Bedwetting-Why Can’t My Child Make It Through The Night?
If your child wets the bed, you are going to love this blog. I’m going to tell of the causes of bedwetting and steps that you can take to help your child become dry at night.
Children learn to control daytime urination as they become aware of their bladder filling. Once this occurs, the child then learns to consciously control and coordinate his or her bladder. This generally occurs by four years of age. Night time bladder control normally takes longer and is not expected until a child is between five and seven years old.
The number of children bedwetting varies by age; at 5 years of age, 16% of children have some difficulty staying dry at night, by 15 years of age, only 1-2 % of children continue to wet the bed. Boys are twice as likely than girls to wet the bed.
For most children, bedwetting resolves on its own without treatment. However, some parents and children may worry as bedwetting can be embarrassing, inconvenient and can affect family life.
In this blog I am go through the causes of bedwetting and the measures you can take to help your child become dry at night.
Let me firstly reassure you. Most children with bedwetting do not have an underlying medical problem. Bedwetting usually occurs when the volume of urine produced at night is more than your child’s bladder can hold or the sensation of a full bladder is not strong enough to wake your child at night. As your child gets older, the amount of urine produced at night is less and they become aware of the bladder signals to the brain when their bladder is full. Meaning the problem goes away on it’s own in most children.
There are some medical problems that may contribute to bedwetting that your GP will want to rule out. These include diabetes, urinary tract infection, constipation and seizures. Bedwetting can also be triggered in children who were once dry at night by anxieties or stresses such as starting school, moving house, a new baby, exams or any other big life changes. Wetting again after a period of dryness is known as secondary nocturnal enuresis and is treated in the same way.
It is also worth mentioning, that a child has a 40% chance of bedwetting if one parent also suffered from this as a child, increasing to 70% if both parents wet the bed.
Treatment of Bedwetting;
Before beginning treatment, it is important to consider how ready and able your child is to participate in the process. Both you and your child must be motivated. Be prepared that treatment can take a while and that it may not be plain sailing. However, although there may be periods of success and failures, by following the below advice, your child should become dry at night. It is vital to mention, that bedwetting is not the child’s fault, and a child should never be punished for this. Scolding does not improve a child’s ability to stay dry.
- Toileting; Encourage regular toileting throughout the day and just before bed (between four to seven times per day). If the child wakes at night, take him or her to the toilet. Remind the child every night to get out of bed and use the toilet when he or she needs to urinate. Moreover, ensure they are not constipated and their bowels are opening regularly (at least four times per week).
- Fluid intake; Total volume depends on the ambient temperature, dietary intake and physical activity. However, I would suggest sticking to non-caffeinated fluids. Furthermore, it may be better to let your child have most of their fluids in the morning and afternoon to prevent over filling of the bladder at night. I would suggest adding up your average child’s fluid requirement, and space the fluids so they have 40% in the morning, 40% in the afternoon and reduce this to 20% in the evening (based on this, if your child drinks 1L daily, then try giving them 400mls in the morning, 400mls throughout the afternoon, reducing to 200mls in the evening). It may also be worth restricting fluids one hour before bed.
- Environment; Help locate the loo easily by using a night light in the hallway or loo. Portable pottys may want to be considered if the loo is far from the bedroom. If they share a room or are in a top bunk, consider moving them to the bottom bunk to make access to the loo easier.
- Bedding; For practical sake, consider purchasing mattress and pillow protectors or waterproof sheets.
- Stop using diapers or pulls ups; as these may prevent a child from wanting to get out of bed.
- Reward System; starting a rewards system with positive awards for agreed behaviour rather than dry nights. For example, give rewards for drinking the recommended levels of fluids during the day, using the loo to pass urine before bedtime and engaging in the process (such as helping to change the sheets after an accident).
- Consider an alarm or drug treatment; this will depend on the age of the child and if the above measures have not been successful. Alarm treatment is appropriate for children who have not responded to advice on fluids, toileting and the rewards system described above. Drug treatment may be appropriate if rapid-onset and/or short term dryness is a priority, for example if your child is attending a school trip or sleepover.
When To See Advice;
You should speak with your child’s GP if they are complaining of pain or burning with urination, have difficulty with needing to urinate frequently or urgently, has extreme thirst during the day, swelling in the feet or ankles or has a new problem with bedwetting months after being dry. These may be a sign of a more serious condition that should be reviewed before any home treatments are attempted.
Dr. Emma Crawley
Private GP in Parsons Green, Fulham