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BED WETTING
Toilet training a child takes a
lot of patience, time, and understanding. Most children do not become fully
toilet trained until they are between 2 and 4 years of age. While many
children at this age are able to stay dry during the day, others may not be
able to stay dry during the night until they are older.
Causes of bed-wetting
Although all of the causes of
bed-wetting (enuresis) are not fully understood, following are some that are
possible:
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Your child’s bladder is not yet
developed enough to hold urine for a full night. |
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Your child is not yet able to
recognize when his bladder is full, wake up, and use the toilet. |
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Your child is responding to
changes or stresses going on at home such as a new baby, moving, or
divorce. |
All young children occasionally
wet their beds while going through nighttime toilet training. Even after
your preschooler is able to stay dry at night for a number of days or weeks,
she may start wetting at night again. When this happens, don’t make an issue
out of it. Simply put her back in training pants at night for a while until
she is ready to try again. The problem will probably disappear as your child
gets older.
Most school-aged children who wet
their beds have primary enuresis. This means they have never developed
nighttime bladder control. Instead, they have had this condition since birth
and often have a family history of the problem. Children who are older when
they develop nighttime bladder control often have at least one parent who
had the same problem.
If you are concerned about your
child’s bed-wetting, talk to your pediatrician. He or she may ask you the
following questions in order to find the cause of your child’s bed-wetting:
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Is there a family history of
bed-wetting? |
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How often does your child
urinate, and at what times of the day? |
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When does your child wet the
bed? Is your child very active, upset, or under unusual stress when it
happens? |
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Does your child tend to wet the
bed after drinking carbonated beverages, caffeine, citrus juices, or a lot
of water? |
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Is there anything unusual about
how your child urinates or the way his urine looks? |
Signs of a problem
If your child has been completely
toilet trained for 6 months or longer and suddenly begins wetting the bed
again, talk to your pediatrician. It may be a sign of a medical problem such
as:
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Bladder or kidney infections |
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Diabetes |
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Defects in the child’s urinary
system |
However, keep in mind that less
than 1% of bed-wetting cases are related to diseases or defects. If your
child has a medical problem that is causing the bed-wetting, there are
usually other signs including:
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Changes in how much and how
often your child urinates during the day |
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Discomfort while urinating |
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Unusual straining during
urination |
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A very small or narrow stream
of urine, or dribbling that is constant or happens just after urination |
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Cloudy or pink urine, or
bloodstains on underpants or nightclothes |
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Daytime as well as nighttime
wetting |
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Burning during urination |
If there are signs that wetting
is due to more than just delayed development of bladder control, and your
child is older than 5 years of age, your pediatrician may order additional
tests, such as an ultrasound of the kidneys or bladder. If necessary, your
pediatrician will recommend that your child see a pediatric urologist, who
is specially trained to treat children’s urinary problems.
Tips to manage bed-wetting
It is important for parents to be
sensitive to the child’s feelings about bed-wetting. For instance, children
may not want to spend the night at a friend’s house or go to summer camp.
They may be embarrassed or scared that their friends will find out they wet
the bed.
Make sure your child understands
that bed- wetting is not his fault and that it will get better in time.
Remember, your child does not have control over the problem and would like
it to stop, too! Until that happens, the following steps might help:
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Protect the bed. Until your
child can stay dry during the night, put a rubber or plastic cover between
the sheet and mattress. This protects the bed from getting wet and
smelling like urine.
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Let your child help.
Encourage your child to help change the wet sheets and covers. This
teaches responsibility. At the same time it can relieve your child of any
embarrassment from having family members know every time she wets the bed.
If your child sees this as punishment, it is not recommended.
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Set a no-teasing rule in your family. Do not let family members, especially siblings, tease a child
who wets the bed. Explain to them that their brother or sister does not
wet the bed on purpose. Do not make an issue of the bed-wetting every time
it occurs.
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Take steps before bedtime.
Have your child use the toilet and avoid drinking large amounts of fluid
just before bedtime.
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Try to wake him up to use the
toilet again right before you go to bed if he’s been asleep for an
hour or more.
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Reward him for "dry"
nights, but do not punish him for "wet" ones.
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Use a bed-wetting alarm device.
If your child is still not able to stay dry during the night after
using the above steps for 1 to 3 months, your pediatrician may recommend
using a bed-wetting alarm. When the device senses urine, it sets off an
alarm so that the child can wake up to use the toilet. When used exactly
as directed, it will detect the wetness right away and sound the alarm. Be
sure your child resets the alarm before going back to sleep. These alarms
are available at most pharmacies and cost about $50 to $70. They produce a
50% to 75% cure rate, although some children occasionally relapse once
they stop using them. Alarms tend to be most helpful when children are
starting to have some dry nights and already have some bladder control on
their own.
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Medications. If the
bed-wetting alarm does not solve the problem after 4 or 6 months, your
pediatrician may prescribe an oral medication. Different medications are
available. Medications usually are a last resort and are not recommended
for preschool-aged children. Although it can be helpful for older
children, some medications can have side effects. About four to five out
of 10 children are helped by these medications. Your pediatrician will
discuss medication options with you, if necessary.
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Avoid unproven treatments.
Because bed- wetting is such a common problem, many mail-order treatment
programs and devices advertise that they are the cure. Use caution; many
of these products make false claims and promises and may be very
expensive. Your pediatrician is the best source for advice, and you should
ask for it before your child starts any treatment program.
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If none of the treatments work
A small number of children who
wet the bed do not respond to any treatment. Fortunately, as each year
passes, bed-wetting will decrease as the child’s body matures. By the teen
years almost all children will have outgrown the problem. Only 1 in 100
adults is troubled by persistent bed-wetting. Until your older child
outgrows bed-wetting, he will need a lot of emotional support from the
family. Support from a pediatrician or a mental health professional also can
help.
Parents need to provide support
Try not to pressure your child to
develop nighttime bladder control before his or her body is ready to do so.
As hard as your child might try, the bed-wetting is beyond control, and your
child may get frustrated or depressed because he or she cannot stop it.
If your child has enuresis,
discussing it with your pediatrician can help you to understand it better.
Your pediatrician can also reassure you that your child is normal, and will
eventually outgrow bed-wetting.
Copyright ©1996
American Academy of Pediatrics
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