Bedwetting is a very common and frustrating childhood sleep problem. With most of the problems we have covered it is the parents who are worried and frustrated. Bedwetting is different, in that most of the time the child is often more frustrated and unhappy than their parents.
Although figures differ from year to year, between different ethnic groups and cultures about 15% of all 5 year olds, 5% of all 10 year still wet their beds. Although the cause of bedwetting is still not fully understood, there have been a number of methods which have proved themselves useful in curing it.
If bedwetting continues after the ages of 6-7 then you may want to seek medical attention as there could be other problems that only a thorough medical examination can bring to light (these are quite rare though).
Some of the main causes of bedwetting are:
- Maturation Hasn’t Happened Yet
Your child will not be able to control their urination (urinary continence) until that part of their nervous system has matured to a certain point. During infancy they have little awareness of their bladder being full or needing to urinate.
Their bladder simply empties by a reflex contraction. But some time between the ages of 18 months and 2½ years of age they begin to recognize when their bladder is full.
At first they won’t be able to postpone the process of urination. They will feel it coming but can’t stop it. Over the period of the next 6-9 months they should learn to postpone that feeling till they get to the potty or toilet.
- Small Bladder Capacity
Many bedwetters urinate more frequently during the day than non-bedwetters and in smaller amounts. You would think this is because they have smaller bladders but when examined under anaesthesia they had normal sized bladders.
This means they must feel the sensation to urinate before their bladders are actually full. The bladder training techniques at the end of this chapter should help if this is your child’s problem.
- Medical Factors
Although medical cases that cause bedwetting are rare do not conclude that your child’s bedwetting has nothing to do with medical issues. In fact, if your child is over the age of 5 take them to the Doctor for medical examination before non-medical treatments begin.
- Food Sensitivity
Although there is no clinical test that have proven conclusive in using foods to decrease or stop bedwetting it has been proven that removing certain foods from a child’s diet can decrease bed-wetting. Unfortunately, children that respond to diet manipulation are in the minority. Still, it may be trying in the case of your child.
- Emotional Factors
Many parents I have met are worried that the cause of their child’s bedwetting is some hidden emotional issue. The truth is that this is rarely ever the case.
The vast majority of bed wetting children are actually well adjusted. The bedwetting may cause some emotional distress but that is the cause of bedwetting rather than a result of bedwetting.
- Environmental Factors
From studies done it is believed that a child’s early experience while being potty trained can have an impact on if they become bedwetters. Also children in lower-income families, middle children and those who faced early stresses like divorce are much more likely to become bedwetters.
It doesn’t mean a child who is provided with a loving and caring potty training period won’t become a bedwetter so don’t beat yourself about something you may have done if your child is a bedwetter.
Heredity seems to be the largest contributing factor in children who bed wet. There is a significant increase in children whose parents were bed wetter’s.
15% of all children are bedwetters, this increases to 45% if one parent was a bed wetter and to 75% if both parents used to wet their beds. It is not yet known what is inherited that causes bedwetting to occur but it could do with the bladder.
Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful:
– Reduce evening fluid intake. The child should try to not take excessive fluids, chocolate, caffeine, carbonated drinks, or citrus after 3 p.m. Routine fluids with dinner are appropriate.
– The child should urinate in the toilet before bedtime.
– Set a goal for the child of getting up at night to use the toilet. Instead of focusing on making it through the night dry, help the child understand that it is more important to wake up every night to use the toilet.
– A system of sticker charts and rewards works for some children. Thde child gets a sticker on the chart for every night of remaining dry. Collecting a certain number of stickers earns a reward. For younger children, such a motivational approach has been shown to provide significant improvement (14 consecutive dry nights) in approximately 70% of children with a relapse rate (two wet nights out of 14) of only 5%.
– Make sure the child has safe and easy access to the toilet. Clear the path from his or her bed to the toilet and install night-lights. Provide a portable toilet if necessary.
– Some believe that you should avoid using baby cloth diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet. Others argue that pull-ups help the child feel more independent and confident. Many parents limit their use to camping trips or sleepovers.
The parents’ attitude toward the bedwetting is all-important in motivating the child.
– Focus on the problem: bedwetting. Avoid blaming or punishing the child. The child cannot control the bedwetting, and blaming and punishing just make the problem worse.
– Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the bedwetting each time it happens.
– Enforce a “no teasing” rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the bedwetting in front of other family members.
– Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help him or her overcome the problem. If applicable, remind him that a close relative successfully dealt with this same issue.
– The child should be included in the clean-up process.
To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers.
Self-awakening programs are designed for children who are capable of getting up at night to use the toilet, but do not seem to understand its importance.
- One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night.
- Another strategy is daytime rehearsal. When the child feels the urge to urinate, he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet.
Parent-awakening programs can be used if self-awakening programs fail. These programs should only be used at the child’s request.
- The parent should awaken the child, typically at the parents' bedtime.
- The child must then locate the bathroom on his or her own for this to be productive. The child needs to be gradually conditioned to awaken easily with sound only.
- When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms.
Bedwetting alarms have become the mainstay of treatment.
- Up to 70% of children stop bedwetting after using these alarms for 12-16 weeks.
- About 20%-30% start wetting the bed again when the alarm is discontinued (relapse). However, the positive response to reinstating the alarm system is rapid due to the behavioural conditioning experienced during the first treatment cycle. With persistence, this method works for 50%-70% in the long run.
- These alarms take time to work. The child should use the alarm for a few weeks or even months before considering it a failure.
- There are two types of alarms: audio and tactile (buzzing) alarms.
- The principle is that the wetness of the urine bridges a gap in the sensor, which in turn sets off the alarm. The sensor is placed either on the child's underwear or bed pad.
- The child then awakens, shuts off the alarm, finishes urinating in the toilet, returns to the bedroom, changes clothes and the bedding, wipes down the sensor, resets the alarm, and returns to sleep.
- Alarms are preferred over medications for children because they have no side effects.
- It is generally believed that all children 7 years and older should be given a trial of an alarm.
- For the alarm to be effective, the child must desire to use it. Both the child and parents need to be highly motivated.
Beware of devices or other treatments that promise a quick "cure" for bedwetting. There really is no such thing. Stopping bedwetting is, for most children, a matter of patience, motivation, and time.
Other Treatments for Bedwetting You Can Implement Are:
Reinforcement and Responsibility Training
The two goals of reinforcement training are to get your child to feel more in control of themselves and secondly, you want to reinforce your child’s motivation to react to night time signals and help them recognize the night time bladder sensation as important. You should do this via reward and not punishment.
Start by discussing with your child ways that they can assume more general responsibility around the house from; cleaning dishes to taking out the thrash to sweeping a little area of the house. Make sure the responsibility is not too large or it can feel like more of a punishment. If there is a reward like a lollipop at the end, even better.
If you can make them take responsibility associated with the event of bedwetting itself then this is best. They can change their own pyjamas and when old enough (about 7) change their bed linen and even do the laundry.
Do not use nappies as this takes them back to a younger time and diminishes responsibility. Use waterproof pads under the sheets if worried about the mattress.
You can start bladder training at the same time as responsibility if you wish or just after.
1) Do not restrict water intake during the day (until after 6pm).
2) On the first 2 days collect the urine each time your child urinates. Note the time between urinations.
3) Record the largest volumes of urine over the 2 day period and use that as a record to beat.
4) If your child urinates more than every three to four hours have them try to increase the intervals by half an hour each day until they achieve a 3-4 hour minimum.
5) Once each day at the same time, have your child hold their urine for as long as possible, at least until discomfort. This will help increase bladder capacity during the day as they try to beat their previous record. There is no specific volume that will guarantee night time continence but a good target is ten to twelve ounces.
6) At least once a day have your child attempt to start and stop the stream of urine several times.
7) When your child has been dry at night for a period of up to 2 weeks should reward them by giving them a treat. It shows you care and are behind their improvement.
The system consists of a ball and a pad and has proven successful regularly. Two pads separated by a thin conductive layer, fit on the bed or are worn inside the pyjamas and connected to an alarm.
Whenever your child starts to bed wet the alarm goes off. Current models are safe with little danger of burns to your child.
The object of conditioning is for your child to wake up as soon as they wet the bed. Both parents and child should understand how it works for the best effectiveness so tell your child what it is for and how it works.
Let the child turn off the ring whenever they wet the bed and you will be ‘reinforcing’ some responsibility into them. If the child does not wake up immediately after the bell goes off it is OK to wake them up but allow them to turn it off.
If this doesn’t work after 5 months you can discontinue it but in most cases after 3 months the child will have been conditioned to wake up before bed wetting.