Bed Wetting Becomes A Problem
When bed-wetting becomes a problem in your home, what do you do?
Often times when a child is wetting his or her bed, the reason is due either to an undiagnosed medical condition or due to psychological effects. As a parent, you will want to find out what is happening with your child so that you can stop bedwetting.
Unfortunately, there are things that prevent many parents from trying to determine what causes their child’s bedwetting. Some of the things that stop parents from helping their children include:
•Shame (parents worry that a child’s bedwetting will reflect badly on them while children may be reluctant to speak with a paediatrician about a problem that is embarrassing for them).
•Misconceptions about bedwetting
•Time (some parents may be reluctant to take the time to help a child, assuming that bedwetting is a normal childhood ailment and will be resolved by itself)
•Anger (parents may feel frustrated or angry with the problem and this may make them think of the problem as unimportant)
This article will give you the knowledge to help your child overcome bedwetting which is organized into tips, you can easily read the article a tip or two at a time, in your spare time, and try several ideas that may be effective in stopping bedwetting. Plus, the facts about bedwetting, and the latest research and information you need to make educated choices that can help your child stop wetting the bed.
Before we start to consider some of the things that can be done to stop bedwetting in its tracks, we need to discuss the very idea of bedwetting. Bedwetting occurs at night, and often in children who have no trouble or little trouble controlling their bladder during the day. This means that for these children, bedwetting makes bedtime a terrible time. Rather than being a time of stories and rest, bedtime becomes a time of conflict and stress for both parent and child.
Bedwetting is not a rare problem. Experts think that five to seven million children in this country wet the bed at least occasionally. The older children get, the less likely they are to wet the bed, as children outgrow the problem at a rate of roughly 15% per year. However, this means that 1% of older teenagers, and 20% of children between the ages of six and five will still wet their bed regularly.
Bedwetting creates stress for the entire family. Parents may be frustrated and fatigued by the washing of sheets, drying of mattresses, and reassurances that follow each incident of bedwetting.
The medical term for bedwetting is Enuresis and it is a serious subject for medical research. Researchers have found that a few basic causes of bedwetting seem to be the culprit for most sufferers of Enuresis.
Among medical causes, ailments such as urinary tract infections, allergies, diabetes, cell anaemia and sleep disorders are often the culprit.
Since bedwetting is often the first sign of these problems, it is a good idea to get your child checked out for these conditions. In addition, researchers have found that psychological reasons such as stress, upset, and trauma often contribute to bedwetting.
Children who wet the bed for any reason often suffer needlessly, and this suffering is the best reason to get your child help for Enuresis. Children who wet the bed often suffer from low self-esteem, withdrawal, stress, fear, and other problems. These children may suffer from sleeplessness because they fear or are embarrassed by what happens when they sleep.
A child with Enuresis is often teased by others and may feel dirty by the smell of urine about them. The child may even avoid others out of fear of ridicule. At the very least, fun childhood activities such as camp, sleep overs, and camping may be made into traumatic rather than happy events for the bedwetting child.
Many parents wonder whether they should seek help for bedwetting. After all, despite the problems of bedwetting, many doctors still recommend patience and time as the best way to resolve bedwetting, as many children overcome the problem with no extra help.
Of course, many children does not mean all children, and telling an anxious child that he or she will wake up dry "someday" is not terribly reassuring for anyone. In general, there are a few signs that you should seek help for bedwetting:
•You child asks for help. If your child thinks that bedwetting is enough of a problem that they need help with it, then bedwetting is serious enough to demand some sort of remedy. Period.
•Your child has suddenly developed a problem after having no problems staying dry before. Often, this is a sign of some problem and should be investigated.
•Your child acts out or has problems with others (teasing or lack of friends) as a result of bedwetting.
•Your child avoids normal activities that they like (camping, going out) because of bedwetting.
•Child is bedwetting regularly after eight years old and the problem is causing distress.
•Bedwetting is causing problems in the household.
If any of the following apply, then consider the following 101 tips - you are sure to find solutions to try for you and your child!
Initial Tips for Dealing with Bedwetting in Your Household
There are some tips you will want to adopt right away in order to deal with bedwetting in your household:
One of the biggest impacts of bedwetting on your child is an emotional one, so you should work on making sure that your household is sensitive to your child’s situation. No one at home should tease your child or make them feel terrible about their bedwetting. The more teased a child is about bedwetting, the more difficult it will be for the child to overcome the problem.
The older a child is, the more ashamed they may be of wetting the bed, and the more important it will be to stay level-headed and calm to prevent shaming the child.
Shaming will only result in trauma and may even make bedwetting worse.
Tip #2: Watch your own sensitivity levels.
It is not just siblings and other children that need to be considered. Parents often inadvertently are insensitive to their child’s bedwetting. They are frustrated by the laundry that must be done and are sometimes even angered by having so many sheets stained or even ruined by urine.
On a rushed morning, dealing with urine-soaked sheets before dashing off to work can be frustrating, but it is crucial not to lose your temper. Even if you manage to be calm most of the time, one outburst about bedwetting will linger in your child’s mind and make them feel ashamed.
If you find that you have no time to deal with sheets and clean-up in the morning, strip the sheets and leave them for later. If you are angry by the cost of bed linens, consider buying less expensive sheets in bulk for a while to reduce costs for yourself. Keep rags and other clean up items (deodorizer and cleaner) safely in the child’s room for fast cleaning.
Work on reducing your stress levels when it comes to bedwetting, and you are less likely to make an unfortunate comment from pure stress.
Tip #3: Educate Yourself
Throughout this article, you will be able to educate yourself about the facts of bedwetting. However, you will want to share what you have learned with others in your household. If you have several children, you need to be aware that siblings will often tease a brother or sister who "still wets the bed." Letting these children know that Enuresis is a condition can help them be more sensitive towards their sibling while measures are taken to prevent bedwetting.
Tip #4: Educate your child
For the child affected by Enuresis, being told the facts about bedwetting can be a big help. Children often hear misconceptions about bedwetting from other children. Myths such as "only babies wet the bed" can be hurtful to your child and can make him or her feel as though there is something "wrong" with them.
Often, explaining that Enuresis is an actual condition and talking about the remedies doctors have come up for it can help persuade your child that bedwetting is curable and a common problem. That way, your child can focus on resolving the problem rather than worry about the embarrassment they feel.
Tip # 5:Visit a Doctor
Since some bedwetting is caused by undiagnosed medical conditions such as diabetes or allergies, it makes sense to take your child to a doctor to be checked out.
If there is a doctor in your area who is known for treating children with Enuresis, so much the better. In either case, ruling out medical problems can be a big relief. If a medical problem is causing your child to wet the bed, coping with the problem will also generally resolve the Enuresis.
Tip #6: Evaluate
Evaluate how much of a problem bedwetting is in your family and how often it happens. Frequent bedwetting that causes many tears and embarrassment or even arguments in your household may need more aggressive treatment than bedwetting that occurs once in a while and results in only some extra laundry.
Tip #7: Different types of bedwetting demand different approaches
Also, be sure to differentiate between primary and secondary Enuresis. Primary nocturnal Enuresis is almost never caused by an underlying medical problem. Secondary nocturnal Enuresis means that a child has had control of his or her bladder but has begun wetting the bed.
In these cases, it is especially important to have the child seen by a good paediatrician, as almost all cases of secondary Enuresis are caused by an underlying problem (psychological or physical) and so responds very well to treatment.
Tip #8: Make it less stressful
Once you have evaluated the bedwetting in your household, you can develop a plan of action. Since you will be learning many tips that you can apply to your plan in the upcoming pages, your plan here is basically a contingency plan. On a paper, write down what your child should do when he or she wets the bed.
Ideally, your child should contact you, and then you should take steps to clean up. Share the plan with your child so that when an accident happens, your child can put the plan into action rather than being ashamed and trying to get your attention.
There are also a few things you can do to make bedwetting less stressful. Putting special sheets on your child’s bed, for example, can make clean-up much easier.
Keeping extra sheets and blankets by your child’s room can also make clean-up much faster, especially in a busy household. Even small things you can do to make bedwetting less stressful will allow you and your child to focus on resolving the problem rather than worry about clean up.
Tip #9: Reality Check
Consider whether there really is a problem. Although we often expect kids to grow up fast today, the fact is that occasional bedwetting up to age three is still considered "normal" by most experts - children at this age are still simply learning to do basic things like use the washroom and control their bladder.
Even kids up to age five may have an occasional bed wetting "accident" and this should not be a cause for concern. Many experts consider children over five who wet the bed regularly to have nocturnal Enuresis. In many cases, this condition tends to run in families and can last well into teenage years.
Before you start worrying unduly about bedwetting, consider the age of your child. If your child is very young, it may simply take a few months or a year to resolve the issue.
Many children have night time accidents until they are five or even older. If your child is older (six, seven, or older), consider whether anyone else in the family suffered from similar bedwetting problems in childhood. Was there something that helped?
Sometimes, just seeing Enuresis as a childhood ailment or a condition in the family that is always resolved eventually can help soothe the frazzled parent and the embarrassed child.
You need to consider the frequency of problems as well. A child who wets the bed after watching a scary movie or before a big day may be less worrisome than the older child who does not seem to be able to sleep through a dry night.
Tip #10: Once you have calmed down, take action.
Many of the above tips are intended to get parents and children more comfortable with the bedwetting and accidents that occur when a child is trying to cope with Enuresis.
This is because bedwetting is such a stressful and emotional issue - in fact, some polls have suggested that besides divorce and family conflict, it is one of the most stressful issues for families. Learning to deal with the problem calmly, then, is a big priority.
However, parents should not just allow themselves to be placated into taking no action at all.
The fact is, bedwetting can still be a nuisance and a problem for your child, and there are many solutions out there. Once your family has learned to deal with the problem in a level-headed way, do encourage your family to seek solutions rather than wait for the problem to go away on its own. There are many solutions out there that can help your child, so that your son or daughter do not suffer needlessly.
Tip #11: Don’t let it become a big deal.
Of course, you want to help your child stop wetting the bed so that they can enjoy a comfortable sleep with no embarrassment in the morning, but be careful that you desire to help does not come across as a sign that there is something wrong. Don’t make bedwetting - an un-dangerous condition - become a big issue at your house.
Tip #12: Keep things low-key
Make sure that the approach to bedwetting is a low-key one. Point out that it is not a child’s fault and that it usually means that a child simply needs to keep growing up - there is nothing abnormal about it. It often helps if the child knows that others in the family have experienced bedwetting and have grown out of it.
Also, make sure that any treatments or remedies used are offered in a low-key, non-threatening way. There is no need to keep stressing the child’s bedwetting throughout the day. Offer some therapy during the day but allow the child to play and just enjoy being a kid.
Tip #13: Let the child tell you when he or she has wet the bed.
If your child wets the bed, make sure that siblings or other well-intentioned members of the household don’t announce "Johnny wet the bed -again." This just leads to shaming.
Instead, it is often helpful to have a quiet time in the morning when your child can tell you himself or herself. Having a system (such as a calendar where the child marks wet and dry nights) can make it easier for the child to approach you, as there is a routine for sharing this information.
Tip #14: Let the child help.
If it will help your child feel less embarrassed, let him or her help clean up. He or she can tidy up the pillows or fold the sheets. In some cases, this can make the child feel less inept and babyish, if they can be entrusted with a grownup chore. Plus, if they can help clean the bed they may feel in control of a small part of their bedwetting.
Do not make cleaning up a punishment, but rather offer it as a way to make the child more comfortable. A comment such as "would you like to put the pillowcases on the pillows to make your bed more comfortable?" makes it clear that the child is not being punished for wetting the bed.
Tip #15: Stay alert for bigger problems
In the big scheme of things, bedwetting is not a big problem. Your child is not in any danger of serious injury or harm if he or she occasionally or even regularly loses control of their bladder at night. To a child, however, it may not seem like a small problem. For this reason, as a parent, you must remain alert for signs of bigger problems.
If your child’s bedwetting causes them to feel so ashamed or upset that their regular lie is affected, then that is a serious problem. If their schoolwork is affected, then their bedwetting may affect their development as well. If children are bullying or teasing your child to the point that social activities are a problem, then your child may experience alarming signs of stress and depression. In any of these cases, swift action is needed to ensure that your child stays safe and happy.
If your child shows any of the following symptoms, he or she may be struggling more than you know and should be taken to a doctor or paediatrician to get help sorting out the emotions he or she could be felling:
•Sudden and big changes in appetite (eats a lot less or far more)
•Fearful or withdrawn with others
•Does not show interest in regular activities
•Does not spend time with others and does not want to spend time with others
•Cries, gets angry or is very quiet often
•Loss of control of bladder during the day
•Grades dramatically worsen
•Bruising on the body or favourite toys are broken (may indicate bullying or self-destructive behaviour)
If you notice these problems, you will want to seek more aggressive treatment for the bedwetting and you will want to visit a doctor or counsellor to help your child deal with the problems caused by bedwetting.
Tip #16: Make sure that no medication is causing the problem.
Check the side effects and directions on your child’s medication. If your child is taking any medications that cause extreme drowsiness or an urgent need to urinate, the medications may be causing the problem. Medications that make your child very tired may simply not allow your child’s body to wake him or her up in time to go to the bathroom.
Talk to your pharmacist or doctor about any medication your child is taking and ask whether the substances may add to the bedwetting problem. Of course, your child may need medication that does not help his or her bedwetting, but in some cases doses or medications can be changed in order to prevent such side effects.
Tip #17: Make sure that your child has easy access to a bathroom.
A bright night light and a bathroom that is easy to access quickly at night will go a long way towards making sure that your child can get to the bathroom in time. Not every household can arrange to provide a bathroom near a child’s bedroom, but consider sleeping arrangements closely and consider rearrangements that could make night time bathroom trips much easier. Even something as simple as moving your child’s bed closer to the bedroom door can save a few seconds at night, reducing accidents.
Tip #18: Get your child to go to sleep a bit earlier.
Children who are tired may have a hard time waking up for anything - including a full bladder. If your child gets the sleep he or she needs, they will not be so overtired that they will be unable to wake up.
Tip #19: Look for psychological triggers.
Emotional states often add to bedwetting or even trigger it. If your child is undergoing an upset (divorce in the family, death in the family, bullying, moving, conflicts with siblings) this may contribute to bedwetting. In these cases, you can either wait for the child to adjust (at which point the bedwetting may cease too) or you can have your child see a paediatrician or child therapist. Sometimes, even talking about the problems can help, so be sure to discuss anything that seems to be bothering your child.
Tip #20: Have Your child self-monitor
Once you develop a system for dealing with bedwetting, or once you and your family start trying to control bedwetting in some way, it is useful to have a child check off on a calendar which nights were completely dry, on which nights a bathroom was reached successfully, and which nights were wet. Keeping track lets your child get involved in the solution process, which will make your child feel more confident. Once your child sees any improvement, he or she will likely be encouraged to further success.
Tip #21: Care for your child’s skin.
Bedwetting has few serious side effects, but one of the physical discomforts it may cause is skin problems. Urine is a mix of fluid and waste chemicals from the body. When left on skin for a few hours in the night, it can irritate. Skin may appear red initially, and may turn sore and flaky if the skin is not treated. The skin will also thicken if the irritation is not treated, eventually turning wrinkled and pale. Although not dangerous, this type of skin irritation can be very painful for a child.
Skin problems can affect any child who wets the bed, but the problem is more aggravated in those who wet the bed often and in those who wear absorbent products to collect the urine. Genitals and buttocks can be affected. In those who wear absorbent underpants, the leg bands and waist bands are often the most irritated.
Once bedwetting is resolved, the rash and skin irritation it causes will disappear as well. Until your child has stopped wetting the bed, though, you can try to reduce the skin irritation the problem causes. To prevent skin rashes and soreness:
•Make sure the child washes each morning, especially after a "wet" night. The skin affected by the area should be especially well washed using a mild and moisturizing soap.
•Encourage your child to rinse the buttocks and genital area when changing absorbent underpants and after waking up after having wet the bed.
•Use a very soft sponge - not a harsh washcloth - on any irritated skin area
•Some parents find that applying petroleum ointment to affected areas and areas affected by urine is helpful
•Choose correct-fitting absorbent undergarments, if your child uses them. Make sure that the waist band and the leg bands are not too snug. Choose the most absorbent type you can and look for a brand that offers a top layer that keeps moisture away from the skin.
•Talk to your paediatrician if skin irritation continues. He or she may be able to offer a medicated cream to soothe sore skin.
Tip #22: Get your child’s consent.
As you continue to read through this article, you will find many tips for dealing with bedwetting. Some of these will seem like great ideas to you and you will likely want to put them into effect right away. However, you should be careful about choosing bedwetting solutions, for any remedy you choose needs to have your child’s consent.
Many well-intentioned parents rush out to buy the latest gadget or device for treating bedwetting or for making it less of a problem only to be horrified to learn that their children want nothing to do with the expensive method.
It is important not to force a method on a child. It is completely ineffective as in some cases (such as behaviour modification) you actually need your child’s enthusiasm and participation for a method to work. In other cases, forcing a bedwetting remedy on a child will be ineffective and can actually lead to more bedwetting because of all the stress caused by the "supposed remedy."
Also, in saying that they don’t "like" a remedy children may be trying to say something more - such as that the remedy is uncomfortable or causes more embarrassment that the bedwetting itself.
Tip #23: Work with your child in resolving bedwetting.
When you approach a child with a way or resolving bedwetting, you can often ensure a better reception by approaching the subject in a sensitive and informative way. Explain to your child what the method involves, answer any questions, and express that it may help him or her with bedwetting. Make sure that you explain whether a method is temporary, as a child will be more likely to accept something new for a little while, or on a trial basis, rather than accept something for a longer time.
Behaviour modification simply means that you train your child or teach your child to wake up in time to go to the bathroom. Behaviour modification is considered the most effective way to help a child with bedwetting, as it actually teaches a child to wake up "in time" rather than just treating the symptoms of bedwetting.
Parents should not take "behaviour modification" to mean that bedwetting is a behavioural problem that needs rigorous correction to fix. Nothing could be further from the truth. Rather, behaviour modification works more by teaching your child the night time bladder control that most children learn sooner or later. There are many types of behaviour modification tips that have been proven effective in helping children overcome bedwetting:
Tip #24: Discipline Will Not Work
Many years ago, it was thought that children who wet the bed were simply poorly taught, were developmentally delayed (or otherwise "abnormal") or just needed more discipline. Even though most parents know better today, many still look at bedwetting as a way of "acting out."
It is important not to discipline your child for wetting the bed. This method not only does not work, but the stress of the discipline may make the problem worse. No child wants to wet the bed after everyone else can stay "dry" for the night. The child who has a hard time not wetting the bed needs sympathy and help, not discipline.
Tip #25: Offer Positive Reinforcement and Praise
When your child makes it through nights without wetting the bed, be sure to offer praise. Not only will this help the child if he or she feels bad when accidents happen, but it will subconsciously motivate your child to continue trying to correct the problem as well. A system as simple as offering gold stars is effective. A week that is dry should be given a slightly larger treat.
You can also use a points system. Have each star or dry night count for a point. When your child reaches three points, allow him or her to have a small treat. Five points can mean a very small gift. Ten points can mean a trip someplace fun, and so on. Keep points posted where they are visible. The excitement generated by this system will encourage your child to keep trying and press on.
Tip #26: Give your child hope that the problem is not forever
If your child seems to be doing better, remind him or her again that most people overcome bedwetting with time and notice that their situation seems to improving itself.
A child who does not believe that the problem will improve will simply have a harder time with the problem and for such a child the problem will seem larger and more dire than it really is. Help your child see that bedwetting will be resolved and your child will be calmer, happier, and so more able to work with you to get help for Enuresis.
Tip #27: Focus on Normal Bladder Control
Most children who wet the bed have trouble at night. However, a small percentage of children have overactive bladders, which means that they frequently have to go to the bathroom and may even have a hard time controlling their bladder during the daytime. If this describes your child, take him or her to a doctor or urologist to see what treatments are available for your child’s overactive bladder.
If your child only has trouble with control over the night, then it may be a good idea to focus on the fact that your child does do well in going to the bathroom during the day. Offer your child encouragement by pointing out that he or she can make it to the bathroom during the day and reassure your child that most people learn to control as well in the night, as well.
Tip #28: Night lifting
Night lifting is a technique that requires the parent to wake up the child in the night. Most children lose control of their bladder at a similar time each night (this is especially true if the child follows the same routine each day). If you can note when each accident occurs, you can set your alarm before this time, wake your child up, and lead them to the bathroom.
You can also try waking yourself and your child up twice a night. In many cases, this helps the child wake dry and encourages the child to keep trying to wake up before they are woken up. However, children may resist waking up in the night, especially if they are tired.
Tip #29: Bladder Control Exercises
Your doctor may prescribe exercises for your child to help him or her control their bladder more effectively. Some patients with Enuresis benefit from holding their urine as long as possible before releasing. The idea is to keep repeating these exercises in order to help the body develop more control.
Bladder control exercise:
1) Have your child tell you when he or she has to "go" during the day.
2) Explain to your child that you are doing an exercise to help him or her stay dry at night. Have the child hold the urine.
3) Have your child go to the washroom
4) Repeat daily, slowly increasing the amount of time you make your child wait
Tip #30: Urination control exercise
Some doctors find that helping the child control urination helps control the urinary sphincter, or the muscle that holds back or releases urine. This exercise is often used in conjunction with the bladder control exercise and is completely safe.
Urine Control exercise:
1) When your child urinates, have your child stop urinating "mid-stream" - that is, have your child start urinating and then stop by squeezing the muscles (urinary sphincter) that control the flow of urine.
2) Have your child start-stop three times.
3) Repeat process during each bathroom visit.
Some parents find the two exercises above useful. The idea is that the child will control the bladder more effectively during the day, causing the control to be present at night, as well.
In general, these exercises work best with children over the age of six years and those who are willing to work hard to control their bladder. Some small improvement should be visible in about two weeks.
Tip #31: Try Visualization
Visualization is a behaviour modification tool that has proven effective in helping people accomplish many things, from waking up without an alarm to quitting smoking. You can use the same technique to help your child overcome bedwetting:
1) To begin, have your child relax and close their eyes. You should be in a quiet and comfortable room that has few distractions. Your child should be sitting down or lying down. Have your child breathe deeply and relax.
2) Now, have your child imagine sleeping in their regular bed and in their regular sleep wear.
3) Next, have then imagine having to go to the washroom. Your child should really imagine the pressure of having to urinate. Ask your child to imagine what it feels like to have to "go" during the day and have your child imagine that same feeling as vividly as possible in their imagining of the sleep.
4) Now, have your child imagine waking up and going to the washroom.
Have your child imagine this several times over a period of time. People who use visualization sometimes practice seeing a goal several times a day for weeks. Experts think that visualization works by having the body imagine how things are to be done so precisely and intensely that the body actually accepts the mind’s visual clues as reality.
The body actually believes what has been visualized is real. If your child imagines waking up in time to go to the bathroom, then, he or she will have set a sort or emotional and mental precedent for doing so in reality. Visualization is especially effective with older children and can be used with other behaviour modification techniques. It is very safe and will generally show results in about two weeks.
Tip #32: Avoid lots of fluids before bed
It is important to keep your child hydrated. Drinking enough water helps the body function properly and helps keep the kidneys healthy. However, encouraging your child to drink most of his or her water intake earlier in the day so that less water is drunk in the hour or two before bedtime can help ensure that the body does not produce lots of urine at night.
Remember, though: Encourage your child to drink more fluids, not less, even if it does mean some wet nights. Drinking fluids helps the bladder and kidney function well, which will help ensure dry nights in the long run. Dehydration and lack of fluids will not solve anything, and may make the problem worse as people with smaller bladder retention have a harder time staying dry at night
Tip #33: Watch what fluids your child drinks
Some fluids cause more problems that others. While your child is trying to overcome bedwetting, it is often best to stick with water. Colas, dark teas, and coffee all contain caffeine that irritates the bladder and also may increase the urgency to urinate more frequently. If your child is older, alcohol may also affect bedwetting by ensuring that motor controls (needed to wake up) are affected while the need to urinate is increased.
Apple juice also seems to cause increased urine in some children, thanks to the two substances, patulin and gallic acid, that it contains. Encourage your child to eat apples during the day, but do not serve apple juice or applesauce in the evenings.
Tip #34: Watch what your child consumes
Some parents have also found that sugary foods, carbonated drinks, milk, yellow cheese and other products containing these foods. Try cutting specific foods from your child’s diet for a while to see whether these foods have any effect on bedwetting. Monitor what your child eats before bedtime closely and eliminate any foods that seem to contribute to bedwetting, or at least limit these foods to morning.
Remember: When limiting specific foods, take great care to ensure that you child eats a balanced diet that still includes plenty of foods from each food group. Bedwetting is a minor problem compared to vitamin deficiency.
Tip #35: Night trips to the bathroom.
Encourage your child to go to the bathroom before sleep. You can even wake him or her up when you go to sleep so that he or she can urinate again. This gets rid of the urine in the bladder, reducing the chances that the bladder will be left with enough urine to vacate in the night again. Even if your child wets the bed, the amount of wetness will be reduced. Some parents also find that this technique alone is enough to help bedwetting. Even if it is not, it is a safe method that can be used with other remedies.
Tip #36: Wake up alarm
For many children who wet the bed, the problem comes from the fact that the bladder simply does not communicate well with the body. For most of us, when we have to urinate during sleep, our body wakes us up and we can head to the bathroom before returning to bed. For children with Enuresis, this system does not work. In addition, many children who wet the bed are also very heavy sleepers.
Basically, the bladder empties itself since the body does not wake up to allow the child to go to the bathroom. In some cases, the child might not even notice the problem until they wake up the next morning.
There are a number of alarms on the market that your child can wear. These emit a noise when moisture is detected. They will wake your child up, allowing him or her to go to the bathroom. Even if your child is a very heavy sleeper and will not wake up, the alarm can wake up the rest of the household, so that you can wake your child up.
The idea behind this device is that the child will eventually learn to wake him or herself after being woken up by the alarm several times. Some improvement will usually be seen in about two weeks.
If your child wets the bed, you will want to try behaviour modification first. However, for some children who wet the bed frequently, there are medication options available. Before deciding to give your child medication, carefully weigh the risks and advantages, as many medications or drugs have side effects:
Desmopressin is used to treat nocturnal enuresis (bedwetting). It is usually prescribed in the form of oral desmopressin acetate, DDAVP. Children taking DDAVP have 2.2 fewer wet nights per week and are 4.5 times more likely to sleep without disruption. This medication works by reducing the amount of urine the body produces at night. DDAVP is based on research which shows that sufferers of Enuresis have lower than normal levels of something called antidiuretic hormone, which is a hormone that regulates the body’s urine production by having the kidneys hold water so that less urine flows to the bladder.
Children with low levels of this hormone produce more urine nightly. DDAVP corrects this problem by supplying a substance that works in the body just as the hormone does (to reduce urine) and is also though to help children wake more easily.
It is important to note that Desmopressin Acetate treats the symptoms of bedwetting. This means that while your child is on this medication, they will urinate less during the night. However, the condition of bedwetting per se will not be cured. In many cases, when children stop taking drugs such as DDAVP, bedwetting returns. The hope is that by the time they stop the medication, bedwetting will have passed on its own. This is not always the case.
DDAVP is more likely to work with older children who have normal bladder capacity. Younger children with small bladders are less likely to be helped by the drug.
DDAVP can be taken as a pill or nasal spray.
US drug regulators banned treating nocturnal enuresis with desmopressin nasal sprays after two patients died and fifty-nine other patients suffered seizures. The nasal spray is usually given to younger patients who may have a hard time with the pill form.
However, the spray may be affected by colds or stuffy noses. The pills have also been found to be slightly more effective in some studies.
DDAVP needs to be taken at night but does not need to be taken daily to be effective. This drug also has some side effects, including stomach upset and headache. These symptoms are more common in patients who take the nasal form of the drug. Patients taking the nasal spray may also experience nosebleeds and sinus or nasal pain. More seriously, children who take DDAVP are at risk of seizures caused by water intoxication.
This medical emergency usually has symptoms such as nausea, vomiting and headache. If your child is taking DDAVP and experiences these symptoms, seek medical help right away.
Water intoxication and the risk of seizure can be prevented if children taking DDAVP avoid drinking water the evenings that they are taking the drug. In general, no fluids should be taken in the two hours before retiring and only small amounts in the late afternoon and evening leading up to bedtime.
Tip #38: Imipramine is another drug option.
Imipramine is an anti-depressant which reduces the amount of urine produced during the night. It is sometimes prescribed to children who are unable to take the similarly-working DDAVP, but many doctors are reluctant to prescribe Imipramine because of its many side effects, which can include sleeping problems, nausea, irregular heart beats, and dry mouth.
Some doctors are also quite cautious with this medication because researchers have not been able to completely define how it works to prevent bedwetting.
Imipramine, like most drugs used to treat bedwetting, works best for older children who have normal bladder capacity. Like most other drugs used to treat the problem, it also only affects symptoms, meaning that those who stop taking Imipramine will frequently resume bedwetting.
This drug is usually taken an hour or two before bedtime. Doses vary based on the patient. Side effects with this medication are rare, but may include irritability, sleeping disruptions, fatigue or drowsiness, changes in appetite, mood swings, and personality changes. It is also possible to die from this drug if an overdose occurs.
Tip #39: Anticholinergic drugs are an option for some patients.
Anticholinergic drugs work by increasing bladder capacity and by stopping the contractions of the bladder that some experts think lead to bedwetting. Common Anticholinergic drugs used for bedwetting include oxybutynin (Ditropan) and hyosyamine (Levsinex).
These drugs, unlike many medications used to treat bedwetting, are effective for children with bladder capacity who have trouble controlling their bladders during the daytime as well as at night.
These drugs are usually used with DDAVP for children who wet the bed but may be used alone if a child wets the bed due to general bladder control problems that are present during the day as well. These drugs are taken once or twice a day, often at bedtime. They are not intended for children under twelve years old. Anticholinergic drugs do have a number of side effects, including flushing and dry mouth syndrome.
Tip #40: Be wary of medicating your child if other options are available.
The drugs used to treat bedwetting do not cure the problem, and since these drugs also carry risks and side effects, any parent should think carefully and consider all the risks and options before choosing medication. Medication can be useful for children who wet the bed very late or who seem to suffer unduly from the problem.
However, medication should never be treated lightly, nor should it be tried as the first method of stopping bedwetting. You should also remember that children who take medication for bedwetting will often revert to bedwetting once the medication has stopped.
Dealing With Your Paediatrician
Your paediatrician will be an important part of dealing with bedwetting. However, since medical health professionals are so busy today, you will want to make sure that you approach your child’s physician in a way that ensures maximum cooperation. Here are some tips that can help you communicate with your child’s paediatrician in a way that will ensure better treatment options for your child:
Tip #41: Keep a diary
One of the best ways you can help your doctor treat your child is to keep a diary of your child’s bedwetting. Starting from the time your child seems to be bedwetting more frequently, keep notes in a small notebook. In this notebook note:
•When your child wets the bed (dates and times, if possible)
•Any family history of bedwetting
•Any results of bedwetting (crying, problems at school, teasing)
•Any medications your child is on or any medical problems your child has had or is having
•Any questions you have about bedwetting
•Any questions or comments your child makes about bedwetting
•Any comments that your child makes before bedtime that may indicate a problem (aches before bed, emotional upsets during the day)
•Any bedwetting products (disposable liners, moisture detectors) your child is using and how effective they seem to be
•Any other symptoms your child seems to be experiencing
•Notes on any resources or information about bedwetting that you encounter that seems helpful
Health care professionals are busier than ever today and keeping such a diary can be a big help to a busy physician. Go over the notebook with your doctor and together look for patters, and possible causes. Get answers to the questions you have written down.
Keeping a diary can also be useful for you and for your child. If your child shows improvement (wetting every few days rather than once a night) you can show your child this improvement. If you yourself have any questions, you can easily refer to the resources and information you have collected in your notebook for more information.
Tip #42: Explain any underlying problems
Sometimes, doctors will not pay attention to bedwetting once they have ruled out an underlying condition, because they assume that it is not a very threatening situation.
If your child’s self-esteem, grades, or social development is affected by bedwetting, you need to let your doctor know because at that point bedwetting has moved from a non-threatening problem to a problem that is affecting your child’s development. Discuss with your doctor the steps that must be taken to stop bedwetting or at least cope with the problems your child has developed as a result of it.
Tip #43: Did your child’s bedwetting develop at the same time as other symptoms?
If your child has developed bedwetting and snoring or extreme fatigue at the same time, you should mention this to your paediatrician.
In rare cases, something called Obstructive Sleep Apnea (OSA) may contribute to bedwetting. OSA means that some blockage - such as enlarged lymph glands called adenoids - block flow of air to the lungs.
In some cases, this problem causes snoring while for some children OSA causes brief periods where breathing is entirely interrupted. OSA is thought to cause enough to seriously interfere with breathing. The most common cause of OSA is restless sleep, early morning headaches, and fatigue.
Some researchers have also linked this condition to bedwetting. Bedwetting caused by OSA is very rare, but can be treated, usually by removing the tonsils or adenoids. Your doctor can run a special test to determine whether your child’s bedwetting is related to OSA.
Tip #44: Get a Second opinion
If you are not happy about your doctor’s response regarding your child’s bedwetting, don’t be afraid to seek more help, possibly from a specialist. Get the care for your child that makes you feel comfortable. Every doctor has a different approach to child bedwetting. If your doctor is satisfied that your child will overcome the problem while you want some form of treatment, you may seek a physician who will help you.
Many parents are reluctant to seek a second opinion, even though they are not satisfied with a child’s care. Many doctors are reluctant to recommend a child see an urologist or other professional because bedwetting is a problem.
However, you are the parent and you should take responsibility for your child’s health. If your instinct tells you that something is wrong, seek a second opinion. Consider the following problems that can easily be mis-diagnosed or overlooked:
•bladder reflux - This illness can contribute to bedwetting and can require surgery to correct
•constipation - If your child does not empty his or her bowels regularly or completely, remaining waste can press down on the bladder and cause bedwetting.
•Malfunctioning of the urinary sphincter - The sphincter muscle is responsible for controlling urine flow. In those people who do not have a functioning sphincter, bedwetting is chronic and will not go away by itself.
•Kidney diseases - Some kidney diseases cause bedwetting as well as other symptoms. Without resolving the kidney problem, there is not much chance in successfully beating the bedwetting problem.
•Undiagnosed underlying problems - Some children may wet the bed due some serious problem such as abuse, diabetes, epilepsy, OSA, or other problems. If medical avenues are not carefully explored, these conditions will remain undetected and untreated, putting the child at risk.
Tip #45: Build a team.
There are many people in your child’s life that can help ensure that bedwetting is a solvable and un-stressful problem:
•Teachers: You do not need to tell your teachers about your child’s bedwetting, but you should be in contact with your child’s instructors to make sure that your child’s grades or social development is not suffering. An alert teacher can also often be your first alert of bullying or teasing that is taking place.
•Paediatrician: Your child’s doctor should be one of your first stops when bedwetting becomes a problem, as your child’s paediatrician can run tests to determine whether there are any physical or underlying causes behind the bedwetting.
•Therapists/Child Psychologists: If your child’s grades, self-esteem, or social skills are affected by bedwetting, you may need to help your child develop a team of emotional support. Therapists and others can discuss your child’s feelings with him or her and can help your child develop coping strategies for teasing and other problems.
•Paediatric nephrologist or urologist (kidney or urinary system specialist): In some children, a medical problem such as a badly working urinary sphincter can cause bedwetting. Kidney specialists and urologists can tell you whether your child’s urinary system is fine or whether there is some underlying medical problem or physical problem behind the bedwetting.
If bedwetting persists very late (such as into adolescence) or is a nightly problem even by age eight or so, medical or physical reasons should be explored very carefully as they are a likely culprit.
Tip #46: Work with your team
You should choose the specialists who work with your child carefully, choosing those who seem to see the problem in the same light as you, and choosing those whose treatment options agree with you. When looking for health care professionals to treat your child’s bedwetting, you will also want professionals who listen to you and your concerns.
Once you have found a team you trust, however, it is just as important that you work effectively with them. This means following instructions to the letter (asking for clarification when needed) and being very frank about other treatments you are using and about which treatments seem to be working and which do not.
Tip #47: Do Your Own Research
While a doctor can be very useful in helping you deal with your child’s bedwetting, health care workers today are busier than ever and no one doctor can keep up with all the research and new information coming out each day. You may want to contact organizations such as the National Kidney Foundation or the American Academy of Pediatrics for more resources and then raise the information you find with your doctor.
You can contact some key resources about bedwetting yourself:
•The American Academy of Pediatrics (AAP) provides lots of useful information, and pamphlets about a variety of conditions, including bedwetting...
American Academy of Pediatrics (AAP)
141 Northwest Point Boulevard
Elk Grove Village, IL 60007_1098
Phone: (847) 434_4000
Fax: (847) 434_8000
The American Academy of Pediatrics
Department of Federal Affairs
601 13th Street, NW
Washington, DC 20005 USA
Phone: (202) 347_8600
Fax: (202) 393_6137
Web Address: http://www.aap.org
•The PottyMD is a great resource about toilet training and bedwetting. Since this groups focuses only on this problem, you are sure to get information that is pertinent to the topic. Many parents swear by this resource.
2216 White Avenue
Knoxville, TN 37916
Phone: 1_877_POTTYMD (768_8963)
Web Address: www.pottymd.com
•Other parents or relatives
Many families have at least a few people in the family who wet the bed. Talking to other parents about bedwetting often brings plenty of support and even some useful advice.
You should never discuss your child’s bedwetting with another person without your child’s knowledge. However, if your family is already aware of the problem you can often get useful information about what methods worked for children and what doctors or professionals in your area seem to have a high success rate in treating Enuresis.
Often, other parents and relatives will tell you information that others cannot know - the fact that a certain alarm is too high-pitched to work or that a certain brand of absorbent underpants has a special feature that make them useful. Those in the know often have great insights.
Pharmacists have plenty of information about all sorts of ailments and treatments. If your child is taking any medications for bedwetting at all (including herbal or all-natural medicine) then you need to talk to a pharmacist to see whether the medication will interfere with any other medication (including over the counter drugs). Your pharmacist can help keep your child safe while he or she learns to control bedwetting.
Tip #49: Be cautious when evaluating bedwetting resources
There are many sources out there about bedwetting. Unfortunately, there is also plenty of myths and misinformation about the subject, too. Make sure that you consider the following about any bedwetting resource you look at:
1) Who wrote it?
Was the author someone who knows about bedwetting?
2) Why was it written?
If something is written to convince you to buy something (an ad) you need to consider the claims more critically than if you were reading an article meant to inform rather than influence.
3) Can the facts be verified?
You should be able to look up the facts in the resource and find that other reputable bedwetting resources offer the same facts.
4) What is the publication date?
Older material may no longer be valid. New information is emerging all the time, so if you are using an old source, you are looking at information that may no longer be true.
5) Is there anything suspicious about this information?
If someone has basic facts wrong or seem to be offering a miracle cure that cures twenty illnesses, proceed with caution. Double-check the information the resource contains, at the very least.
Tip #50: Know what to expect.
Knowing what to expect when you take your child to the doctor with a bedwetting problem can make the trip less stressful for both you and your child. The first thing that the doctor will likely ask is about the bedwetting itself.
You may also be asked whether the child can control the bladder during the day (an answer of "no" means that the problem is not bedwetting per se but a problem controlling the bladder). Parents will also be asked whether the child has experienced any stress or changes lately and what the bedwetting is like (whether it is constant, when the child wakes up, etc.).
Finally, parent history and medical history will be taken, as some medical problems cause bedwetting, as do genetics (children with two parents who were bed wetters as children have a more than 76% chance of having a problem with wetting the bed themselves). Your doctor will likely check to see whether any medication or medical treatment your child is getting may contribute to the problem.
Once your doctor has evaluated the problem through questions and answers, he or she may decide that your child’s age and medical history indicate no cause for concern and that waiting is the best solution. He or she may also order further testing.
One very common test is to determine whether the body can hold 200cc's of fluid. To determine this, the child is asked to hold urine for as long as possible and then have whatever urine is produced measured (often this is done by having the child urinate into a container so that the urine can be measured).
If the child cannot produce 200cc’s then that is an indication that the bladder simply may not have developed enough. Doctors may also order urine or blood tests to see whether any underlying cause may be the problem.