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Bedwetting in Children & Teens
Approximately fifteen percent of children over three years old wet the bed. Known as nocturnal enuresis, bedwetting is not a disease but rather a symptom of an underlying issue. Wetting the bed occurs more often in boys than girls and is more common in children with allergies, attention deficit disorder and learning disabilities.
Although the disorder ends before the onset of puberty in most cases, it can continue into adulthood.
Regular bedwetting in girls over age four and boys over age five may indicate:
- a bladder control issue
- a sleep disorder
- emotional issues, such as fears, stress and insecurities.
Chronic versus Occasional Bedwetting
Experts classify bedwetting as either primary (chronic) or secondary (occasional):
- Primary functional enuresis, a condition that can be inherited, occurs when a child is rarely or never dry at night. About 5 to 7 million children in the U.S. suffer from primary functional enuresis. Either an immature bladder or deep sleeping causes this type of bedwetting.
In most cases, these children sleep so deeply that they do not awaken when the bladder tells the brain it is full. Treatment for this type of bedwetting includes medication, bladder training exercises and/or therapy.
- Secondary functional enuresis refers to occasional bedwetting that tends to occur during times of emotional stress like hospitalization, starting school or the arrival of a new sibling. This type of bedwetting often clears up on its own when the cause of stress goes away or is understood.
However, if the child starts wetting the bed more often, consult a doctor to determine if there is an underlying physical cause of the disorder. Generally, children outgrow secondary functional enuresis as their muscles mature, their bladder capacity increases and their deep sleep becomes lighter.
Preventing Bedwetting
Parents and families need to understand that wetting the bed is typically an accident. Although bedwetting is an uncontrollable condition that often corrects itself over time, it is an embarrassing condition that may cause your child to withdraw from sleepovers and other activities that require sleeping away from home. Parents can help by offering positive support and encouragement.
Here are some ways parents can decrease the incidence of bedwetting:
- Avoid punishment.
- Encourage children to use the bathroom before going to bed.
- Limit eating and drinking before bedtime.
- Praise the child for having a dry night.
- Use nighttime diapers, pull-ups or plastic pants.
- Wake the child during the night to use the bathroom.
Treatment Options: Medication And Behavior Modification
If bedwetting persists despite lifestyle adjustments, pediatricians tend to recommend two possible solutions (or a combination of the two): medicine and behavior modification. One of two medications will be prescribed:
- Imapramine (Tofranil), which has a thirty percent success rate, either improves the child's sleeping patterns or the functioning of the bladder muscles. This medication can have serious side effects that should be closely monitored by a pediatrician. Possible side effects include heart palpitations, tremors, seizures and rash.
- Desmopressin acetate, administered as a nasal spray, reduces the amount of urine the body produces. While less dangerous than Tofranil, this medication also has side effects, including headaches, nausea and mild cramps. In most cases, these side effects disappear when the dosage is reduced.
Along with or as an alternative to medication, doctors often recommend behavior modification to decrease instances of bedwetting. Behavior modification includes the use of conditioning devices like bedwetting and moisture alarms, retention control training and hypnosis.
In recent years, hypnosis has been found to be quite effective in treating bedwetting, effectively reprogramming the child to wake up when his bladder is full. In some cases, parents may want to consult a child psychiatrist to discuss potential emotional issues that might cause children to wet the bed.
Resources
American Academy of Child Adolescent Psychiatry (2007). Bedwetting – Facts for Families. Retrieved January 17, 2006, from the American Academy of Child Adolescent Psychiatry Web site: http://www.aacap.org/page.ww?name=Bedwetting§ion=Facts+for+Families.
Child Development Institute (2007). Help for Bedwetters. Retrieved by January 17, 2006, from the Child Development Web site: http://childdevelopmentinfo.com/disorders/bedwetting.shtml.
