Bedwetting (enuresis)

Enuresis is the medical term for wetting beyond the age when bladder control is expected. As a parent, it is very important that you remain supportive of your child. Although the problem may be frustrating for you, it can be very discouraging and embarrassing for your child.

Children who wet the bed cannot help it. They will grow out of the problem. Reassure your child that many others have this trouble and it goes away.

An estimated 5 to 7 million children wet the bed. At 5 years of age, up to 15 percent of children wet the bed at least monthly. By 15 years of age, only about 2 percent wet the bed. For only a few, it can occur into adulthood.

Children develop bladder control at different ages, but most children develop this by age 6. Daytime bladder control usually occurs before nighttime dryness. However, many children wet the bed long after they learn daytime bladder control.

Types of enuresis

Diurnal enuresis is daytime wetting. Nocturnal enuresis is bedwetting. There are two types of nocturnal enuresis, primary and secondary.

Primary enuresis refers to when the child has never been dry at night. Children with secondary enuresis may be dry for months or years and then start wetting the bed again. Primary enuresis is more common and both types occur more often in boys.

Causes are not clear

There is no known cause for bedwetting. It is not a behavior problem. For many, there is often a family history of bedwetting. Urinary tract infections and structural abnormalities can cause bedwetting. If your child urinates normally during the daytime (empties the bladder completely) and has never had a bladder infection, then it is very unlikely that there is a problem with the urinary system.

Constipation can sometimes cause both daytime and nighttime wetting. When the constipation problem is taken care of, the wetting usually stops also.

Treatment options

Treating enuresis begins with your patience and understanding as a parent. Your child begins learning how to deal with this problem by watching how you cope with it.

There are several methods of treatment for bedwetting, but no particular treatment works for every child. You may need to try one or two before finding what works best for your child.

If you child is at least 5 years old, the following suggestions may help:

  • Limit fluids after the evening meal.
  • Completely empty the bladder before bed.
  • Use positive reinforcement (praise, rewards). Do not punish for accidents.

Conditioning therapy involves using a signal alarm device that is triggered when the child wets. This method teaches children to wake up and hold their urine until they can get to the toilet. This has the highest reported success rate of all treatments.

Self-hypnosis or hypnotherapy is sometimes effective with children who wet the bed. The most effective time to begin this kind of treatment is when your child is older than 7 years of age. This kind of therapy can also help children build self-esteem.

Diet therapy may be a successful treatment for a small number of children who wet the bed. Eliminating milk, carbonated beverages, citrus juices, drinks containing caffeine, and drinks with artificial coloring sometimes works. Coffee, chocolate, and other food with caffeine should always be avoided.

Medicines

While antidepressant medication like Tofranil® (imipramine) are successful for some children, they are not recommended because they interfere with sleep and can be toxic if taken in quantity.

Antidiuretic hormone such as desmopressin acetate (DDAVP) is shown to be safe and effective in 40 percent of children. It comes in tablet and nose spray form, and works by reducing the child's nighttime urine output. The disadvantages are that DDAVP is expensive and when discontinued enuresis often returns. However, DDAVP may be useful for overnights or at camp.

Easing the burden

Wet bed linen is the issue that makes bedwetting so stressful. Finding a way to deal with this can mean the difference between coping with enuresis or feeling overwhelmed by it. "Pull-ups" often help keep the bed dry, but may reduce your child's awareness of wetting.

Using a heavy plastic mattress cover and waterproof pads will eliminate the need for the entire bed to be changed when the child wets. You may want to teach your child how to change the sheets after wetting the bed to help relieve negative feelings. Please note that changing bed linen should never be used as a punishment.

Picture book techniques

  • "Dry All Night," a book by Alison Mack, is a story with colorful and lively imagery about staying dry during the night. It also has a section for parents that outlines steps they can take to reduce the stress of a family dealing with a child who wets the bed. Other helpful books include:
  • "Getting to Dry: How to Help Your Child Overcome Bedwetting," published by The Harvard Common Press.
  • "Childhood Constipation and Soiling," published by Children's Hospitals and Clinics, Minneapolis/St. Paul, Mn.

When should I call my child's doctor?

Call your child's doctor for advice and treatment options if any of the following occur:

  • Your child is at least 7 years old and is still wetting the bed.
  • Your child is troubled by wetting the bed, even if younger than 6.
  • Your child was able to stay dry, but has begun wetting again.
  • Your child wets or has bowel movements in his or her pants in the daytime.
  • You are troubled or frustrated by the wetting.

Reassure your child with positive encouragement

There is no doubt that bedwetting is a very frustrating problem for both you and your child. Try to remember that reassurance and encouragement are essential to protect your child's self-esteem during this stressful time. Your constructive efforts will have a positive effect on your child long after the bedwetting has stopped.


Family Focus is a series of positive discipline parenting tips and information sheets developed by specialists at Children's Hospitals and Clinics, Minneapolis/St. Paul, MN. For a complete list of topics, visit our Web page: http://www.childrensmn.org/.../parenting-resources/parenting-tips.