Few conditions are as embarrassing for children and unsettling for parents — and completely normal — as nocturnal enuresis, or bedwetting. An estimated 6 million American children are affected by accidental urination during sleep. As pediatric urologist Dr. Jeff Pugach points out: “You can walk into any major retail store and find shelves of specialized undergarments that help address this problem — and these products aren’t just for younger kids. Some of the GoodNights, for example, fit children who weigh up to 120 pounds.”
While it is natural to be concerned about children’s bladder health, bedwetting is considered “perfectly normal” for children up to age 7, notes Pugach, who practices at Urology Associates of North Texas Pediatrics.
Still, Selena Escalante, who leads Santé Pediatrics’ Pediatric Incontinence Program, says that even though bedwetting may be normal, children may still be embarrassed (particularly at sleepovers). But families are not alone in the challenge to stay dry at night. “There are steps that parents can take at home or with the help of a physical therapist to avoid bedwetting,” Escalante says.
UNDERSTANDING BEDWETTING
Before rushing to implement changes in your child’s nighttime behavior, experts say it’s important to understand the possible causes of bedwetting. Some parents might be surprised to hear that oftentimes nocturnal enuresis can be genetic. Anjana Shah, a nurse at The Center for Pediatric Urology at Children’s Medical Center of Dallas, says a child who has one parent who wet the bed as a child has a 44 percent chance of wetting the bed himself. For a child with two parents who have histories of bedwetting, the chances nearly double.
On the other hand, some kids simply struggle to stay dry because of their diets. “A low-fiber diet can cause constipation, which is one of the most common causes of nighttime and even daytime incontinence,” Pugach says.
Sleep is also thought to play a role in bedwetting. “Many children who wet the bed are sound sleepers; it’s commonly thought that these children do not awaken to the sensation of a full bladder while asleep,” Shah says.
Another notable cause of nocturnal enuresis is stress, especially if your child has been dry through the night and suddenly exhibits problems, Pugach says. Stress brought on by school, family changes or grief may cause sleep problems in children, leading to the inability to maintain bladder control throughout the night, Pugach explains, adding, “If you suspect stress is the culprit of bedwetting, talk with your child about possible stressors. Sometimes a simple discussion can ease anxiety.”
If at any point your child is experiencing urinary tract infections, daytime incontinence or if he or she reaches the age of 8 or 9 years old and still experiences frequent bedwetting, it’s important to talk with your pediatrician. In some scenarios, medication can be prescribed to reduce urine made during the night.
Pugach says: “It’s most important for parents to realize that they’re not alone. Part of the problem is that parents expect kids to simply stay dry during the night, maybe because they hear that other children can do this. Bedwetting is very common and very normal.”
HOW TO STAY DRY
Susan* of North Texas is frustrated with her 6-and-a-half-year-old daughter’s twice-weekly bedwetting. “I’ve been told that there’s not much we can do about it except wait for her to grow out of it,” the mom of two says.
However, Escalante, the physical therapist who specializes in pediatric incontinence, says there is much to be done (even at young ages) to avoid embarrassing bedwetting. “The first step I take is to educate the child about their bladder and the muscles that control their bladder,” she says. “It’s amazing how many kids simply don’t understand how their pelvic floor muscles work.”
Pugach and Escalante both call for parents to keep a journal of their child’s diet (cutting back on foods and liquids in the evening) and their bathroom patterns (keeping an eye out for constipation).
Paying close attention to day-to-day behavior will shed light on possible causes to nocturnal enuresis. “A common trouble spot is hydrating for sports practices,” Pugach says. “Your son might opt to hydrate in advance of football practice so that he doesn’t consume lots of liquids when he gets home, right before he goes to bed.”
Next, Pugach recommends trying a bedwetting alarm program, which requires parents to set an alarm for themselves. Once awake, mom or dad must awaken the child and take him or her to the restroom. “Try this two or three times a night for a couple of weeks, reducing the number of nightly trips as you move on,” he suggests. “Give it a chance for about three to six months before you determine its success — you’re changing behavior, so it will take some time and patience.”
*Susan requested her last name and her daughter’s name be withheld for anonymity.
