By Shilpa Vernekar, M.D.
Significant number of children and adolescents suffer from primary nocturnal enuresis disorder, more commonly known as bedwetting. This disorder means more than a child having an accident once or twice and is defined by a child who has not been dry on most nights. From a child’s perspective, bedwetting becomes uncomfortable and embarrassing, and for the parent, it can become an aggravation to have to get up in the middle of the night to change the sheets as well as a potential concern about a greater issue.
So, when do most children stop bedwetting?
Most children are expected to be dry by night by 5- 6 years of age. With increasing age the tendency to be dry by night increases with this being a problem in only a small percentage of teenage children.
When is bedwetting a problem?
If your child frequently wets the bed, it is worth having a discussion with your pediatrician to rule out a medical and/or psychological reason for your child to not control bedwetting. Additionally, the healthcare provider can advise on the social consequences that often stem from bedwetting at night.
Medical or psychological causes have all been ruled out. What can I do as a parent to help my child?
- Alarm therapy is highly effective when used the right way and in approximately 8 to 12 weeks’ time, more than half of the children would by dry by night. As the name suggests, a sensory alarm that is attached to the undergarment rings immediately when the child passes urine, waking the child up. If the child does not wake up, then the parents need to wake the child up and accompany him/her to the bathroom. It must be used every night and may require 3 to 4 months to achieve the results. Eventually, a child will learn to wake up even before the alarm begins to ring. Since this is a behavior modification, there are no side effects other than the fact that till the child to learns to do this on his own, he will need help and support from his parents.
- Minimize the amount of fluid intake 1-2 hours before bedtime if possible. Also, limit any caffeine drinks for a few hours prior to bedtime.
- Ensure the child uses the bathroom just before going to bed.
- Try to avoid Pull Ups diapers, which are quite padded and may prevent the child from feeling the wet sensation that occurs with bedwetting. It is important for the child to feel the dampness in order to wake up while bedwetting is occurring and get up to use the bathroom.
- Have a dim light on so that the child can make it safely to the bathroom, and keep a fresh set of clothes ready by bedside for him to change after the bedwetting episode.
- Use positive reinforcement strategies by repeatedly and emphatically praising the child each time he/she has a dry night. Ensure that those who are close to the child and already know about the condition, such as another parent or grandparent, also offer praise and encouragement for dry nights. It is important not to let his/her peers or outside strangers know about this condition, which could cause embarrassment for the child. Also, consider some incentive for this positive behavior so that dry nights become connected with a favorite reward. Non-food rewards are preferred in this situation.
- Avoid showing displeasure if the child wets the bed after you have started to take precautions to avoid it. Like all other behavior modifications, this takes time and patience.
- Remember that bedwetting has a familial inheritance, and if parents or siblings took longer to have dry nights, there is a possibility that this one might do the same.
- Lastly, medications can be used if all else fails. Medications can be used daily or as needed (ie for visiting relatives or during sleepovers.) Note that these may not permanently cure the problem. Consult your child’s pediatrician for more information.