General:
 |
By five years of age, 15% of children continue to have episodes of bedwetting |
|
By ten years of age, only 5% of children still wet their beds |
|
Even through adolescence, 1 - 2% of children have occasional bedwetting |
|
Males outnumber females by six to ten times |
|
Although only 50% of children over the age of ten are bedwetters, this number increases to 45% if one parent was a bedwetter and up to 75% if both were bedwetters |
Philosophy:
|
Generally, bedwetting is actually not a medical problem. It is primarily only a developmental delay |
|
For younger children, intervention into solving bedwetting is usually undertaken for the benefit of the parents and not the child |
|
Older children and adolescents may be psychologically troubled by persistent bedwetting and their self esteem may suffer |
|
If a child is dry at night, even occasionally, it suggests that he can recognize bladder fullness and can hold the urine until the appropriate time if properly trained |
Causes of Bedwetting:
|
Children with enuresis actually have a smaller bladder capacity. This is the primary problem that "bladder training" addresses |
|
Urinary infections - This is far more common in females than in males. Typically, daytime symptoms such as dribbling, incontinence, or frequent urges to pass small amounts of urine may signal a bladder infection |
|
Food sensitivity - Although very few children respond to changes in the diet, some sleep experts feel that food-related bladder irritation may cause increased bladder contractions and decreased bladder capacity |
|
Emotional stress - Anxiety may worsen pre-existing enuresis; however, children with enuresis do not have a higher incidence of psychological problems. The stresses of toilet training or disruptive family situations may temporarily worsen enuresis |
Treatment:
|
The two predominant methods of treatment are reinforcement and bladder training. Medical management is chosen as a last resort |
Reinforcement / Responsibility:
|
Large quantities of fluid should be avoided after 6:00 p.m. However, severe restrictions of fluid during the early part of the day is not appropriate |
|
Award stickers for dry nights. These should be placed on a calendar. In-expensive gifts can be awarded for accumulated dry nights without punishment for wet nights |
|
Children, especially greater than seven years of age, are usually able to help change their own bed linens |
Medication:
|
Imipramine is the most commonly prescribed drug for recurrent enuresis. There is also a nasal spray |
Bell and Pad:
|
25% of children improve within two to six weeks, 50% are dry by three months, and 90% are dry by six months. The bell and pad method should not be started until the child is at least seven years of age, since they may not fully understand the method and reasoning behind this process. An alternative to the bell and pad method is an alarm that can clip onto the child's pajamas |
Method:
1. The child should wear thin pajama bottoms (or none at all) while they are lying on the pad
2. When the alarm rings, the child is expected to awaken and turn the alarm off themselves. However, the parents may need to take over this task, gradually allowing the alarm to ring until the child is able to awaken and turn off the alarm themselves. The primary cause of alarm failure is lack of using the alarm system nightly. One must be prepared to continue the alarm system for up to four months or, in unusual cases, six months.
3. If the child has been dry for two weeks, the fluid intake between 6:00 p.m. and bedtime can be increased to up to one quart depending upon age
4. Discontinue of the alarm system can be considered if the child has remained dry for at least three weeks
Bladder Training:
1. Avoid restricting the child's fluid intake during the day. However, only small sips should be allowed after 6:00 p.m.
2. Collect the child's urine volume each time the child urinates at home for two days. Measure and record the volume appropriately. Also, record the period of time between each urination
3. Record the largest volume of urine over the two-day period and use that as the "high" to beat
4. The interval between urination should be increased by 30 minutes daily, until a three-hour urinary minimum is reached
5. At least once daily, ask the child to attempt to pass precious record high urine volume. Optimally, a 12 oz urine volume may be considered maximum depending upon the age of the child. Alternatively, a 50% improvement over the initial largest urine volume for the first two days may be adequate
6. Once daily, have your child practice starting and stopping the urine stream five times during one urination
For more detailed information, you can contact:
The National Enuresis Society
1-800-637-8080 or
http://www.peds.umn.edu/centers/nes
Back to Sleep Page
To email us with questions, comments, or suggestions, click