What is bed-wetting?
Bed-wetting (enuresis) is urination (peeing) at night that your child cannot control. The child may also have trouble recognizing when the bladder is full even when awake, and may pass urine without meaning to in the daytime. Bed-wetting is also called nocturnal enuresis. Day-time wetting is called diurnal enuresis. They are two very different conditions.
Bed-wetting is common in young children. Bed-wetting is found in about 1 in 10 five-year-old children. It declines to about 2 in 100 teenagers 15 years of age. Unintentional and unconscious urination at night is a normal stage in your child’s development. Do not look at it as failed toilet training. Each child matures and develops good bladder control at a different pace. Very few children have dry nights before 3 years old. Most children start to stay dry at night some time between the ages of 3 and 8 years. Until your child achieves this milestone, your patience and understanding is helpful and encouraging for your child.
Causes
In most cases, bed-wetting occurs because your child is simply a deep sleeper and does not wake up when the bladder is full.
Often, the tendency to wet the bed can run in families. If you were a bed-wetter, your child is more likely to do the same.
In very rare cases, type 1 diabetes or a congenital defect of the urinary tract can be the cause of the enuresis. However, these conditions do not simply cause bed-wetting, they cause day-time symptoms too. In the absence of daytime symptoms you can rest assured that your child is likely to be completely healthy.
Emotional and behavioural problems, like anxiety or dealing with a new home or sibling, are not causes of bedwetting. Anxiety and poor self-esteem may develop if bed-wetting is treated as the child’s "problem". Bed-wetting is, simply, a laundry challenge.
When should you see a doctor?
It may be necessary to make an appointment with your child’s doctor if the enuresis occurs during the day AND if it continues when your child is 6 years of age or older.
Your child should see a doctor if a 6-month, completely dry period has been followed by sudden onset of wetting.
Treatments and drugs
If your child’s doctor finds a physical cause for day-time wetting (diurnal enuresis), medication may be prescribed, such as antibiotics to treat a urinary tract infection.
For bed-wetting (nocturnal enuresis), your child’s doctor may prescribe a hormone called desmopressin (DDAVO), but only for sleep-overs and camp.
How to help your child with enuresis
Your child may require your reassurance and understanding. Encouragement and positive reinforcement (praising dry nights) is no longer recommended because it is difficult to convince children that there is no shame in wet nights when we praise dry night. Gentle reminders to urinate before going to bed may help but ‘lifting’ (waking a child to urinate) is probably more trouble than it is worth. Most children stop wetting the bed without treatment.
Control anger and reassure your child
If you find yourself constantly washing your child’s sheets, it is easy to get frustrated. Instead of punishing or humiliating your child, reassure him that it is not his fault, and that in time it will get better.
Other family members should be sensitive to the condition as well. Don’t let other family members make jokes or tease your child.
Other common-sense tips to help your child include:
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Remind your child to get up at night and use the toilet.
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Make sure the path to the toilet is accessible.
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Encourage your child to go to the toilet before bedtime. Another option is to ask your child to go to the bathroom at the beginning of the bedtime routine, and then again just before going to bed.
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Use a plastic cover on the mattress.
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Include child in any morning cleaning routines in a non-humiliating, non-punitive way.
For more information, please read Bladder Retraining.
Key points
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Bed-wetting is common in young children.
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Every child develops bladder control at a different pace.
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Speak to a doctor if your child is having difficulty controling his bladder during the day and night after 6 years of age.
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Treatment should include reassurance and gentle reminders about bathroom routine.
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Punishment and humiliation will not help your child develop better bladder control.