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KIDS AND BEDWETTING

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by Dr. Howard J. Bennett

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Every day, 5 million American children wake up not knowing if their bed will be wet or dry. Many of these children feel embarrassed and ashamed — and some are punished. Bedwetting is almost as common as asthma, but it is often not discussed, even with doctors, because of its embarrassing nature.


According to a recent study by Amy Dunlop, PNP, there is a significant communication breakdown between parents and doctors on this issue. While 82 percent of parents want healthcare providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves. Furthermore, 68 percent of parents said their children’s doctor has never asked about bedwetting at routine visits.

Bedwetting is rarely caused by a serious medical disorder. In most cases, it results from a combination of three main factors: increased urine production at night, a small bladder capacity, and poor arousal from sleep. A fourth factor, which is often overlooked by doctors and parents alike, is constipation. Because the rectum is right behind the bladder, constipation can interfere with bladder emptying or the way the bladder signals the brain that a child needs to go to the bathroom. This can lead to both daytime and nighttime wetting episodes.

There is no magic age when children are ready to work on becoming dry, however, most children show some concern about the problem by the time they are 6 to 7 years old. (Bedwetting is so common that doctors do not consider it to be a “problem” until children are at least 6 years of age).

Whether or not a child is ready to work on becoming dry, there are a number of steps parents can take to help youngsters feel better about themselves:

—Do not punish or shame children for being wet at night.
—Remind children that bedwetting is no one’s fault.
—Let children know that lots of kids have the same problem.
—Let children know if anyone else in the family wet the bed growing up.
—Maintain a low-key attitude after wetting episodes.
—Praise children for success in any of the following areas: waking up at night to urinate, having smaller wet spots, or having a dry night.
—Encourage children to go on sleepovers.

The most effective treatment for bedwetting is a product called the bedwetting alarm. Most are small, battery-operated devices children wear to bed at night. One part of the alarm attaches to their undershirt or pajama top and the other to their underpants. When the child urinates, the alarm goes off, creating a loud buzzing sound. The sound is designed to wake the child and teach him what his bladder feels like when it fills up with urine. As the alarm begins to work, it teaches children to wake up before they wet the bed. Over time, most kids stop waking up at night to urinate. This happens because the bladder learns to hold all of its urine until morning.

There are a few medications available to treat bedwetting. Desmopressin (brand name: DDVP) is prescribed most often; it works by reducing the amount of urine a child makes during the night. The effects are not long lasting, however, and most children relapse when the medication is stopped. Consequently, doctors generally recommend it for short-term use such as sleepovers, vacations, or as an adjunct to other behavioral measures.

So why is it that parents and doctors are not talking to each other about bedwetting? Parents are either embarrassed about the problem or they aren’t sure the doctor can help. Doctors aren’t asking about bedwetting because they assume parents would bring it up if it were a concern. For every child who gives the doctor an indication something is bothering him, there are many more who never say a word. The prescription for this situation is simple: Doctors need to ask about bedwetting at routine checkups, and parents need to be more proactive by asking for help if they have a child who is wet at night.

DR. HOWARD BENNETT is a pediatrician in Washington, DC. who has specialized in bedwetting for 25 years, He is the author of Waking Up Dry: A Guide to Help Children Overcome Bedwetting, a self-help guide written for children and parents. On his website, www.wakingupdry.com, he posts bedwetting-related information. Dr. Bennett devotes an entire chapter to managing sleepovers in his book; this chapter can be downloaded free from his website.


The Top Questions Parents Ask About Bedwetting

Does bedwetting run in families?
Most children who wet the bed have at least one parent or another close relative who had the same problem as the child.

Why do children wet the bed?
Bedwetting is due to a maturational delay in the way the brain and bladder communicate with each other at night. There are three main factors that contribute to the problem:
—Bladder size: Children who wet the bed usually have bladders that are smaller than their peers. As a result, their bladder has less room to “hold” urine at night.
—Nighttime urine production: The brain produces a hormone at night that reduces the amount of urine the kidneys make. Some children who wet the bed produce less of this hormone and thereby make more urine while they sleep.
—“Deep” Sleep: Some children have difficulty waking up at night. As a result, the brain may not respond when the bladder signals that the child needs to urinate.

Do medical disorders cause bedwetting?
If a child has always been wet at night, a medical problem is unlikely to be the cause of his bedwetting. However, if a child starts wetting after being dry for six months or more, a medical problem may be the culprit.
Medical disorders that can cause bedwetting include constipation, urinary tract infections, diabetes, severe snoring that interferes with a child’s breathing, and certain neurological disorders.

Does bedwetting go away on its own?
Every year, 15 percent of children over age 5 who wet the bed become dry with no intervention. Because there is no way to predict when a child will overcome his wetting, I recommend children start a bedwetting program if they’re motivated to become dry.

How can I tell if my child is motivated to work on becoming dry at night?

There is no magic age when children become ready to work on this; however, most children show some concern about the problem by the time they are 6 to 7 years old.
There are four signs you can look for to see if your child is ready to work on becoming dry:
—He starts to notice that he’s wet in the morning and doesn’t like it.
—He tells you he doesn’t want to wear Pull-Ups any more.
—He tells you he wants to be dry at night.
—He doesn’t want to go on sleepovers because he wets at night.

What can I do to help my child avoid the negative feelings associated with bedwetting?
There are a number of steps parents can take to help their children feel better about themselves. They include the following:
—Remind your child that bedwetting is no one’s fault.
—Let your child know that lots of kids have the same problem.
—Do not punish or shame your child for being wet at night.
—Let your child know if you or anyone in the family wet the bed growing up.
—Maintain a low-key attitude after wetting episodes.



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