetting is very common. In the United States, approximately five to seven million children wet the bed. 10-15 percent of children will continue to wet the bed until age 6. Each year approximately 15 percent of children who wet the bed will stop spontaneously, though 1-2 percent will continue to experience bedwetting into adulthood. Bedwetting is twice as common in boys as it is in girls. It is also more common in children who have a close relative with a history of bedwetting as well as in children with attention deficit hyperactivity disorder.

Types of bedwetting and their causes

Primary nocturnal enuresis is when a child has never been consistently dry at night. Most children who experience bedwetting have primary enuresis. It is not caused by psychiatric or emotional problems. It may be associated with increased urine production, small bladder capacity, or overactive bladder. These children do not wake to the body’s signal for the need to void. The most common cause for this may be delayed development of the brain’s regulation on the bladder.

Secondary nocturnal enuresis is when a child has made it through at least a six-month stretch of dryness at night and then starts wetting the bed again. Secondary enuresis is less common than primary nocturnal enuresis and accounts for approximately 25 percent of children with bedwetting. Associated medical problems may include a urinary tract infection or constipation, in addition to type I diabetes or sleep disordered breathing. Secondary nocturnal enuresis may also be associated with a change in the child’s life, including stressors such as divorce, moving, a new sibling, or a death in the family. A visit to your child’s doctor can help uncover the cause.

When should I speak with my child’s doctor about bedwetting?

Bedwetting may be problematic if a child is 5 years of age or older and wets the bed at least two times per week for at least three consecutive months. If your child has primary nocturnal enuresis and is not demonstrating improvement in terms of reduced volume or frequency of wetting by age 7, or if the family is experiencing difficulty at any age, consider speaking with your child’s doctor. However, if your child continues to have nocturnal enuresis at 8 years of age, without a family history of enuresis, ask that your child be evaluated by his or her doctor. Even though many children will outgrow bedwetting, the psychological effects or interference with the ability to socialize are the primary reasons to get treatment.

How is bedwetting evaluated?

Contact your child’s doctor if you have any concerns regarding bedwetting. It may be helpful to complete an elimination diary documenting his or her voiding and stooling habits. It may also be useful to keep track of your child’s daily fluid intake, including any caffeine intake. All this information can be very useful to your child’s doctor. In addition, the doctor will complete a physical exam and a urinalysis may be collected. A urinalysis is a laboratory study completed on a sample of your child’s urine, which can help evaluate concentration, signs of infection, or the presence of glucose.

Tips and treatments for bedwetting

Remember: Never punish your child for wetting the bed! It is not helpful as bedwetting is not a deliberate act. There are many different treatments options and ways to help empower your child. Of note, behavioral interventions are less likely to be successful if your child is not a motivated participant in the process. Your child’s doctor can assist you in deciding which treatment may work best for your child. Here are some tips and treatments:

  • Be patient and understanding. Most children will attain continence with time, even without treatment.
  • If a family member was affected by bedwetting, it may be helpful to have them speak with your child in order to minimize feelings of isolation.
  • Respect your child’s privacy and do not discuss bedwetting in front of others, unless medically necessary.
  • Restrict fluid intake in the evening; however, it is important that your child maintains adequate hydration throughout the rest of the day. In general, your child should consume approximately 2/3 of their daily fluid intake by the end of the school day and the remaining 1/3 after returning home. One caveat to this is children who participate in after-school sports, as hydration is essential. Advise against additional fluid consumption in the hour before bedtime.
  • Establish a regular bedtime routine and sleep patterns, which will enable your child to be well rested.
  • Encourage your child to void prior to going to bed and anytime he or she wakes up overnight.
  • A bedwetting alarm is a first-line treatment, as it is very effective (approximately 2/3 of children will respond) especially in terms of long-term cure rate. It utilizes a sensor in the underwear that sets off an alarm, vibratory or auditory, when it gets wet. Use of the alarm is a family-team effort, as children with nocturnal enuresis require help waking up to the alarm in the beginning. Once the child wakes up, he or she should void in the toilet and assist in changing pajamas and bedding. This should be done in a matter-of-fact manner, as a means of taking responsibility for personal hygiene rather than as a punishment. The alarm should be used consistently for at least two to three months. The alarm should be used until at least 14 consecutive nights without a bedwetting incident. However, if nocturnal enuresis recurs after earlier success, replace the alarm until an additional month of successful use. Of note, consider using a reward system, such as a sticker chart, in conjunction with the alarm system to incentivize cooperation.
  • Another first-line treatment is a medication named Desmopressin, which reduces urine production overnight. The recommended trial duration is approximately three months but it can be used intermittently for specific social events such as a sleepover. Of note, relapse may occur at a higher rate with Desmopressin as compared to the bedwetting alarm.
  • In addition, if constipation is contributing to your child’s bedwetting, working with your child’s doctor to achieve regular stooling may be beneficial. Adequate fluid and fiber intake, as well as physical activity, may be helpful in achieving regular stooling habits.

Additional resources:

  • National Kidney Foundation
  • Bedwetting (AAP)

Updated by Kimberly Levitt, MD, and reviewed by Barbara Felt, MD

Updated March 2018

Bedwetting (Nocturnal Enuresis)

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What Is Enuresis?

The medical name for not being able to control your pee is enuresis (pronounced: en-yuh-REE-sis). Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder. (Involuntary urination that happens during the day is known as diurnal enuresis.)

Most of us think of bedwetting as something that happens with little kids. But this problem affects about 1–2 out of every 100 teens.

What Happens in Enuresis?

There are two kinds of enuresis:

  • Someone with primary nocturnal enuresis has wet the bed since he or she was a baby. This is the most common type of enuresis.
  • Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control their bladder.

The bladder is a muscular receptacle, or holding container, for pee (urine). It expands (gets bigger) as pee enters and then contracts (gets smaller) to push the pee out.

In a person with normal bladder control:

  • Nerves in the bladder wall send a message to the brain when the bladder is full.
  • The brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom.

But people with nocturnal enuresis have a problem that causes them to pee involuntarily at night.

What Causes Enuresis?

Doctors don’t always know the exact cause of nocturnal enuresis. But they think that these things may play a role:

  • Hormonal problems. A hormone called antidiuretic hormone, or ADH, causes the body to make less pee at night. But some people’s bodies don’t make enough ADH, which means their bodies may make too much urine while they’re sleeping.
  • Bladder problems. In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of pee. Some teens and adults also have relatively small bladders that can’t hold a lot of urine.
  • Genetics. Teens with enuresis often have a parent who had the same problem at about the same age. Scientists have identified specific genes that cause enuresis.
  • Sleep problems. Some teens may sleep so deeply that they don’t wake up when they need to pee.
  • Caffeine. Using caffeine causes a person to pee more.
  • Medical conditions. Medical conditions that can trigger secondary enuresis include diabetes, urinary tract abnormalities (problems with the structure of a person’s urinary tract), constipation, and urinary tract infections (UTIs).
  • Psychological problems. Some experts believe that stress can be linked to enuresis.

Doctors don’t know exactly why, but more than twice as many guys as girls have enuresis. It is often seen in combination with ADHD.

How Is Enuresis Diagnosed?

If you’re having trouble controlling your urine at night, talk to your doctor to learn more about nocturnal enuresis and to rule out the possibility of a medical problem.

The doctor will do an exam, and ask you about any concerns and symptoms you have, your past health, your family’s health, any medicines you’re taking, any allergies you may have, and other issues. This is called the medical history. He or she may ask about sleep patterns, bowel habits, and urinary symptoms (such as an urge to pee a lot or pain or burning when you pee). Your doctor may also discuss any stressful situations that could be contributing to the problem.

The initial exam will probably include a urinalysis and urine culture. In these tests, urine is examined for signs of disease. Most of the time in people with nocturnal enuresis, these test results come back completely normal.

How Is Enuresis Treated?

Doctors can do several things to treat bedwetting, depending on what’s causing it. If an illness is responsible, which is not very common, it will be treated.

If the history and physical exam do not find a medical problem and the urine tests are negative, several behavioral approaches can be used for treatment:

  • Manage what you eat and drink before bed. People with nocturnal enuresis can take some basic steps to prevent an overly full bladder, such as decreasing the amount of fluids they drink before going to bed. You can reduce the chances that you’ll wet the bed by going to the toilet just before bedtime.
    It may help to avoid eating foods that can irritate the bladder. These include coffee, tea, chocolate, and sodas or other carbonated beverages with caffeine.
  • Imagine yourself dry. Using a technique called positive imagery, where you think about waking up dry before you go to sleep, can help some people stop bedwetting. Some people find that rewarding themselves for waking up dry also works.
  • Use bedwetting alarms. Doctors and nurses sometimes prescribe bedwetting alarms to treat teens with enuresis. With these alarms, a bell or buzzer goes off when a person begins to wet the bed. Then, you can quickly turn the alarm off, go to the toilet, and go back to sleep without wetting the bed too much. It can take many weeks for the body to unlearn something it’s been doing for years. Eventually, you can train yourself to get up before the alarm goes off or to hold your urine until morning.
    People who sleep very deeply may need to rely on a parent or other family member to wake them up if they don’t hear the alarm. The key to bedwetting alarms is waking up quickly — the sooner a person wakes up, the more effective the behavior modification for telling the brain to wake up or send the bladder signals to hold the pee until the morning.
  • Sometimes doctors treat enuresis with medicine. But no medicine has been proved to cure bedwetting permanently, and the problem usually returns when the medicine is stopped. Doctors sometimes prescribe a manmade form of ADH to decrease urine buildup during the night. Other medicines relax the bladder, allowing it to hold more pee.

If you’re worried about enuresis, the best thing to do is talk to your doctor for ideas on how to cope with it. Your mom or dad can also give you tips on how to cope, especially if he or she had the problem as a teen.

The good news is that it’s likely that bedwetting will go away on its own.

Reviewed by: Marcella A. Escoto, DO Date reviewed: December 2018

Nocturnal enuresis is the medical term for bedwetting. Most children wet the bed occasionally or even nightly during the potty-training years. In fact, it is estimated that seven million children in the United States wet their beds on a regular basis. Controlling bladder function during sleep is usually the last stage of potty-training. In others words, it is normal for children to wet the bed while sleeping during that learning process. Bedwetting is typically not even considered to be a problem until after age 7.

Bedwetting in children is often simply a result of immaturity. The age at which children become able to control their bladders during sleep is variable. Bladder control is a complex process that involves coordinated action of the muscles, nerves, spinal cord and brain. In this case, the problem will resolve in time. On the other hand, it may be an indication of an underlying medical condition, such as obstruction of the urinary tract. If bedwetting persists beyond the age of 6 or 7, you should consult your pediatrician.

There are both primary and secondary forms of bedwetting. With primary bedwetting, the child has never had nighttime control over urination. The secondary form is less common and refers to bedwetting that occurs after the child has been dry during sleep for 6 or more months. Secondary bedwetting may be caused by psychological stress but may be the result of an underlying medical condition such as constipation or urinary tract obstruction. With secondary bedwetting, contact your doctor for an evaluation.

Symptoms of Bedwetting

Bedwetting refers to involuntary urination during sleep in children over the age of 5. Bedwetting may occur at any point during the night but usually occurs during the first few hours of sleep. Occasional bedwetting for children over the age of 5 is not uncommon but if it happens more often than 2-3 times per month, parents should consult their pediatrician.

How to Treat Bedwetting

Because bedwetting tends to happen during the first few hours of sleep, a good method of preventing it is to make sure that your child goes to the bathroom before bed. Commonly prescribed behavioral methods for treating the problem include:

  • Establishing a regular bedtime routine that includes going to the bathroom
  • Waking your child during the night before he/she typically wets the bed and taking him/her to the bathroom
  • Developing a reward system to encourage your child, such as stickers for dry nights
  • Talking to your child about the advantages of potty-training, such as not having to wear diapers and becoming a “big kid”
  • Limiting beverages in the evening – even those last minute water requests
  • Using a “bell-and-pad” which incorporates an alarm that goes off whenever your child’s pajamas or bed become wet during an accident. These systems teach your child to eventually wake up before the bedwetting occurs

As a last resort, a doctor may prescribe medication for bedwetting, either for short or long-term use. Some examples are imipramine (an antidepressant), which relaxes the bladder, and desmopressin, a man-made copy of a normal body chemical that controls urine production at night. Although medication usually helps, bedwetting typically resumes once the child stops taking the medicine. As with any drug, it is important to monitor your child’s response to the medication.

Coping with Bedwetting

There are products that parents can buy for school-aged children with enuresis:

  • Disposable absorbent underpants
  • Reusable absorbent underpants
  • Sleeping bag liners
  • Moisture alarms that go off when the child begins to wet the bed

There is no reason for punishment if your child wets the bed. Your child cannot help it. Talk to your doctor about treatment options and following these coping tips may help:

  • Be patient, understanding and attentive
  • Do not talk about the bedwetting in front of others
  • Talk to your child about how the bladder works
  • Avoid fluids in the hours before bed

Sleep in America (TM) Poll Data

According to the National Sleep Foundation’s 2003 Sleep in America poll, 14% of preschoolers and 4% of school-age children wet the bed a few nights per week or more and 21% of preschoolers and 7% of school-aged children do so once a week or more.

Reviewed by Jodi A. Mindell, Ph.D., June 2010

Bedwetting

Bedwetting happens when a child pees during sleep without knowing it. Many children will use the toilet well during the day long before they are dry through the night. It can be many months, even years, before children stay dry overnight.

Most children, but not all, stop bedwetting between the ages of 5 and 6 years old. Bedwetting is more common in boys and in deep sleepers.

What causes bedwetting?

Bedwetting is most often related to deep sleep—the bladder is full but the child doesn’t wake up. Some children have smaller bladders, or produce more urine during the night. Constipation can also lead to bedwetting because the bowel presses on the bladder.

If your child has always wet the bed and has never had 6 months or more of dry nights, there is nothing “wrong” with your child. This type of bedwetting is NOT caused by medical, emotional or behavioural problems.

But if your child has been dry overnight for at least 6 months and starts to wet the bed again, talk with your doctor.

Does bedwetting run in families?

Yes. In fact, scientists have discovered a gene for bedwetting. A child with one parent who wet the bed when they were young is 25% more likely to wet to the bed. If both parents wet the bed as children, that number rises to about 65%.

When do children outgrow bedwetting?

Most children will outgrow bedwetting on their own over time.

  • At 5 years of age, 15% of children wet the bed.
  • By 8 years, 6% to 8% of children wet the bed.
  • Without treatment, about 2% of children still wet the bed by 15 years of age.

Does bedwetting need to be treated?

Usually not. The more important question is whether the bedwetting is a problem for your child. If bedwetting isn’t upsetting her, then you probably don’t need to seek treatment. Most children eventually outgrow it.

However, by 8 to 10 years of age, bedwetting may start to affect your child’s self-esteem and interfere with social activities like sleepovers. If this is the case, you can talk to your doctor about the following options:

  • An alarm that your child wears at night. The alarm goes off when he starts to pee and helps teach him to wake up when he has a full bladder.
    • It’s a good idea to talk to your doctor before you decide to buy one because she can provide advice on how to use the alarm properly.
    • The alarm needs to be used daily over a 6 week to 3 month period to be effective.
  • Desmopressin acetate (or DDAVP) is a medication that has been used to treat bedwetting since the 1970s. It comes as an oral melt (a tablet that melts under the tongue) or a pill. Studies show that it works for most children on nights the medication is given. It won’t stop bedwetting completely, but it may be useful for special situations, such as sleepovers or camp.
    • Children should not drink water 1 hour before and 8 hours after taking DDAVP.
    • DDAVP can have mild side effects, such as headache or stomach pain. It can have severe side effects if not used properly or if your child has certain medical conditions such as cystic fibrosis or problems with fluid balance. Have a discussion with your child’s doctor if your child has any side effects.
    • Like all medications, DDAVP should only be used as prescribed by your doctor.

Whether you and your doctor decide to treat the bedwetting or simply wait for your child to outgrow it, be sure that your child knows that bedwetting is not a bad behaviour or laziness. Don’t ever punish your child for bedwetting. It is not his fault. Your comfort and support are very important.

What else can I do to help my child?

  • Make sure your child doesn’t drink too much fluid before bedtime.
  • Avoid drinks with caffeine (such as pop).
  • Encourage your child to go to the bathroom before bedtime.
  • Use training pants instead of diapers.
  • Make sure your child can easily reach the bathroom at night. For example, use a night light in the hall or in the bathroom.
  • Use a hospital-strength plastic mattress cover to avoid damage to the mattress.
  • Place a large towel underneath the bed sheet for extra absorption.
  • It’s not necessary to change a sleeping child who is wet. There is no harm in sleeping in wet PJs. Leave a towel and change of clothes in case your child does wake up.
  • Don’t wake your child up to pee when you go to bed. It doesn’t help with bedwetting and will just disrupt your child’s sleep.
  • When your child wets the bed, help him wash well in the morning so that there is no smell.

When should I talk to my doctor?

Talk to your doctor if your child:

  • is concerned or upset by the bedwetting.
  • is having daytime accidents.
  • has been dry for many months and suddenly starts bedwetting.
  • has other symptoms, such as a frequent need to pee or a burning sensation when peeing.
  • is still wetting past 5 to 6 years of age.

More information from the CPS:

  • Enuresis (position statement)

Reviewed by the following CPS committees:

  • Community Paediatrics Committee

Last Updated: November 2017

Pediatric Bedwetting Causes And Treatments | NAFC

Pediatric urologists are surgeons that specialize in the urinary tract. They are experts in bedwetting and spend a lot of their time helping children become dry.

Urologists are particularly skilled helping children with complicated types of wetting.

Pediatric nephrologists are pediatricians that specialize in kidney problems. They also know a lot about wetting problems.

Child psychologists and child psychiatrists also treat children with nocturnal enuresis.

WHAT TO EXPECT AT THE DOCTOR’S OFFICE

Some doctors prefer to tackle bedwetting during separate visits where it can be addressed in more detail.1 In addition to obtaining a medical history, healthcare providers will examine the child and get a urine analysis. Blood tests and radiologic procedures are not routinely needed for the diagnosis and treatment of nocturnal enuresis.

Treatment options will vary depending on the child’s age, the frequency of wetting, the impact on the family, and any symptoms that may be associated with the bedwetting. Both pharmacological and behavioral treatments exist. To better combat the problem, a combination of treatment modalities may be used if necessary. Unless an underlying medical cause is identified, primary and secondary bedwetting are treated the same way.

The most important aspect of treatment is determining if the child is motivated to become dry. There is no magic age when children are ready to work on their wetting, however, most children show some concern about the problem by the time they are 6- to 7-years-old.

There are five signs parents can look for to see if their child is ready to work on becoming dry:

  • He starts to notice that he is wet in the morning and doesn’t like it
  • He says he does not want to wear pull-ups anymore
  • He says he wants to be dry at night
  • He asks if any family members wet the bed when they were children
  • He does not want to go on sleepovers because he is wet at night

HOW PARENTS CAN HELP

There are a number of things parents can do to reduce the stress associated with nocturnal enuresis:

  • Remind children that bedwetting is no one’s fault
  • Let children know that lots of kids have the same problem
  • Do not punish or shame children for being wet at night
  • Make sure the child’s siblings do not tease him about wetting the bed
  • Let children know if anyone in the family wet the bed growing up
  • Maintain a low-key attitude after wetting episodes
  • Reinforce any efforts the child makes to help with his wetting, (e.g. stripping the bed or helping parents carry wet bedding to the laundry room)
  • raise the child for success in any of the following areas: waking up at night to urinate, having smaller wet spots, or having a dry night

MANAGEMENT

In addition to a treatment program, there are practical measures that parents can use to make it easier to live with bedwetting.

  • Mattress Covers. When a child wets the bed, urine can soak through the sheets and into the mattress. Over time, the mattress will begin to smell like urine. To prevent this from happening, parents should protect the mattress with a waterproof cover. Mattress covers protect the top and sides of the mattress or encase it completely. Parents can buy mattress covers at department stores or from medical supply companies that sell bedwetting products. Cheap mattress covers may crack or leak, so try to find one that is well made.
  • Absorbent Briefs. This product is a form of modified underwear that is built to absorb liquid, preventing leakage through to clothes or sheets. Both reusable and disposable products are available.
  • Odor Protection. Bedrooms can pick up a urine smell even if parents take care of wet beds promptly. The easiest way to handle odors is with room freshener. There are many types available, but they all work by putting a pleasant smell in the air. Room fresheners can be purchased at pharmacies and grocery stores. Another way to handle urine smells is to use a product that eliminates odors instead of masking them. These products come as sprays and solid odor absorbers and are available from medical supply companies.

BEHAVIORAL MODIFICATIONS

  • Restricting Fluids. Limiting a child’s fluid intake after dinner is designed to reduce his urine production at night. Although there is little data to support this approach, many parents find it an easy way to treat bedwetting.
  • Nighttime Waking (lifting). One of the techniques parents use to help children stay dry is to take them to the bathroom a few hours after they go to sleep. There is some data showing that lifting can help children become dry at night.
  • Bladder Therapy. This approach encourages children to increase their fluid intake during the day, to think about the sensation of a full bladder, to respond to their bladder at the first signal, and to fully empty their bladder each time they have to go.
  • Bedwetting Alarm. Available in a variety of models, all alarms work on the premise of waking a child if the wetness sensor detects urine.
  • Psychotherapy. A treatment option for children with secondary enuresis due to a change or traumatic event in their life or for those experiencing a significant problem with self-esteem because of their bedwetting.

PHARMACEUTICAL TREATMENT

There are a small number of medications that doctors use to treat bedwetting.

  • Desmopressin. This helps the kidneys produce less urine.
  • Imipramine. This medication boasts a 40% success rate but also has a fine line between an effective dose and toxic dose.
  • Oxybutynin. Oxybutynin is not an effective treatment for bedwetting by itself, but when used in conjunction with the bedwetting alarm or desmopressin, it may relax the bladder enough to make those treatments more successful.

Bedwetting is neither the fault of the child nor the parent. No one should feel ashamed or embarrassed. What is key is to speak with your physician and develop a plan to resolve this issue. Being proactive, using reinforcement and full commitment can help remedy this situation.

At what age is bedwetting a problem? It’s a common question fielded by pediatricians everywhere.

Bedwetting among older children is common, but can be uncomfortable and embarrassing for children and frustrating for parents. Because it’s rarely talked about among friends and extended family members, both parents and children can feel like there is something wrong with them when bedwetting continues into the elementary years and beyond.

So how can you get an older child to stop wetting the bed?

What parents should know about bedwetting

Jennifer Kirk, MSN, CPNP, a nurse practitioner in the Division of Urology at Children’s Hospital of Philadelphia (CHOP), works with dozens of families every year to help children overcome bedwetting.

Her first piece of advice is to recognize how common bedwetting is, and that most children naturally outgrow it. Experts estimate that 15 to 20 percent of children between the ages of 5 and 7 wet their beds at least occasionally. The numbers drop steadily as children age, down to about 2 percent at age 16. “About 15 percent of children who wet the bed will become dry every year,” says Kirk.

Bedwetting causes

Why do children wet the bed?

  • In many cases, bedwetting is a genetic pattern, inherited from a parent, aunt or uncle.
  • Most older children who wet the bed are very sound sleepers, so the signals of a full bladder aren’t strong enough to wake them.
  • Some children have small bladders or don’t produce enough of a hormone (vasopressin) that reduces urine production during sleep.
  • Bedwetting can be triggered by stress and by changes in the family, even positive ones, like a new baby or a different bedtime schedule over vacation.

In some cases, especially when bedwetting is a new occurrence, it can be a sign of another health problem. If your child is older than 7 and has started to wet the bed after many months of being dry, talk to your pediatrician. Your child’s primary care provider will ask if there have been any stressful events or changes in your child’s life, and can screen for health problems such as diabetes, constipation, sleep apnea or a urinary tract infection.

“You should only consider bedwetting a problem if your child does, for example if they feel embarrassed or upset, or if there is a medical cause for concern,” says Kirk. “The motivation to stop bedwetting needs to come from the child.”

How parents can help a child who wets the bed

“The key thing is not to blame or shame your child,” says Kirk. “Instead, focus on positive encouragement and practical steps you can take together.”

What are some of those practical steps to stop bedwetting?

Manage daytime fluid intake and urination

“Focus on what is going on during the day,” says Kirk. “The timing of fluid intake and urination during the day affects what happens at night.”

  • Work with your child to make a habit of urinating every two or three hours during the day, even when they don’t feel the need. Have them void twice at bedtime — once an hour before they go to bed and then again right before they go to bed.
  • Have your child use a calendar tracker to understand urination patterns over time. CHOP offers two of these trackers on its website, one for children and preteens and one for teens. This can give your child a sense of control over their bedwetting and help them see and feel good about progress.
  • Encourage your child to drink plenty of fluids early in the day, rather than waiting until the end of the day to quench their thirst. Children who participate in sports late in the day should hydrate before their practice or game, then try to limit fluid intake during the evening.

Minimize disruption and discomfort at night

Use a waterproof mattress cover and keep a clean set of sheets and sleepwear at hand in case a change is needed.

Consider a bedwetting alarm

Bedwetting alarms have a moisture sensor that triggers a bell or buzzer when the child’s pajamas start to get wet. “The alarm is for the parent, at least at first,” says Kirk. “A child who can sleep through a wet bed will sleep through the alarm.” So you might want to put a baby monitor in the child’s room.

The process takes time, but after three or four months most children (not all) learn to awaken when the alarm sounds and to get up and use the toilet.

“The alarm requires a motivated child and a motivated family to work,” says Kirk. “Timing is important. Pick a time free of stressors and when the family isn’t overcommitted.”

Talk with your child’s primary care provider about medication

Some children are helped by a medication — DDAVP®, or desmopressin — taken as a pill before bedtime to reduce the amount of urine produced during sleep. DDAVP can be a valuable tool for special events like sleepovers and sleep-away camp when used in addition to fluid and voiding management during the day.

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What Is Nocturnal Enuresis (Bedwetting)?

There are many treatments for bedwetting, some work better than others. Often, treatment starts with simple changes like:

  • Reducing the amount of fluids your child drinks 1-2 hours before bed
  • Creating a schedule for bathroom use (changing toilet habits)
  • Wetting alarm devices
  • Prescription Drugs

These strategies may be tried one at a time, or together.

The following strategies have not been shown to help:

  • Stopping food and fluid intake
  • Night waking
  • Pelvic muscle exercises
  • Alternative therapies

Reducing the amount of fluids your child drinks 1-2 hours before bed

Begin by encouraging your child to drink 1 or 2 extra glasses of water in the morning or at lunchtime. Then in the evening, your child should only drink to quench thirst. Try to prevent drinking 1 to 2 hours before bed. Also, limit or stop your child from drinking caffeinated and carbonated drinks like soda. 

Creating a schedule for bathroom use (changing toilet habits)

Bladder training is a way to set a bathroom schedule with your child. For example, have your child sit on the toilet five times each day and before bed, even if he/she says he/she doesn’t have to go.

Bedwetting (enuresis) alarms

Bedwetting alarms have a special sensor that detects moisture in a child’s pajamas or Pull-Ups® training pants. It triggers a bell or buzzer to go off with wetness. The child wakes with the alarm and tries to get up to go to the bathroom before having an accident. An adult will need to help, since most children who wet the bed sleep very deeply and do not wake up by themselves at first. The alarm works by “conditioning” a child to wake when it’s time to urinate. This is behavioral-type therapy that is known to be very successful.

Bedwetting alarms work with a sensor in the child’s pajamas or underwear that links to an electronic alarm. The alarm is either attached to the child’s clothing near the shoulder or clipped to the waist. The alarm unit may also be wireless, and placed on the counter. When the sensor becomes moist, the alarm is triggered. Some alarms also have a vibration mode that shakes the device. The alarm wakes the child so he or she can get to the bathroom to urinate or finish urinating.

Success for alarm therapy depends on parents understanding that this is a learning process. There are stages that a child and parents must go through for best results. Without patience, parent and child frustration will lead to quitting. Please try not to give up.

In the first and second stage of therapy, parents must wake up with the alarm and then wake the child from bed. The child then gets up, goes to the toilet, and tries to urinate for couple of minutes. they should then clean themselves in the shower, change their bed sheet or put on new pull up. The parent should be supportive and help. Then the child will turn the alarm back on, and go back to bed. In the third stage of therapy, the child should be able to wake on his or her own when their bladder feels full. Once the child successfully reaches this stage, parents should ask the child to use the device for 2-3 more weeks to reinforce this behavior.
Everyone at this stage should feel proud and relieved.

Tips for success:

  • Choose 3-4 months when a simple home routine can be made for treatment.
  • Agree with the child on a date when therapy will begin.
  • Perform a few drills with the alarm during the day so the child knows what to expect and what to do.
  • Keep a calendar in the child’s room to monitor progress.
  • Do not punish your child for accidents. Punishment is counterproductive. Instead, offer rewards for cooperating with therapy and completing tasks.

Advantages:

  • Not a prescription medication, so there are no side effects
  • Low rate of recurrence after device is stopped upon successful treatment
  • If used the right way, the chances of success are about 75% after 1 to 2 months of nonstop alarm treatment.

Disadvantages:

  • They require hard work and commitment from parents
  • They are not good for sleepovers.
  • They disturb siblings who share a bedroom
  • Many health plans do not pay for these devices, and they cost around $100

Drugs

Desmopressin acetate (DDAVP)

Desmopressin is made from the hormone “vasopressin”.

In normal conditions, vasopressin is produced by the kidneys when the body tries to conserve water. For example, athletes secrete more vasopressin when they are active and sweating. Most people have naturally higher levels of vasopressin during sleep. That is part of the reason why we can sleep through the night without needing to pass urine. In many children with enuresis, this hormone surge is absent. DDAVP is available as a pill. It can be given an hour before going to bed for a period of 3-6 months, with a one week break. Because it works to decrease the volume of urine made, it is used with a schedule of drinking less fluid.

Advantages:

  • When it works, it works very well
  • Can boost confidence on sleepovers
  • Can be used privately
  • The cost is usually covered by most health plans

Disadvantages:

  • This drug works on less than half of the treated children
  • The child’s body can adapt with time and stop responding to the drug

Oxybutynin and Tolterodine

These prescription drugs stop the bladder from having spasms with overactive bladder symptoms. It is helpful when a child has small bladder capacity, by increasing that capacity.

Advantages:

  • The drug can be combined with desmopressin to become more effective. The medication is safe and well tolerated by children.

Disadvantages:

  • The drug doesn’t work for everyone. It may
  • Common side effects include dry mouth, constipation, and facial flush. If constipation becomes a problem, be aware that this can make bedwetting worse.

Imipramine

Imipramine is an anti-depressant medication that has been used for many years to treat children with bedwetting. It does not mean that depression is a cause for bedwetting. It is not clear how imipramine helps in this case, but it is believed to improve the child’s sleep patterns and bladder capacity. Side effects can include irritability, insomnia, drowsiness, reduced appetite, and personality changes. Overdose can be deadly. This drug must be used and stored safely.

Finally, your health care provider should look for signs of constipation. Treatment with dietary advice and laxatives may be recommended. This may help with your child’s bedwetting issue.

Treatments That Are Not Recommended

Stopping all food and fluids before bedtime

Many parents think that if their child stops eating and drinking several hours before bed, it will help reduce or eliminate the bedwetting. However, this rarely helps. It’s a good idea to stop drinks 1-2 hours before bed and to always limit caffeinated and carbonated sodas. However, if a child is hungry or thirsty, it is okay to provide small amounts of food and water. (Note: Limiting drinks is needed for treatment with vasopressin drugs.)

Scheduled night waking

Before seeking medical care, many parents try waking a child during the night to take him/her to the bathroom. Some families try this more than once during the night. While it can be helpful in the short term, it is hard to continue over time. It is hard on family members and does not always work. Sometimes the child will still wet the bed

Pelvic floor muscle exercises

Adults with bladder control problems may find help with pelvic muscle exercises, like the Kegel. During these exercises, adults are asked to hold a full bladder and try to stop their urine stream. This effort does not usually help children. Children who hold their urine on purpose during the day may lead to problems with urgency, daytime wetting and even UTIs.

Alternative therapies

Homeopathy, herbal cures and chiropractic practices have not been found to help with children’s bedwetting.

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