Is There a Connection Between Snoring and Bed Wetting?

It was once believed that bed wetting was due to a sleeping disorder. This is because in some children snoring appears to accompany bed wetting. Snoring in children can sometimes be a result of what is known as obstructive sleep apnea (abbreviated to OSA). This breathing problem is much more common in adults, especially middle aged men, than it is in children but children can still develop it. Obstructive sleep apnea means, “there is a partial blockade to or intermittent interruption of the flow of air to the lungs, enough to seriously interfere with breathing.” The most common reason for OSA to develop is children are due to large adenoids. The adenoids are to be found situated behind the nasal passages and are similar in their function to tonsils as they are “collections of lymph glands” that serve to fight infection.

Plenty of children who have large adenoids do snore but don’t necessarily suffer from obstructive sleep apnea. Nor are they any more likely to wet their beds on a consistent basis. Those children who do develop obstructive sleep apnea suffer short periods of time throughout the night when they actually stop breathing all together. This can be a dangerous condition that can affect many areas of a person’s life including endangering their physical health, causing problems with school and friends and problems in the family. Obstructive sleep apnea in children can result in restless sleep at night, which can lead to excessive daytime tiredness. It can also lead to waking up feeling unrefreshed in the morning and morning headaches. Children who suffer from OSA have more trouble concentrating in school than do other children and they often suffer from memory loss and can be inattentive and grouchy towards others.

In those proponents who see a connection between OSA and bed wetting, they believe that it is the chemical imbalance that takes place in the brain due to obstructive sleep apnea that increases the potential for bed wetting. It is important to keep in mind that it is in only a small amount of children that snoring and/or OSA happens along with bed wetting. In the case of OSA for children, the adenoids and tonsils are often standard medical procedure and this seems to have a positive effect on the incidence of bed wetting as well. However this does not automatically mean that in children who both wet their beds on a regular basis and snore that they should have their tonsils and adenoids taken out. It is best to consider other options before going straight to surgery.

In instances where snoring and bed wetting began around the same approximate time it might be a good idea to discuss with the doctor if the tonsils and adenoids might be to blame. While snoring and obstructive sleep apnea is both considered “uncommon causes of bed wetting” the fact that they started occurring close together might be an indicator of where the problem lies. It is important to schedule an appointment with your child’s doctor to discuss all the health possibilities and implications of both snoring and bed wetting.

When it is Time to Speak with Your Child’s Doctor about Bed Wetting

Bed wetting episodes before a child turns six years of age are not usually a cause for alarm. In fact bed wetting is very common among children who are two to three years of age and just beginning toilet training all the way up to children who are entering elementary school at age five or six. However if your child still wets his or her bed on a regular basis past the age of six it might be a good idea to schedule a visit to the doctor’s office. There are cases as well where a child begins wetting their bed out of the blue and it is accompanied by other physical or psychological symptoms. This could mean that there is a medical problem behind the episodes and therefore his or her family doctor or pediatrician should examine the child.

Before being able to make a proper diagnosis a doctor will go through a child’s complete medical history with the parents and then will do a thorough physical exam. If the doctor deems it necessary, he or she will send the child for laboratory tests such as blood tests and/or a urine test (also known as a urinalysis). In some cases x-rays will also be done. The main health problems doctors want to rule out by doing tests are the risk of a bladder infection, a kidney infection, other types of bladder problems, constipation and diabetes. Severe stress can also bring on a case of secondary enuresis so if all medical tests show that the child is healthy, the doctor may sit down and talk at length with the and/or the child and his parents to see if there might be a psychological link for the bed wetting in terms of new stress on the home front or to do with school.

Ninety percent of the time, bed wetting is not related to a physical problem. If that is the case then a doctor may suggest a variety of therapies that can be undertaken to help rid the child of the problem. Sometimes however both the bed wetting child as well as his parents simply require information, advice and a great deal of reassurance from the doctor.

If the doctor believes that the bed wetting is serious enough to warrant treatment there are a number of different ones that can be tried. Behavior modification and the use of moisture alarms are two of the most commonly used therapies. They both are deemed safe and have high success rates with low percentages for relapses. There is also motivational therapy and bladder training exercises as well as a variety of medications that can be used. Two of the most commonly used drugs for bed wetting are desmopressin acetate (DDAVP) and imipramine. Psychotherapy is another treatment option and in rare cases, allergies can bring about bed wetting and therefore call for a change in diet.

Get in touch with your doctor if your child suddenly begins wetting the bed for reasons unbeknownst to you and also if your child starts wetting their pants throughout the daytime, complains of abdominal pain and/or experiences a feeling of burning when he or she goes to the toilet.

What Causes Bed Wetting?

Medical professionals have not been able to isolate any one specific reason for bed wetting and instead attribute it to more than one factor. It is considered widespread among children who are six years of age and younger. It is estimated that on average fifteen percent of six year olds wet their bed on a regular basis while approximately five percent of ten year olds do. The ability to control one’s bladder during the daytime usually develops first and the ability to do so during the night comes later. Most doctors do not believe that children who suffer from this problem have any serious medical and/or deep-seated psychological problems in relation to children who are not bed wetters.

Bed wetting can be broken down into two categories- primary nocturnal enuresis and secondary nocturnal enuresis. Primary nocturnal enuresis (which is often abbreviated to PNE) means that a child has mastered bladder control during their waking hours but for a period of at least six months has experienced consistent episodes of bed wetting and it has developed into a chronic problem. On the other hand, secondary nocturnal enuresis (SNE) means that the person has developed control over their bladder functions during their nighttime sleeping hours for a period of at least six months but then starts experiencing problems with bed wetting again.

There are believed to be a number of causes for primary nocturnal enuresis. There appears to be a genetic link when it comes to bed wetting. If a parent, grandparent, aunt or uncle had the same problem as a child then you are more likely to develop the problem. Many children have very deep sleeping patterns and don’t awaken when their bladder relays the message to the brain that it needs to be emptied. Some children have a central nervous system that develops slower than normal and therefore interferes with bladder functions. Some children simply have a smaller than average bladder that requires that it be emptied more often than most people’s. A bladder infection that has gone undiagnosed and untreated can also be the cause of primary nocturnal bed wetting, as can abnormalities that exist in the ureter in males and females and for boys it can sometimes be problems with their urethral valves. Children who suffer from chronic allergies, attention deficit disorder (ADD) or a variety of learning disabilities appear to have a higher incidence of bed wetting problems than do other children.
Secondary nocturnal enuresis is most often related to a build up of stress that is occurring in a child’s life at any given time. Most often once the source of stress has passed in the child’s life, the bed wetting then becomes a thing of the past. The three most common stress triggers for secondary bed wetting in children include starting school for the first time, being hospitalized or seeing a parent who must stay in the hospital for a few days and the birth of a new brother or sister. Although these events can be exciting many children are also frightened and therefore develop secondary problems as a result, thus the name, secondary nocturnal bed wetting. Problems that exist in a family can also trigger bed wetting. These problems might include abuse, neglect, and constant fighting between parents, divorce, alcoholism and financial worries.

Bed Wetting – Summer Camp worries

Should a child who wets their bed on a regular basis not be allowed to attend summer camp? Absolutely not. According to the National Kidney Foundation, approximately five to seven million children who reside in the United States are bed wetters yet still manage to enjoy the regular activities that other children engage in such as summer camp. More and more summer camps are becoming aware of how widespread this problem is and they are preparing ahead of time for it and using the utmost discretion to do so. According to one program director at a summer camp in Indiana, bed wetting is all in a day’s work and just something that the summer camp employees are taught to cope with in as sensitive a manner as possible. Besides bed wetting the other most common problem that camp counselors deal with feelings of homesickness.

Whether your child wants to attend a camp for the entire or just an overnight camp it is important for parents to try to deal with it beforehand. It is wise to first begin limiting how much fluid your child consumes before bedtime and in particular to decrease drinks that are filled with sugar and caffeine. Also encourage your child to always use the toilet before he goes to bed at night and try to make bedtime as calm and relaxing a time as possible. If your child is a deep sleeper perhaps you might want to wake him up at some point of time during the night to see if he needs to use the bathroom.

If none of these methods help a visit to the doctor should take place. A doctor will run tests to determine if your child is suffering from a physical problem such as constipation, kidney disease, a bladder infection or diabetes. If all of these problems are ruled out then one of the best treatment options to try is a bed wetting alarm (also called a moisture alarm). This special alarm is affixed to your child’s bedclothes or bed sheets and at the first drop of spilled alarm it sets off an alarm to let your child know that he must get up and go to the washroom. Moisture alarms are believed to have the highest success rates of all treatment methods.
Talking about what your child can and can’t expect to happen at camp is a good idea before he leaves for camp. Answer all of his questions as honestly and as completely as possible. Always make the staff at the camp aware of your child’s bed wetting problem before he goes. The more informed the counselors are, the better able they are to help your child. Include it on the information you fill out about your child for admission to the camp and discreetly remind a staff member when you drop your child off. It’s also a good idea to be as specific as possible in regard to instructions as limiting the child’s intake of fluid two to three hours before bedtime and so on. While it is not a requirement at all summer camps, some ask that parents send their bed wetting children with an ample supply of disposable absorbent underwear.

Some final bedwetting tips

Be patient.

This is the advice most often given to parents about children’s bedwetting. Although it is difficult advice to follow, it is also sound advice to a point. Since bedwetting often corrects itself in part or in full with time, a combination of some treatments and some patience is often necessary for success.

When trying new bedwetting treatments, it is often a good idea to give the treatments time to work, as well. There are no “instant” resolutions for bedwetting, and trying many remedies in rapid succession is not likely to work. In fact, it will not solve the problem but will often frustrate you as well.

Magnetic Therapy

New research has suggested than an alternative treatment called magnetic therapy has been shown useful in treating bedwetting in some children. A Korean University has found that children who were given treatment four times a week were less likely to suffer from Enuresis.

In this therapy, the child’s pelvic floor is exposed to the magnetic therapy by having the child use a special magnetic chair. More research needs to be done on this, but it is thought that in the future, this therapy will be used to treat some children.

Check for rashes.

Once of the only physical effects of bedwetting is possible skin irritation and skin rashes cause by having urine so close to the body. This problem is most common in children who wear absorbent underpants or who wet the bed very frequently. In most cases, these rashes can be prevented with frequent mild washing and maybe with a soothing cream.

Check for Infection

Some children, especially younger children, though, may scratch at irritated skin. Left untreated, this can cause an infection, which causes even more unnecessary misery. If your child has an infection, you need to prevent scratching by keeping the child’s nails clipped short. You also need to visit your doctor for a medicated cream to treat the infection.

Consider Dry Bed Training

Some clinics offer a sort of intensive and advanced behavioral modification approach to bedwetting called “dry bed training.” This can only be done by a professional, or with professional help, as it is quite complicated.

Children using this approach learn to stop wetting the bed through a combination of urine retention training, urine alarm system, self-correction, rapid waking training, positive affirmations and reinforcement, larger water intake, and toilet training. Some clinics and hospitals offer this program.

Your pediatrician or urologist may be able to help you find the training program nearest you. Because of the sometimes high cost of this method, it is often restricted to those patients who have tried many other methods with no success.

Take care of the problems the problem causes

Even if no method is immediately available in treating bedwetting, or if no method seems to work, parents can help children cope with bedwetting more effectively, knowing that the problem will in most cases go away by itself. Even while you are waiting for methods to take effect, though, you may want to consider treating the problems that bedwetting causes.

After all, bedwetting itself is not dangerous or a huge problem. When children are upset by bedwetting, what they are often really reacting to are some of the problems associated with the problem. As a parent, you can help your child deal with these problems. When you do, your child will worry less about the problem and will be better able to handle the problem as you try treatment or as you wait for it to pass. Some of the most common problems that children face with bedwetting are:

When your child thinks, “I’m embarrassed.”

Children often feel embarrassed by urinating at night, especially since it makes them feel that they are doing something embarrassing, hidden, or upsetting. For many children, processes like urination and body parts associated with urination are embarrassing. Bedwetting just highlights all the embarrassment that children feel about the whole topic.

You can help your child by repeatedly explaining that there is nothing to be ashamed of. Speaking frankly of body parts and processes can help, as can explaining frankly how the body creates urine and what happens when people wake up in time or don’t wake up in time to urinate. This will demystify the process for your child and make it seem less of an embarrassing thing.

When your child thinks, “Does this mean that I’m ‘bad’?”

Many children think that not controlling their bladder at night makes then “bad.” This may come from a few places. Children may hear adults saying “bad” to children who have had an accident (they may even see this on television). Children may also pick up on their parents’ frustration with having to clean the sheets and bed after an accident. The extra work a parent has to do, along with the frustration, can make a child feel guilty or even that he or she is unloved.

Reassure your child that urination is a body process and that it simply takes longer for some children to control their bladder. Continue to praise your child when he or she makes it to the bathroom in time, and never scold or punish your child for accidents. Make clean-up as easy on you as possible so that your child will not see you frustrated or upset as a result of bedwetting.

When your child thinks, “This will never get better.”

For children, time passes differently. A problem they have had for weeks may well seem forever. If they are the last children in their class or group of friends to wet the bed, they may feel that their problem will last “forever.” Children who feel this may get discouraged and upset by the problem.

Reassure your child that the problem is temporary. If possible, have other family members discuss their own bedwetting experiences (and how they overcame it) with your child. Collect stories in the press of celebrities who wet the bed as children but outgrew it (celebrities will sometimes mention this sort of thing – or their biographers will – in interviews). This will help convince your child that the problem is only temporary.

When your child thinks, “I’m not normal.”

Children of a certain age worry very much about “fitting in.” Anything that interrupts this often causes undue upset. Whether it is not having the “right” shoes or being different because of a medical condition, children who do not feel that they belong experience lots of stress. If your child thinks that he or she is the last 6-year-old (or 8-year-old or 16-year-old) that still wets the bed, your child may conclude that there is something “wrong” with them.

Have your doctor talk to your child and assure him or her that bedwetting is normal. Better yet, follow the advice above – have people that your child sees as normal talk about their childhood bedwetting. Once your child realizes that he or she is not “strange” by wetting the bed, some of the anxiety will decrease.

When your child thinks, “It takes so much time and work.”

Ok, this is the cry of most parents who are faced with a child who wets the bed, but your child may also face anxiety about the upheaval that a “wet” night causes, especially if there are other people around to witness the fuss. If your child spends lots of time trying to work with bedwetting remedies or spends extra time cleaning up, he or she may also resent the time and work bedwetting takes up.

You can make bedwetting less of a problem for you and your child by making clean-up easier. Have your child wear absorbent underpants while trying to control bedwetting, or at least protect the bed and pillows with protective mattress liners. Keep extra bed linens and cleaning products in your child’s room so that clean-up takes only a minute. Do larger loads of laundry to save some time, if you can.

When your child thinks, “I’m ashamed.”

Many children are shamed by bedwetting – usually by the remarks made by a parent or another child. In general, a child is made to feel ashamed because those around him or her seem to make bedwetting a big deal or a sign of failure.

You can prevent your child from being ashamed by sticking to a “no big deal” attitude yourself. Make sure that your home is a no-tease zone and do not let other adults belittle your child. If a well-meaning relative starts to say something to your child about wetting the bed, praise your child publicly for doing well.

Saying something as simple as “Oh, John is doing much better with that now. We’re all very proud of him” right to an adult who is making your child feel ashamed will make your child feel better. Positive reinforcement of any kind, in fact, will help your child. One of the best antidotes to shame is showing your child that you love and are proud of them.

When your child thinks, “This means I’m lazy.”

It is one of the myths about bedwetting that it is caused by laziness. Your child may hear this myth from another child or from an adult. It can make your child feel as though he or she is not “good enough.”

Explain to your child how urination works and why some children cannot control their bladder until they are older. Point out all the things that your child does (chores, help, activities, school play) that prove that he or she is not lazy. Discuss what a myth is and explain why some people believe them.

Try saying something like, “Before, doctors didn’t know why some kids wet the bed and some didn’t, and someone thought that maybe it was because some kids were lazy. Now, doctors know that it’s not true. Kids wet the bed because their bodies still need to grow in some ways, but some people haven’t heard of this, and so they still believe the old idea.”

This should help convince your child that the myth is not true.

When your child thinks, “This means I’m stupid.”

Sadly, many people try to look for explanations in illnesses or conditions, trying to find out the “cause” behind something or trying to find out what something supposedly “means” rather than focusing on care or treatment. Your child may also be under the impression that the lack of bladder control “means something.” Your child may assume that there is something wrong with his or her mind, as other kids have “learned” to stay dry.

When your child hears that the body does not wake the mind up to go to the bathroom – a common way Enuresis is explained to children – the child may assume that there is something wrong with their mind that is causing the bedwetting.

Praising your child’s intellectual ability (putting good grades on the fridge or rewarding well done assignments) can help convince your child that he or she is intelligent. You can also take care to explain that children who wet the bed do not have anything wrong with their minds at all – they are just waiting for some body parts to grow up. This can hep reassure them that they are bright, that they just need to wait a bit longer to control their bladder.

When your child thinks, “I’m dirty.”

Children who wet the bed may be teased by other children about the urine odor which may linger about their clothes and rooms. Even if this is not the case, many children associate urine with something “gross” or “dirty” and may feel disgust with their own bodies. If skin irritation develops, children may feel even dirtier, seeing marks of their bedwetting on their skin.

You can help your child feel clean by keeping their room and clothes clean and odor-free. Frequent washing, airing out of rooms and clothes, and use of a deodorizing cleaning product will usually keep odor away. Room sprays can also help. Using absorbent undergarments or sheet liners can help control odor and wetness. Also, help your child care for his or her skin or body and ensure that they always have fresh sheets and clothes on hand to use after an “accident.”

You will also want to speak frankly with your child about urine and body waste. Explaining where it comes from and what it is can help your child overcome some of his or her disgust. Be sure that you do not encourage any of these negative feelings by wrinkling your nose or expressing distaste when cleaning after your child. Any other person in charge of cleaning up after your child should be taught the same.

When your child thinks, “I’m angry.”

This is often a case of “why did this have to happen to me?” Children may feel that it is unfair that they have a problem with wetting the bed when others seem to have no problems sleeping a dry night. Some children may also be angry that other tease them about it. Anger often takes many forms, for withdrawal, to outbursts to violent flare-ups of anger with other children.

Getting your child to cool down is a top priority. Always have your child calm down quietly by himself or herself after a display of temper or defiance. Then, give your child a chance to tell their side of the story.

Of course, as a parent, you know that there are no answers as to why some things happen to some children and not to others. Explain that it is unfair that not everyone develops at the same time. Explain to your child some of the reasons behind bedwetting and sympathize with their anger.

Then, talk about what should be done when they feel anger. Discuss why anger happens and what can be done about it. If your child feels anger at home, you can try to encourage him or her to sit quietly, breathe deeply, and wait for the feeling to go away.

If your child is angry about being teased, try getting your child to act out what it said to him or her and have your child act out what he or she might say the next time something happens that is similar. You should not give your child excuses for expressing anger or violence, but you need to help your child deal with the feelings in a non-destructive way.

When your child thinks, “I’m being teased.”

Many children are teased at school for bedwetting. While adults know that most children will be teased for something at some point, and pay the problem no mind, teasing can be devastating to a child. Cruel nicknames such as “baby diapers” or worse can stick to a child and bring on the feelings of shame, anger, embarrassment, and worthlessness mentioned above, and this can be quite serious.

Have grown-ups talk to your child about what they were teased as a child (all the better if they were teased about bedwetting, too) and have them tell your child how the problem eventually got better.

Also, you may want to suggest to your child some things he or she can say when he or she is being teased. The best way to do this (especially with younger children) is to play make-believe. Have your child pretend to be the teaser, and pretend to be the child.

Have your child tell you where you are and have your child tease “you.” Make the remarks you think are appropriate, suggest many things that the child could say. Then, switch roles. This game has several advantages:

• It makes the child feel in control, rather than helpless (which is the feeling teasing often creates)
• It allows the child to laugh at teasing
• It gives the child some idea of what can be said or done to teasers
• It builds the child’s confidence
• It gives you a chance to evaluate the level and type of teasing your child experiences
• It opens communication with your child. Since the child feels free to tell you what is happening through “play acting” he or she may be willing to tell you what is happening in more detail, which can help you in deciding what to do about the teasing.

When your child thinks, “I’m being bullied.”

One thing that you need to watch out for in terms of teasing is bullying. Bullying is teasing that has taken a more aggressive turn. In many cases, it escalates with time and can include actual physical violence. Some children have even died at the hands of bullies who have targeted them.

Sometimes, it can be hard to tell when teasing has taken the turn to bullying, but in general if your child seems traumatized by the teasing he or she is getting at school, you should treat the teasing as bullying.

Also, if there is any physical aggression or any threats then the situation is certainly bullying. Bullying is a crime in many locations and needs to be brought to the attention of parents, school authorities, and possibly authorities as well. Bullying needs to be taken seriously at once, as it can very quickly get completely out of hand.

Of course, adults know that bullying and teasing are not caused by bedwetting – child bullies will target any child who seems unsure of themselves and any child who displays signs of being “different.” However, bedwetting can be a sign of difference and can affect a child’s self-esteem to the point where they do make a target for other children.

In some cases, therapy or visits to a counselor can help your child get the social skills needed to deal with teasing. In other cases, more help is needed, especially if bullying is an issue.

In many cases, trying to deal with the bully’s parents has little effect, as not all parents can control what their children do outside the house. Moving away is also not always effective, as teasing may simply continue at the new location.

When your child thinks, “I feel like a baby.”

For children, acting “grown up” is important, partly because children look up to adults so much and often want the power and control they think that adults have. For a child who wets the bed, though, there is a sense of the opposite feelings – lack of control, and lack of power. Children who wet the bed may feel powerless.

Many children may worry that they are acting “babyish,” especially since this is one of the first accusations leveled against bed wetters on the playground. For an adult, being called a “baby” may not be a big problem, but it can feel like a devastating problem to a child, especially a younger one who may see being a “baby” as being left behind while others in the same age group “grow up.”

To offset these feelings, make sure that your child understands that children of all ages – even children who are older – wet the bed. It is truly not a problem of age, but a problem of bladder control, and it can affect people of all ages. While children do eventually “outgrow” the problem in many cases, many children your child would consider “grown up” still face the same problem.

When your child thinks, “I hate having a big secret.”

Most children try to keep bedwetting a big secret, as they are fearful that others will find out. However, having a large secret can affect the way your child’s relationships and can leave him or her feeling lonely. Having a large secret is isolating, to say the least.

Plus, your child has all the stress of knowing that the secret may be exposed. The older a child is, typically the more effort will go into keeping bedwetting a secret. Among the things that children will do to keep bedwetting a secret are:

• Avoiding sleep overs, camping trips, and other events for fear of being “found out.”
• Avoiding bringing home other children, out of fear that someone in the home will “tell.”
• Adopting an “I don’t care” attitude or acting aloof in order to avoid getting close to others.
• Avoiding making friends.
• Staying up all night on camping trips or during sleep overs in order to prevent accidents.
• Teenagers may avoid dating.
• All children may avoid attention or notice by refusing to try to excel at school or activities.
• Acting in a “tough” or self-destructive way so that no one will guess the “truth.”

Your child may put themselves through a lot to prevent others from finding out that they wet the bed. This can create a lot of tension in the home and also ensures that your child will not make close friends.

Worse, your child may give up fun trips or exciting events just out of fear of accidents. This is limiting. You certainly don’t want your child to grow up fearfully or in great tension.

Generally, whether your child chooses to tell others about their bedwetting or not is up to them. You should never tell someone else about your child’s bedwetting – the child should be able to decide who to trust and who not to trust.

Telling anyone – even a well-meaning teacher or relative – without the child’s consent is a recipe for disaster, especially if your child is keeping the problem a secret. Your child may simply cease to trust you and will likely feel more fearful as well as resentful.

However, you can help your child open up to others by showing your own acceptance of the problem. If you treat the problem matter-of-factly and with sensitivity, your child may start to trust that others will, too.

Plus, you should encourage your child to spend time with others as much as possible. Discuss things such as camping trips or other events ahead of time and discuss with your child how he or she could handle bedwetting or the possibility of accidents in such a situation.

In a way, your child may be relieved when his or her secret is finally revealed. However, it can also be a very traumatic time, especially if the “truth” is met with teasing or disapproval.

You may want to speak to your child about what he or she would feel like if someone did find out. Discuss the responses that your child expects from others and then suggest more gentle responses that may be possible, too. Talk with your child about things that he or she could say to negative or insensitive comments.

When your child thinks, “I don’t want to go anywhere.”

Many children who wet the bed show less interest in spending lots of time with others, especially if they are teased or are trying to prevent others from learning about their bedwetting.

This can lead some children to isolate themselves and can also lead to such a low state of self-esteem and happiness that children will stop their regular fun activities as well – even if those activities do not involve sleeping over or even other people. This can be a serious sign of upset and should be taken seriously.

A lack of interest in what is happening can be a big problem of bedwetting. Children can become unenthusiastic, depressed, listless, and apathetic, leading to lack of activity and increasing depression.

You can try enticing your child’s interest in new things by encouraging him or her to take part in new activities that seem appealing. Offer support for activities that your child has done in the past that he or she has excelled in, and offer some part of an activity as a treat. For example, if your child has always liked baseball, buy him or her a new glove or a baseball card to revive interest. If nothing seems to work and apathy lasts longer than a week or so, take your child to a doctor to make sure that no physical problem or serious emotional trauma are causing the disinterestedness.

When your child thinks, “I feel insecure.”

No child will simply come right out and say it that way, but there are many signs that a child is feeling that way on some level. Children who feel this way will often try to be loud to garner more attention or will be quieter and try to attract as little attention as possible. Children may bully others or attract bullies as a target. They may cling to the home, fearful of venturing anywhere else. They may become quite clingy and demanding in all sorts of ways.

Insecurity is a bigger problem than many think. It can lead to experimentation with drugs in older children who want to “fit in” and it can lead to a host of destructive behaviors, even in younger children. It can prevent children from trying new things and hold them back from excelling. It can also lead to image problems and feelings of unhappiness or even depression.

Building self-esteem in children is a long road, but it can be done. Start by praising your child for the things that he or she does right. Also encourage your child to take part in activities or try things outside the home. Often, when a child accomplishes something “all by themselves” the pride of the success will outweigh all the positive praise possible, as it creates a real feeling of accomplishment.

When your child thinks, “What will others think?”

Children often worry most about other people’s reactions rather than about actual bedwetting. Put another way, if there was no one else around, bedwetting would be far less stressful for a child as there would be no one else to know about the problem. Many children imagine what others would say, and the imagination is always worse than the reality. Or, your child may have had one or two experiences of being teased for the problem and now is fearful that others will react in a like way.

Either way, worrying what others will think makes a much bigger problem out of bedwetting. Such anxiety also puts lots of stress on a child, often unnecessarily. You can help your child overcome this problem by discussing with your child possible reactions people might have to the bedwetting and discussing what could be said in response.

If someone accuses him or her of being a baby, for example, you child can point out that lots of older kids wet the bed or tell the teaser that bedwetting is not about being a baby, but rather a condition. Be sure to discuss possible nice or sensitive things people could say, too, so that your child is not just imagining the worst.

If your child is hesitant about other people’s reaction because he or she has already had a negative experience, you will have to work a bit harder. Talk to your child about the incident, and consider why someone would have a bad reaction (Could they have been ignorant about bedwetting? Could they have been having a bad day and just taken it out in that way? Could they just be mean-spirited, saying something unpleasant about anyone, whether they wet the bed or not?).

With your child, discuss what the child would do or say in the same situation. Then, talk about any positive experiences the child has had with people learning about his or her bedwetting and discuss possibly kind things that people could say once they find out.

This sort of role playing is very effective in having your child feel in control of situations where people learn about the bedwetting. Often, the most frightening thing about someone’s reaction to us is that we cannot control the reaction. Imagining what to say gives your child some of that control. Also, imagining or remembering positive reactions will take your child out of the mind frame that all reactions will be bad.

When your child thinks, “This makes home feel terrible.”

Bedwetting affects not just the child afflicted with Enuresis, but rather the whole family. In some cases, children may resent the home or may feel that their problem creates an unpleasant atmosphere at home.

Parents may disagree over the treatment options, siblings may feel jealous of the attention the child receives or may tease their sibling over the problem. The child may also come to associate his or her bedroom with nighttime discomfort. There are many ways that bedwetting can affect the home, and few of them are pleasant.

The best way to counteract this problem is to work together as a team. Everyone in the family should be included in decisions that affect the whole household (decisions such as changing a sleeping room so that one child will be closer to the bathroom, for example).

You should also try to make home as un-tense as possible. Make bedwetting less of a family upheaval by making clean-ups easy and by making the child affected help with some clean-up. Also, make sure that you have everyone in the household agree to no teasing. Creating a serene home environment is helpful for everyone affected by bedwetting.

Take it one step at a time.

You can’t expect your child to stop wetting the bed overnight. For many children, the process takes months or years, and even then the occasional “accident” can happen. Take things one step at a time, slowly helping your child and celebrating successes (such as a week or a record three days dry in a row). Rushing will not accomplish anything and will just put unnecessary pressure on the child.

Stay organized.

Try one method at a time and carefully record on paper how effective it is (the easiest way to do this is to mark off which nights are dry and which are not so that you can see if there is an improvement). If you try several methods at once, you will have no way of knowing which remedies are working and which are not.

Give a method time to work before tossing it aside.

In general, most methods should give you at least some minor result within two weeks. However, some methods may take longer to show effect. Do not be in a rush to try every method. The goal is to help your child, and you do not want to overlook a method that would work just because you want “instant” answers. If you have not seen improvement in a few weeks, though, by all means try some other method to see whether your child can find relief some way.

Combine some tips for best results.

Where no interaction is a factor, try combining tips to get great results. For example, you can often combine natural or homeopathic alternative therapies with behavior modification. Most tips work well with comfort tips such as protecting sheets. Of course, you do not want to combine medications, but combining behavioral modification with some natural supplement or dietary changes may do the trick.

If you are going to be combining remedies, make sure above else that the two methods will not be dangerous together. Then, introduce each therapy to your child one at a time so that your child can get used to each treatment and so that you can observe any adverse effects.

Try simplest methods first.

You want the best for your child, but the best is not always the most complicated or high tech method. With young children, especially, simplest methods are best. They also tend to be the most effective. For example, low-cost moisture detector alarms have very high rates of efficiency, even when compared to high-priced training. Look for inexpensive treatments that are simple enough for your child to understand. If those are ineffective, then you can move on to other methods.

If you start with the most complicated gadgets and solutions, you may find yourself spending a lot money than you planned if that first treatment does not work. Plus, if you put too much faith in the latest high-tech solution and your child’s problem is not resolved, both you and your child will have to deal with the disappointment.

Keep your expectations realistic (gradual improvement over time) and keep your solutions simple. Both your child and your wallet will thank you for it.

Understand all risks before you begin

Some methods of bedwetting treatment have almost no risks (think of the honey cure or visualization, for example). Some are risky when administered improperly (alternative or holistic medicine, chiropractic therapy) and some are risky (all medications carry risks of side effects). Make sure that you understand what can go wrong with each treatment before you begin it. Make sure that you can cope with the eventuality if it happens.

Of course, you should try low-risk options (behavior modification, for example) before higher risk options (such as medication). It makes sense to keep your child safe, especially if the bedwetting issue can be resolved with no possible injury. Move onto riskier methods if the low-risk methods do not seem to be working after a few weeks.

Keep your eye on the big picture

As you browse through this ebook, you may be excited that so many possible solutions exist for bedwetting. However, do not focus on these tips so much that you lose track.

Your main goal is to make your child feel comfortable and to help your child feel happy.

If you can do this with methods for getting rid of bedwetting, then great. However, putting the focus on your child first means that you will not lose track of your child’s comfort level as your try to help your child stop wetting the bed.

Love your child

If you are reading this book and trying to help your child, then you likely don’t need to be told – but does your child? Children who are experiencing bedwetting and treatment for the problem often experience great upheavals of emotions. They need your love more than ever, and they especially need to be told that they are loved – right now. Being affectionate and loving with your child will help reassure your child more than anything that he or she is still loved and accepted. This can help give your child the strength to get over teasing and the other problems associated with bedwetting.

Don’t just assume your child knows you love them – especially if you have been short-tempered with them concerning bed wetting or bedwetting treatment. Tell them.

The Social Consequences of Bed Wetting for a Child

Bed wetting does not only affect a child physically but psychologically as well. It often puts social limitations on a child’s behavior, affects a child’s self-esteem that is in its developmental stages and can cause teasing and ridicule, both from other children as well as adults. Bed wetting often carries with it a social stigma that can hurt a child greatly.

Children who wet their beds often feel helpless and sometimes their parents struggle with this problem as well in relation to their child. Parents often feel helpless to completely keep their children at ease about bed wetting. Many children live in fear that their friends and peers will discover their bed wetting and will then tease and ostracize them from the group. They fear having no friends and always being left out. No one wants to be the only child standing alone on the playground and no one wants to be called names or laughed at.

A child’s sense of self is shaky at best when they are developing and enuresis can complicate the matter tremendously. All children want to be accepted by their peers and to have lots of friends to play with and have fun with. Being a part of the larger whole helps children grow in a happy and healthy way. All parents want this for their children, whether they wet the bed at night or not. Studies have shown that great deals of child who fall victim to bullying are children who suffer from enuresis.

Parents in turn often avoid the situation dismissing it as uncomfortable and embarrassing while they hope it will go away on its own while other times they berate and punish their child for behavior that the child cannot control. Neither response is a good one. As well parents often give into frustration over constantly having to change a child’s wet bedding and pajamas and may not want to do laundry as often as they need to in order to keep up with the problem. Many parents feel as though the bed wetting is a consequence of their poor parenting skills and they believe they are a failure because the child won’t stop wetting his or her bed. The child often feels this feeling of failure as well who then feels it even more strongly when it is magnified through a parent. Coupled with feelings of shame, confusion and anxiety the situation often gets worse instead of better until treatment is undertaken. Unfortunately in the general population there is a lot of misinformation and downright ignorance regarding bed wetting and this can cause even more stress and anxiety on both the parent and the child.

Parents should be assured that bed wetting is extremely common in children and they should schedule a visit for their child to see a doctor in order to discuss treatment options. If a child is particularly concerned with the negative social aspects of bed wetting the doctor can make suggestions in that area as well. The most successive bed wetting treatments are aimed at not just fixing the physical problem but repairing the social side of things as well.

Signs and Symptoms of Bed Wetting

There is one main symptom that lets you know that bed wetting has become a problem. It is when “involuntary urination” during a child’s sleeping hours takes place at least twice in the run of a month and sometimes more. Bed wetting is not named as such until a child is five or six years old. Those younger are not considered to be bed wetters as bed wetting is very common among those who are two, three and four years of age.

When it comes to signs and tests, a doctor will perform a thorough physical exam on a bed wetting child to determine if the problem has a physical connection. Often a urine test (or urinalysis) will be done to determine if the bed wetting is a result of the onset of diabetes, constipation, a urinary tract infection or other related bladder problems. Often bladder problems including infections are accompanies by other symptoms such as a burning sensation upon voiding, pain in the abdominal area, headaches and sometimes pain in the lower back. In some cases a doctor may recommend x-rays be done of the bladder and kidneys to see if there might be an obstruction that is causing problems. Sometimes these medical problems are accompanied by pain and sometimes they are not.

Bed wetting is defined as “recurrent, uncontrolled urination that occurs during sleep.” While both males and females can experience it, this problem is more likely to affect boys. Recent studies have shown that on average five to seven million children who are six years and older wet their beds at night but in fifteen percent of cases on an annual basis, it goes away without any type of treatment. It is estimated that twenty-six percent of four year olds wet their beds on a regular basis while that number drops to seven percent for five year olds. An estimated three percent of ten year olds wet their beds while among teenagers it is one point five percent at age fourteen and one percent at the age of eighteen. The risk of suffering from bed wetting increases for those who had a family member who also wet their bed (such as a parent, grandparent, aunt or uncle) as well as those who suffer from juvenile diabetes or who have hade a succession or bladder infections in the past.
For parents the most widespread response to a bed wetting child is to punish him or her or to ignore the problem and hop it goes away. Neither one of these approaches is helpful or healthy for the parent or the bed wetting child. Studies have shown that taking the initiative and attempting to solve the problem will make it possible for the majority of children to kick the problem in eight to twelve weeks. By doing nothing, eighty-five percent of children who wet the bed in any given year will still be doing it the following year until help is sought. It is important to first determine whether your child is suffering from primary or secondary enuresis and then work from there. Your pediatrician should have plenty of information and advice to provide to you regarding help for your child.

Secondary Enuresis and the Arrival of a New Baby

When a new baby comes home it is a blessed occasion but for another child in the household it can bring on a bout of stress and anxiety that can result in a case of secondary enuresis. Older children fear that their parents will love them less or have less time for them because of the new baby. They also fear that the status quo will change in their family. Change is often a scary prospect, as they cannot see the bigger picture so they fear the worst. However many children also are very happy that they have acquired a new brother or sister but this still brings with it a measure of stress. The arrival of a new baby can cause an older child to begin wetting the bed after having been dry for a period of six months or longer or it can cause bed wetting to start all of the sudden. When bed wetting is the result of a stressful situation it is referred to as secondary enuresis.

Older children may very well love their new baby brother or sister but they still may have reservations about sharing their parents with another human being. This is especially the case for children who have been “the one and only child” for a long period of time. Not all children react the same to the arrival of a new sibling. Some are anxious and frustrated at the turn of events that they begin withdrawing or becoming passive-aggressive in their behavior and begin “acting out” in inappropriate ways. These children may become less reliable, more likely to forget things and also lazy and sloppy in their habits, thereby making it imperative for their parents to pay more attention to them and their newly acquired problems. Secondary nocturnal enuresis is a very common outlet for this stress and frustration.

According to experts, this is a stressful time for both parents of a newborn baby as well as the older sibling who fears he will lose a portion of his parents’ love and time to the new addition to the family. It is important to not scold or get angry with your child for wetting the bed at night. Pay close attention to the tone you use when addressing your child. Refrain from accusing or blaming your child and realize that he feels embarrassed and upset enough about the situation. Don’t compound the problem by making him feel ten times worse. Instead try to come up with suitable ways to rectify the problem.

Take the time to talk with your older sibling to get to the root of the problem. Explain to your child that he or she is loved no less just because a new person has entered the family. Make sure you reassure your child as many times as you need to until he or she begins to feel secure again. Tell him that he is the big brother and that he should be proud of that. Allow him to help you out with the care of the newborn as often as possible. Make him feel a part of the larger whole of the family and spend as much time with him as you possibly can.

Reacting Positively to Bed Wetting Episodes

Bed wetting is very common in children and is often a condition that children do eventually grow out of without the need for treatment. According to research done on the subject, how a parent reacts to the bed episodes can often help diffuse the situation on the positive side, or on the negative side, can make it much worse. It is important to realize that a child who experiences bed wetting on a regular basis already feels plenty of stress and anxiety about the whole situation. The worst thing a parent or caregiver can do is blame a child for bed wetting or call the child a “bad child” because of it. Parents must educate themselves first before laying blame on an innocent party.

Bed wetting is not within a child’s realm of control and since it is not an enviable state, it is not something that a child deliberately does to upset his parents or make more work for them in regard to laundry. A child does not enjoy waking up wet and cold with the smell of urine permeating their bedroom. A child does not look forward to the stern look of disapproval that will cross their parent’s face when they find out that it has been another wet night for the child.

A child’s self-esteem is in its beginning stages in childhood and it can be damaged very easily by harsh words, criticism and looks of displeasure. Remember that a parent plays an extremely significant role in a child’s early development and all children want to make their parents happy as opposed to unhappy. Every child craves approval and acceptance and not scorn and rejection. By heaping more stress on an already stressful situation, a child is likely to get into a vicious cycle that keeps going round and round and appears to have no end.

So then what is the best way to react to a bed wetting episode? Doctors agree that being empathetic, supportive and understanding is key. Tell your child that you understand that he or she is upset, embarrassed and uncomfortable about the bed wetting. Assure your child that you love him no matter what and that together you will work through the problem. Tell him that plenty of children all over the world wet their beds and that they feel exactly the same as your son does. Children feel less alone when they know that others can relate to their discomfort.

Reassure your child every time he wets his bed that he is perfectly normal and that with time the bed wetting will come to an end. Tell him that if he doesn’t naturally outgrow it that he might need to visit the doctor for some suggestions about treatment but in the end everything will turn out okay and he should not worry himself too much.

If your child wants to help you change the wet bed sheets let him do so but don’t make a huge deal about it. If he doesn’t want to then don’t make him as changing sheets should never be viewed as a form of punishment. This would only be detrimental to his development.

Say No to Punishment When it Comes to Bed Wetting

A bed wetting child does not deserve to be punished because he or she has not done anything to warrant it. When a child does something that is wrong such as hitting his or her sibling or hurting an animal or speaking inappropriately to a parent then the parent feels the need to teach the child a valuable lesson and send the message that what you did is wrong and this behavior will not be tolerated. The goal of punishment is to make sure the child never does the behavior again. Sometimes this works, other times it doesn’t.

By punishing a child for bed wetting you send the wrong message. As well he associates a problem he is having with a misdeed. He then tries to control the behavior and prevent it from happening but since bed wetting is out of a child’s control, he becomes more and more agitated and anxious about the situation. He also becomes confused as to why you keep punishing him every time he wakes in the morning to a wet bed when he knows he is doing everything to stop the behavior. Bed wetting followed by punishment often becomes a vicious cycle that just keeps on going round and round in an exhausting repetitive manner and has no end in sight.

As a parent it is important to realize that punishment will not work if it is handed out on a regular basis nor will it work if the child has done nothing wrong. What often happens in this case is that a child will come to the conclusion that you will get angry with him no matter what he does so he begins acting out in other areas such as throwing temper tantrums, screaming right back at you and being mean to others.

Questions a Pediatrician Will Ask Parent of a bed wetter

If as a parent you can answer yes to more than one of the following questions then it might be time to schedule an appointment with your child’s pediatrician to discuss options in regards to treatment for bed wetting. The questions in no specific order are:

-Is your child past the age of five or six and frequently wets the bed at night?

-Did you toilet train your child at a younger age than most? (Most doctors recommend that a parent begin potty training a child somewhere between the ages of two to three years.)

-As a child did you ever have a problem with bed wetting? Did the child’s other parent or any other family member’s that you are aware of?

-Is your child going through a particularly stressful time in his or her life right now? (such as for example the recent death of a loved one, a family crisis, problems with school or friends or the birth of a sibling)?

Upon taking your child to the doctor he will need to answer a variety of questions of the parent to arrive at what could be the source of the recurring bed wetting problem. Your doctor should discuss with you the difference between primary nocturnal enuresis and secondary nocturnal enuresis and feel free to ask about anything you do not fully comprehend.

Your doctor will explain to you that there is often a genetic link when it comes to bed wetting and he will therefore he you if there is any history of bed wetting in your family that you are aware of. This goes for both the mother and father’s side as well. If both parents were bed wetters when they were young, a child has a seven in ten chance of being one as well. If only one parent was then a child has a four in ten chance of becoming a bed wetter.

The doctor will ask about your child’s toileting habits throughout the day. How often does your child use the toilet and approximately what times of the day does he do so? The doctor may also ask about the child’s bowel movements, as constipation is sometimes a cause of bladder control problems at night.

The doctor will want to know as much as he can about the circumstances under which your child wets his bed. Is it on weekends, weekdays? Is it on certain nights or does it happen haphazardly? Does it happen on a night in which the child was very active the day before? Is the child anxious, upset or bothered by a problem when the bed wetting episodes take place?

What are your child’s habits regarding the liquids he consumes? Does the bed wetting take place on nights when he drinks a lot of water before bed? What about nights when he fills up on carbonated beverages such as soda pop, chocolate milk or citrus (such as apple or orange) juices?

Does your child suffer any discomfort or pain when he urinates? Does the urine have an unusual color (for example is it extremely dark and concentrated) or does it smell particularly bad? If yes then the doctor will probably send your child for a urine test and/or x-rays because the cause of the bed wetting could be medical.

Questions Children Need Answered About Bed Wetting

Children who suffer from bed wetting on a regular basis are admittedly bothered by the physical problem. Just as children are filled with questions about just about everything that also includes their concern over bed wetting. Let’s take a closer look at some common questions children have concerning bed wetting.

What is bed wetting?

This is one of the first questions that children need answered. The scientific or medical word for bed wetting is enuresis and it means that you pee or wet at night while you are sleeping.

When do most children stop wetting their bed at night?

Bed wetting is very common among toddlers and approximately five million youngsters in the United States continue to wet their bed at night after they have passed the age of six years. Rest assured that if you wet your bed, you are not alone in this.

Why do I wet my bed?

Be aware that you are not to blame for wetting your bed. You wet your bed at night because your brain doesn’t awaken you in time to go to the bathroom to empty your bladder. Other reasons it might occur is because your kidneys are manufacturing more urine than they do for other children and/or you might have a very small bladder that will only hold a small quantity of urine. Also bed wetting is sometimes genetically linked. In other words someone in your family might have also had the problem. Wetting the bed can also be caused by a bladder infection so your parents might want to take you to your doctor to get checked out.

Is there any help for my bed wetting?

Absolutely there is. These are not guaranteed methods to stop the habit but they can help you. First of all limit your consumption of fluids before bedtime. Drink more in the morning and afternoon than the evening. Don’t drink beverages that contain caffeine such as chocolate drinks or soda pop. Have your mom or dad wake you during the night to see if your bladder is full and if you need to use the washroom. Trying using a special bed wetting or moisture alarm. This is an alarm that fits comfortably inside your underwear and if you start to pee in the night it goes off by either vibrating or ringing, thereby alerting you to the problem. Wear disposable underwear at night to prevent too many pairs of soiled underpants and also soiled sheets.

Why should I talk to my mom and dad about my bed wetting?

Your mom and dad love you and you can trust them with your concerns. If you feel uncomfortable or embarrassed about this situation they will help reassure you and put your mind at ease.

Is there any chance that my bed wetting will not end?

It takes longer for bed wetting to end in some children then in others. However the majority of kids do outgrow it as the muscles of their bladder grow and get stronger. To use an example, there are only one or two kids out of approximately every one hundred who continue wetting their bed at night when they turn fourteen or fifteen years old.

Products to Buy for Children who suffer from Bed Wetting

If your child has problems with bed wetting there are products you can buy to make him or her feel drier and more comfortable.

For example a special bed wetting alarm is a way to help your child overcome the nightly problem whereas other products such as disposable underwear are able to absorb the urine so it does not wet or stain clothing or bed sheets and it also contains the urine odor so a child can still do all his or her normal daily social activities such as playing sports, going on field trips with his or her class and attending pajama parties or staying overnight at a friend’s house. Children who have a bed wetting problem want to be able to have a normal life like other children their age and don’t want to have to worry about the odor of urine or its leaking out on clothing, a sleeping bag or the floor. Be aware however that these problems are a stopgap measure and will not get rid of the bed wetting problem. It might be wise before you do anything else to take your child to the doctor in order to rule out physical problems as the cause of the bed wetting behavior.

There are a variety of absorbent disposable as well as reusable products that you can purchase for your child to help ensure his comfort. Diapers that absorb urine readily are available for both babies and toddlers and there are assortments of absorbent underpants that can be purchased for those in the age range of three to five years. If your child is of school age and has problems with enuresis or incontinence (which is bladder control issues during the daytime) there are absorbent disposable pants that are designed to fit his or her growing body. Many of these products can be purchased from your local pharmacy or grocery store. If you are unable to find them there then check into a local or regional medical supply company. It is quite possible that you may be able to purchase the products you need online.

Disposable products such as disposable underwear are those that are able to absorb a large quantity of urine all at once and then can be sufficiently gotten rid of in the garbage. Disposable products come in handy when you are traveling or when your child wants to spend the night with a friend. Disposable products are very convenient as they can just be removed and thrown away once they become wet, unlike regular underwear that must be washed. This cuts down on the amount of laundry that needs to be done to keep up with a child’s bed wetting habits. However it can also become expensive if you need to buy disposable products on a regular basis. It is important to bear in mind that just like sanitary pads, disposable underwear cannot be flushed down the toilet but instead must be “disposed” of in a proper garbage receptacle.

Reusable products are just that, underpants that can be used a number of times and like regular underwear, can be washed and then worn again. You can buy your child either one-piece briefs or two piece briefs. The former is geared for “low volume bed wetting” while the latter is best for “high volume nighttime wetting” as it comes complete with a waterproof and absorbent cotton liner built into the underwear.

Pre-teens, Teenagers, and Bedwetting

A small number of pre-teens and teens still wet the bed, and for these children, the problem can be quite upsetting. Since far few children in this age group wet the bed, Enuresis can be especially isolating for this age group.

Also, children at this age worry especially often about image and external appearance – what others think of them matters more, which can make a problem like bedwetting seem like a much greater concern. Pre-teens and teenagers are also more likely to be taking part in activities – such as dating and overnight trips – which are more affected by Enuresis. There are a few tips that apply specifically to pre-teens and teens who wet the bed:

Seek medical help aggressively.

By this stage, you should look for medical treatment aggressively, as it is clear that the old adage of “wait until he or she grows out of it” may not work in this case. Have a doctor do a full physical, and seek help from an urologist to find any medical conditions. If all seems well, then ask for tests to be run for rarer diseases. Then, seek a second opinion.

Keep an eye out for symptoms of trouble.

Teenagers and pre-teens may simply have a harder time dealing with bedwetting. The body or self image of children in this age group is still developing, and something like bedwetting can affect self-esteem and self-image considerably.

At the same time, children in this age group tend to have more mobility and tend to be away from parental controls. Parents may not notice signs of problems until too late.

Parents will want to keep an eye out for:

•Signs of “acting out” – Older children may have access to drugs, alcohol, and other self-destructive habits (sex, stealing, cheating) that can become dangerous very quickly. Don’t let a small problem become a big one.

•Signs of a poor body image – Older children who feel as though their bodies are acting against them may feel uncomfortable in their bodies. This can lead to serious conditions such as anorexia and bulimia. Do not let your older child’s bedwetting become a serious body problem

•Signs of depression or emotional upset – Signs such as loss of appetite, loss of interest in regular activities, and severe problems with sleep, school, and peers often indicates an emotional upset that needs to be handled.

•Drops in school marks – At the teen and pre-teen levels, school is very important as grades begin to count towards university acceptance and other life-altering events such as that. Any drops in grades could affect your child’s future.

Physiology of Bed Wetting

The way in which a child’s bladder develops and matures is dependent on three specific things and each of these must take place at the same time. The three things include the development of what is considered to be “normal bladder capacity”, the development and proper maturation of the urethra and sphincter muscle and the development of both the brain and the neural pathways that connect it in regards to the control of voluntary urination.

It is important to remember that everyone upon being born is incontinent. In other words the bladder of a baby empties on an involuntary basis according to the quantity of urine in the bladder at any given time and other stimuli. As a baby grows into an infant the “bladder control center” that is to be found in the brain begins to develop as does the muscles in his bladder and his pelvic nerves. It is a gradual process that takes longer for some children to master than others and also goes along more smoothly for some than others but eventually bladder control becomes a voluntary instead of an involuntary function. The bladder capacity of an individual “increases one ounce (30 ml) each year during the first eight years of life.” Females tend to have a bigger capacity for urine volume than do males.

Bladder control during the daytime comes first and then comes nighttime control. Daytime bladder control is easier to achieve because the person is awake and alert and is able to answer the call of their bladder. On average a child is able to gain control of his or her bladder control in the daytime by the time he is two or three years old. Bladder control at night happens closer to the age of four, and sometimes five in some children. Girls have a tendency to become successfully trained in using the toilet earlier than boys do. Boys also tend to experience bed wetting at night more than girls do.

Bed wetting before the age of five or six is generally not considered a problem as it is very common and not all children are able to achieve bladder control at night at the same period of time. As previously mentioned daytime control usually comes first and sometimes nighttime control takes a while to become successful. After the age of six is bed wetting is present most of the time it is due to a bladder that has not fully matured. In this case time and patience are the best antidotes. The pathways of nerves that link the bladder and the brain need to develop and the fact is that some children simply have smaller bladders that can accommodate less urine then other children. Sometimes bed wetting is the result of a child who sleeps so soundly that they aren’t able to tune into the message that the brain is sending for them to wake up and empty their bladder. Bed wetting can be, but is not often, related to a physical problem such as a bladder infection or diabetes. If bed wetting continues or occurs with increasing frequency past the age of six it is wise to take your child to the doctor for an examination.

Myths and Facts about Bed Wetting

There are many myths surrounding bed wetting. Let’s take a look at them and then dispel the fallacies with the truth.

Myth- Children who wet the bed are lazy.

Fact- Laziness has nothing whatsoever to do with bed wetting. Bed wetting is an involuntary problem. Many bed wetters are very deep sleepers who do not awaken when their brain receives the message that their bladder needs to be emptied. It can greatly affects a child’s self esteem to be called lazy because of bed wetting.

Myth- Consuming too many liquids before bedtime can cause bedwetting.

Fact- It is a good idea to limit the amount of liquids a child consumes before bedtime, in particular those full of caffeine. However this alone is not alone as consuming too many fluids is not the cause of bed wetting.

Myth- Bedwetters are children with deep-seated emotional or psychological problems.

Fact- This is very rarely the case. Bedwetters are normal, healthy children who have not yet developed nighttime bladder control. However psychological problems can result due to the bed wetting. This behavior can cause a child humiliation and can wreck havoc on one’s level of self-esteem. There is a form of bed wetting known as secondary enuresis whereby a child who is having emotional issues such as problems at school; the death of a family member, etc. may begin wetting their bed due to the stressful situation.

Myth- Putting diapers or disposable underpants on a bedwetting child will only prolong the bedwetting habit.

Fact- Diapers or disposable underwear will not prolong bedwetting but are instead a way to assure that a child does not wake up in the morning feeling both wet and cold. This is also a way to cut down on the amount of laundry that needs to be done on a regular basis and will prevent sheets from having to be changed during the course of the night. Wearing disposable underwear is for the comfort of the bed wetter and has no effect on when the behavior will be over.

Other bedwetting facts worth being aware of:

• Bed wetting seems to have a genetic connection. Studies have proven that three out of every four bedwetters came from a family where there was a history of it.
• Most children outgrow the deep sleep that causes them to not be aware of the “internal signal to urinate.”
• Some children who are bedwetters have a bladder that is not “anatomically smaller” than other people but is instead “functionally smaller.” What this means is that they are not aware that their bladder is full and needs to be emptied until after there has been an accident.
• Some children who wet their beds “produce insufficient amounts of the hormone that tells the kidneys to make less urine while they sleep; as a result their bodies make more urine.”

Although it is not terribly common, there are medical problems that can cause bed wetting. Some of these problems include bladder infections, diabetes, constipation and spinal cord abnormalities. Of these conditions constipation is the most common medical reasons for bed wetting to develop.

Medications to Treat Bed Wetting

If your child wets the bed, you will want to try behavior modification first.

No one medication is able to cure bed wetting. The good news is that most children do tend to outgrow the habit of bed wetting. As they grow and mature, the muscles of a child’s bladder get stronger and therefore so do their ability to control their bladder functions. As well they do not tend to fall into as deep a sleep every night as they did when they were toddlers. Children often become more attuned to the brain’s message that the bladder needs to be emptied. In the meantime if bed wetting is a consistent and embarrassing problem for a child there are medications that can be prescribed by a doctor to help treat the problem.

The first drug that appeared on the market to help bed wetting was Imipramine (Tofranil). This drug helps to encourage a child’s restful sleep pattern while also improving the quality of the muscles of a child’s bladder during sleep. However studies have proven that this drug is only beneficial in approximately thirty percent of children who take it. Unfortunately after the medication is stopped often the bed wetting episodes begin all over again. This medication is generally not given to children who are under six years of age. Imipramine is considered to be a tricyclic antidepressant and is only available in tablet or capsule form. This drug has its share of side effects which could include anxiety, irritability, insomnia, moodiness and a loss of appetite. Those taking this drug must be carefully monitored by a doctor.

Desmopressin Acetate (DDAVP) is a synthetic version of the natural antidiuretic hormone that works to help the bladder manufacture less urine and by so doing there is a lesser chance that a child’s bladder will overfill and then spill out while he or she is sleeping. DDAVP “promotes water reabsorption, resulting in increased urine concentration and decreased output during sleep.” This drug is very safe and effective with a success rate of twenty-five to sixty-five percent. DDAVP is considered to be safer than Imipramine but it is more costly. However while there can be side effects they are for the most part minimal. This medication can be administered either in tablet form (approximately a 0.2 milligram tablet before bedtime for a period of one week to start) or as a nasal spray. The medication generally goes to work very fast and if it is beneficial to the patient it can be used every week for a period of three to six months and then gradually decreased. For example, it can go from a schedule of seven days a week to five to three or four to two and finally to none.

While there are other drugs that be prescribed by a physician the two described above are the most common. It is important to discuss with a doctor whether or not bed wetting is serious enough to require medication or whether you can weather the storm until it passes. It is important to try not to become too filled with tension over bed wetting as this can make the problem ten times worse.

Medications and Side effects

Before deciding to give your child medication, carefully weigh the risks and advantages, as many medications or drugs have side effects:

DDAVP (Desmopressin Acetate) can help some children

DDAVP is a medication that can help some children stop wetting the bed. This medication works by reducing the amount of urine the body produces at night. DDAVP is based on research which shows that sufferers of Enuresis have lower than normal levels of something called antidiuretic hormone, which is a hormone that regulates the body’s urine production by having the kidneys hold water so that less urine flows to the bladder.

Children with low levels of this hormone produce more urine nightly. DDAVP corrects this problem by supplying a substance that works in the body just as the hormone does (to reduce urine) and is also though to help children wake more easily.

DDAVP is more likely to work with older children who have normal bladder capacity. Younger children with small bladders are less likely to be helped by the drug.

DDAVP can be taken as a pill or nasal spray. The nasal spray is usually given to younger patients who may have a hard time with the pill form.

However, the spray may be affected by colds or stuffy noses. The pills have also been found to be slightly more effective in some studies.

DDAVP needs to be taken at night but does not need to be taken daily to be effective. This drug also has some side effects, including stomach upset and headache. These symptoms are more common in patients who take the nasal form of the drug. Patients taking the nasal spray may also experience nosebleeds and sinus or nasal pain. More seriously, children who take DDAVP are at risk of seizures caused by water intoxication.

This medical emergency usually has symptoms such as nausea, vomiting and headache. If your child is taking DDAVP and experiences these symptoms, seek medical help right away.

Water intoxication and the risk of seizure can be prevented if children taking DDAVP avoid drinking water the evenings that they are taking the drug. In general, no fluids should be taken in the two hours before retiring and only small amounts in the late afternoon and evening leading up to bedtime.

Imipramine is another drug option.

Imipramine is an anti-depressant which reduces the amount of urine produced during the night. It is sometimes prescribed to children who are unable to take the similarly-working DDAVP, but many doctors are reluctant to prescribe Imipramine because of its many side effects, which can include sleeping problems, nausea, irregular heart beats, and dry mouth.

Some doctors are also quite cautious with this medication because researchers have not been able to completely define how it works to prevent bedwetting.

Imipramine, like most drugs used to treat bedwetting, works best for older children who have normal bladder capacity. Like most other drugs used to treat the problem, it also only affects symptoms, meaning that those who stop taking Imipramine will frequently resume bedwetting.

This drug is usually taken an hour or two before bedtime. Doses vary based on the patient. Side effects with this medication are rare, but may include irritability, sleeping disruptions, fatigue or drowsiness, changes in appetite, mood swings, and personality changes. It is also possible to die from this drug if an overdose occurs.

Anticholinergic drugs are an option for some patients.

Anticholinergic drugs work by increasing bladder capacity and by stopping the contractions of the bladder that some experts think lead to bedwetting. Common Anticholinergic drugs used for bedwetting include oxybutynin (Ditropan) and hyosyamine (Levsinex).

These drugs, unlike many medications used to treat bedwetting, are effective for children with bladder capacity who have trouble controlling their bladders during the daytime as well as at night.

These drugs are usually used with DDAVP for children who wet the bed but may be used alone if a child wets the bed due to general bladder control problems that are present during the day as well. These drugs are taken once or twice a day, often at bedtime. They are not intended for children under twelve years old. Anticholinergic drugs do have a number of side effects, including flushing and dry mouth syndrome.

Be wary of medicating your child if other options are available.

The drugs used to treat bedwetting do not cure the problem, and since these drugs also carry risks and side effects, any parent should think carefully and consider all the risks and options before choosing medication. Medication can be useful for children who wet the bed very late or who seem to suffer unduly from the problem. However, medication should never be treated lightly, nor should it be tried as the first method of stopping bedwetting. You should also remember that children who take medication for bedwetting will often revert to bedwetting once the medication has stopped.

Making a Comparison Between Bed Wetting and Riding a Bicycle

It is generally considered by physicians that bed wetting is not a problem until it begins to take place on a more or less consistent basis in girls who are five years or older and boys who are six years and older. Boys tend to be developmentally slower in more areas than girls and this includes both daytime and nighttime bladder functions as well.

Often children who have dry beds for weeks or months on end and then begin bed wetting either have a medical problem such as a kidney infection, a bladder infection or the onset of juvenile diabetes or else they are suffering from severe stress that has brought it on. The latter is often referred to as secondary enuresis. If an illness is the cause of the bed wetting the emphasis has to be on proper treatment. However children who always have wet beds are not likely to have a physical oriented problem. It is more likely that they simply need to learn how to control their bladders.

Remaining dry all nightlong can be compared to learning to ride a bicycle. Some find it a simple skill to learn while others have a more difficult time mastering it. Learning to ride a bike is similar to nighttime bladder control because both are learned skills. When it comes to learning to ride a bicycle, the brain has to become attuned to the nuances of balance and it has to learn to shift and correct the body’s position as it moves about on the bike. At the same time the brain has to remember to watch for pedestrians and traffic, avoid bumps in the road as well as potholes and it has to make sure the feet using the pedals are in sync with the action of the brain.

When it comes to both sleeping and waking up dry in the morning, the brain has to be aware of when the bladder is full to capacity with urine and its response must be one of two things- it either must send a message to the brain that the child must be woken up immediately in order to urinate or it must squeeze and close off the urethra in order to keep the urine in place until the person is fully awake and can let the pee out of the body. All of these messages between the bladder and the brain must take place while a child is asleep in his bed. Both learning to master the skills that can enable you to ride a bike as well as learning to remain dry all night long seem almost impossible until you actually do. After that both bike riding and nighttime bladder control get easier.

This analogy works well for children who suffer from the angst of bed wetting. A child who admits with pride to having effectively learned to ride a two-wheeler can see the correlation between that and learning to stay dry. It is all a matter of learning how to do it and then to keep on doing the learned behavior properly.

Breast feeding & bed wetting

Bed wetting is a problem that affects millions of children throughout the world. Everyone is a bed wetter at some point, and getting over the problem is easier for some than others. In this article, we’ll relay some information that has been recently published in various news sources that relate to the topic of bed wetting.

A study was conducted that examined the differences in bed wetting behavior amongst both children that were breast fed as a child and children that were not breast fed. Conducted by Robert Wood Johnson Medical School located in Brunswick, New Jersey, the study examined 55 children who wet the bed and were between the ages of 5 and 13. 117 children who were not bed wetters were also included in the study to act as a control group.

The researchers conducting the study predicted that since bed wetting may be the result of delayed neurodevelopment in children, breast milk may help to prevent bed wetting. The results showed that only 45 percent of the bed wetters were breast fed as a child. Also, 81 percent of the control group who never wet their beds were breast fed as a child. The researchers conducting the study argue that this is conclusive proof that breast feeding does have a positive effect when it comes to warding off bed wetting in children. This research is of note considering that bed wetting is a problem to some 5 million children. It is a sleeping disorder that can cause immense shame and low self esteem to the sufferer, as well as causing damage to sheets and beds. Any research that works in the way of helping to prevent bed wetting should be heralded as great news.

A separate study was conducted in Hong Kong regarding the likelihood of bed wetting when it comes to adolescents. Since adolescents are better able to hide the symptoms of bed wetting than children, it’s tough to get actual statistics in the respect of how many teenagers actually wet the bed. The Hong Kong study consisted of a questionnaire given to 16,500 children between ages 5 and 19. The results showed that approximately 1 in 50 teenagers still wet the bed. That is a relatively high number, considering that after age 5, a child’s likelihood of spontaneously quitting bed-wetting is about 15 percent per year. The numbers wane as the child grows older, and it was thought to be of little worries to a teenager. Dr. Chung Yeung, the researcher helming the project, stated that if the teenagers with bed wetting problems do not seek treatment, they may well carry their problem with them throughout their adult lives. For that reason, it’s important that you visit a doctor to address your bed wetting problem if you are still experiencing bed wetting problems well into adolescence. There are many different reasons that one may have a bed wetting problem, and a medical diagnosis can go a long way in helping you to recover from your problem.

Secondary Enuresis

Secondary enuresis or secondary nocturnal enuresis (SNE) is when an individual has maintained proper control over their bladder during the night time hours for a consecutive period of six months and then the bed wetting problem starts again. Secondary enuresis is very common in young children but can affect teenagers and adults as well. Very rarely is the cause of secondary enuresis (or secondary bed wetting) a physical problem, more often then not it is related to a psychological stressor. Once the period of stress or the stressful situation or event has come and gone usually the bed wetting disappears as well.

The three most common psychological stress triggers for children include beginning school, the birth of a new baby in the family and needing to spend a few days in the hospital without mommy and daddy in the next room. While the first two events can also be exciting to the child, many find them frightening prospects and worry about how their life will change as a result. Many other types of circumstances in a child’s life can also bring on secondary enuresis. These include problems with schoolwork, problems with a teacher or a bullying situation, abuse or neglect at home (or seeing the abuse of another family member or a pet), divorce, financial pressures, alcoholism, constant fighting between spouses or between a parent and a child, fear over an upcoming test, school project, field trip, etc.

Regardless of whether this happens to a child or an adult if there is complete nighttime bladder control for a six-month period and then bed wetting begins, whether it be every night or even once or twice a week, it should not be ignored or brushed aside. If left unchecked and if it becomes ongoing, bed wetting can lead to sleep patterns that are disrupted which can then lead to serious sleep deprivation. Sleep deprivation in turn ushers in a host of both physical and psychological concerns for an individual. Not to mention the fact that bed wetting can become a social oriented problem if you live with other people. As well bed wetting on a fairly regular basis necessitates the washing machine being used a great deal to keep up with the soiled bedding and pijamas.

It is a good idea to schedule a visit to the doctor and have a thorough medical exam to rule out any physical problems for the cause of secondary enuresis such as a urinary tract infection. If that is not the problem then ask yourself if you are getting enough sleep every night. If you go to sleep at approximately the same hour every night and you always get seven to eight hours sleep a night then it is much easier to keep your bladder in check at night. When it comes to adults in particular, altering sleep patterns can bring on secondary enuresis.

Stress is a very common trigger as well. If you have recently suffered the death of a loved one, lost a job or are experiencing financial worries this could cause unwanted stress and your body chooses to express the anxiety by a lack of bladder control at night. For children the stress could result from worries about schoolwork, an argument with a friend and family problems such as divorce, alcoholism or abuse.

Primary Enuresis

Primary enuresis or primary nocturnal enuresis (PNE) is when a child has easily developed the ability to control their bladder during the daytime but still after a six month period cannot control their bladder at nigh while they sleep. Bed wetting affects approximately five to seven million children every year, more of these boys than girls. Primary enuresis is particularly common in children who are six years and younger and in most cases it is something that children will outgrow. Studies have shown that approximately every fifteen out of one hundred children who are chronic bed wetters simply stop doing the behavior and do not require a visit to the doctors or any form of treatment whatsoever.

Most children who suffer from this chronic problem are embarrassed and troubled by it. It is important to reassure children who suffer from this chronic problem that this is a problem that will go away in time. Also make your child aware that bed wetting does not mean that he or she is strange or abnormal in any way, not physically and not psychologically. For some children it is a natural part of their development and bladder control is not achieved at the same age for every child.

Be aware that primary enuresis is often believed to happen for one of two reasons. First the child has an immature bladder either in a physical sense or a neurological one and secondly, the child falls into a very deep sleep and is unaware that the bladder has sent a message to the brain that it is full and needs to be emptied. As well primary enuresis is believed to have a genetic link and may not be something a person can help.

Primary enuresis or primary nocturnal enuresis (PNE) is when a child has easily developed the ability to control their bladder during the daytime but still after a six month period cannot control their bladder at nigh while they sleep. Bed wetting affects approximately five to seven million children every year, more of these boys than girls. Primary enuresis is particularly common in children who are six years and younger and in most cases it is something that children will outgrow. Studies have shown that approximately every fifteen out of one hundred children who are chronic bed wetters simply stop doing the behavior and do not require a visit to the doctors or any form of treatment whatsoever.

Most children who suffer from this chronic problem are embarrassed and troubled by it. It is important to reassure children who suffer from this chronic problem that this is a problem that will go away in time. Also make your child aware that bed wetting does not mean that he or she is strange or abnormal in any way, not physically and not psychologically. For some children it is a natural part of their development and bladder control is not achieved at the same age for every child.

Be aware that primary enuresis is often believed to happen for one of two reasons. First the child has an immature bladder either in a physical sense or a neurological one and secondly, the child falls into a very deep sleep and is unaware that the bladder has sent a message to the brain that it is full and needs to be emptied. As well primary enuresis is believed to have a genetic link and may not be something a person can help.

Preparing the Bed of a Bed Wetter

Whether your child suffers from primary enuresis or secondary enuresis, it is important to take measures to make sure your child will be as comfortable when he goes to bed as night. One way to do this is to prepare his bedroom so it is as ready for a bed wetting episode as can be. This will help put both the bed wetting child’s mind at ease as well as the parent(s).

It is a good idea to buy a protective mattress cover and place it over the mattress to protect it from the potential of bed wetting accidents. Mattress covers can be found in the bedding department of any department store and don’t cost too much. It is best to buy a heavy cover that is made of plastic. In case of accident not only will this ensure that the urine does not seep into the mattress but also it decreases the chance of odor.

Suggest that your child wear extra-thick underwear or pajamas to bed. Not only will this help the child from feeling wet and cold in the morning it will also means that in case of an accident less urine will go all over the sheets. This also provides an extra measure of security for a child and can help boost lagging self-esteem. However make sure to not buy your children extra-thick nightwear that is too tight or scratchy and during the hot nights of summer the child will probably not want to wear pajamas or underwear that is extra think in its construction!

Diapers should become a thing of the past for children who are past the age of four, even if they are regular bed wetters. Diapers are likely to wreck havoc with your child’s self-esteem and also to thwart their motivation to end bed wetting. Instead opt for disposable absorbent underpants such as Goodnites that are specifically designed for bed wetting children.

Always encourage your child to use the toilet before he crawls into his bed at night and limit his fluids at least two to three hours before bedtime. Also decrease his intake of sugary drinks that contain a lot of caffeine. Sugary drinks include many types of juice and drinks filled with caffeine include soda pop, tea and chocolate milk.

Place an extra pair of pajama bottoms and/or an extra pair of underwear near your child’s bed at night so in case of an accident he can quickly change before going back to sleep. It also would be a good idea to tell him if he should simply cover over the wet spot in his bed with a towel or wake you to change his sheets. If it were the latter, it would be wise to have a change of sheets in close proximity.

Awaken your child at some point in the night to see if he needs to urinate. If your child is old enough to do so, have him set his alarm clock to awaken him at a certain hour so he can empty his bladder if need be.

Always praise and reward your child for dry nights and never give in to the desire to blame, ridicule or punish your child for behavior that is beyond his control.

Tips for Dealing with Bedwetting in Your Household

There are some tips you will want to adopt right away in order to deal with bedwetting in your household:

Work on Sensitivity

One of the biggest impacts of bedwetting on your child is an emotional one, so you should work on making sure that your household is sensitive to your child’s situation. No one at home should tease your child or make them feel terrible about their bedwetting. The more teased a child is about bedwetting, the more difficult it will be for the child to overcome the problem.

The older a child is, the more ashamed they may be of wetting the bed, and the more important it will be to stay level-headed and calm to prevent shaming the child. Shaming will only result in trauma and may even make bedwetting worse.

Watch your own sensitivity levels.

It is not just siblings and other children that need to be considered. Parents often inadvertently are insensitive to their child’s bedwetting. They are frustrated by the laundry that must be done and are sometimes even angered by having so many sheets stained or even ruined by urine.

On a rushed morning, dealing with urine-soaked sheets before dashing off to work can be frustrating, but it is crucial not to lose your temper. Even if you manage to be calm most of the time, one outburst about bedwetting will linger in your child’s mind and make them feel ashamed.

If you find that you have no time to deal with sheets and clean-up in the morning, strip the sheets and leave them for later. If you are angry by the cost of bed linens, consider buying less expensive sheets in bulk for a while to reduce costs for yourself. Keep rags and other clean up items (deodorizer and cleaner) in the child’s room for fast cleaning.

Work on reducing your stress levels when it comes to bedwetting, and you are less likely to make an unfortunate comment from pure stress.

Educate Yourself

You will be able to educate yourself about the facts of bedwetting. However, you will want to share what you have learned with others in your household. If you have several children, you need to be aware that siblings will often tease a brother or sister who “still wets the bed.” Letting these children know that Enuresis is a condition can help them be more sensitive towards their sibling while measures are taken to prevent bedwetting.

Educate your child

For the child affected by Enuresis, being told the facts about bedwetting can be a big help. Children often hear misconceptions about bedwetting from other children. Myths such as “only babies wet the bed” can be hurtful to your child and can make him or her feel as though there is something “wrong” with them.

Often, explaining that Enuresis is an actual condition and talking about the remedies doctors have come up for it can help persuade your child that bedwetting is curable and a common problem. That way, your child can focus on resolving the problem rather than worry about the embarrassment they feel.

Visit a Doctor

Since some bedwetting is caused by undiagnosed medical conditions such as diabetes or allergies, it makes sense to take your child to a doctor to be checked out. If there is a doctor in your area who is known for treating children with Enuresis, so much the better. In either case, ruling out medical problems can be a big relief. If a medical problem is causing your child to wet the bed, coping with the problem will also generally resolve the Enuresis.

Evaluate

Evaluate how much of a problem bedwetting is in your family and how often it happens. Frequent bedwetting that causes many tears and embarrassment or even arguments in your household may need more aggressive treatment than bedwetting that occurs once in a while and results in only some extra laundry.

Different types of bedwetting demand different approaches

Also, be sure to differentiate between primary and secondary Enuresis. Primary nocturnal Enuresis is almost never caused by an underlying medical problem. Secondary nocturnal Enuresis means that a child has had control of his or her bladder but has begun wetting the bed.

In these cases, it is especially important to have the child seen by a good pediatrician, as almost all cases of secondary Enuresis are caused by an underlying problem (psychological or physical) and so responds very well to treatment.

Make it less stressful

Once you have evaluated the bedwetting in your household, you can develop a plan of action. Since you will be learning many tips that you can apply to your plan in the upcoming pages, your plan here is basically a contingency plan. On a paper, write down what your child should do when he or she wets the bed.

Ideally, your child should contact you, and then you should take steps to clean up. Share the plan with your child so that when an accident happens, your child can put the plan into action rather than being ashamed and trying to get your attention.

There are also a few things you can do to make bedwetting less stressful. Putting special sheets on your child’s bed, for example, can make clean-up much easier. Keeping extra sheets and blankets by your child’s room can also make clean-up much faster, especially in a busy household. Even small things you can do to make bedwetting less stressful will allow you and your child to focus on resolving the problem rather than worry about clean up.

This ebook is dedicated to finding and then providing solutions about how to best help and treat the child that wets the bed. As you continue with this ebook, you will find many additional tips for small things that can be done to help make bedwetting less stressful in your home.

Reality Check

Consider whether there really is a problem. Although we often expect kids to grow up fast today, the fact is that occasional bedwetting up to age three is still considered “normal” by most experts – children at this age are still simply learning to do basic things like use the washroom and control their bladder. Even kids up to age five may have an occasional bed wetting “accident” and this should not be a cause for concern. Many experts consider children over five who wet the bed regularly to have nocturnal Enuresis. In many cases, this condition tends to run in families and can last well into teenage years.

Before you start worrying unduly about bedwetting, consider the age of your child. If your child is very young, it may simply take a few months or a year to resolve the issue.

Many children have nighttime accidents until they are five or even older. If your child is older (six, seven, or older), consider whether anyone else in the family suffered from similar bedwetting problems in childhood. Was there something that helped?

Sometimes, just seeing Enuresis as a childhood ailment or a condition in the family that is always resolved eventually can help soothe the frazzled parent and the embarrassed child.

You need to consider the frequency of problems as well. A child who wets the bed after watching a scary movie or before a big day may be less worrisome than the older child who does not seem to be able to sleep through a dry night.

Once you have calmed down, take action.

Many of the above tips are intended to get parents and children more comfortable with the bedwetting and accidents that occur when a child is trying to cope with Enuresis.

This is because bedwetting is such a stressful and emotional issue – in fact, some polls have suggested that besides divorce and family conflict, it is one of the most stressful issues for families. Learning to deal with the problem calmly, then, is a big priority.

However, parents should not just allow themselves to be placated into taking no action at all. The fact is, bedwetting can still be a nuisance and a problem for your child, and there are many solutions out there. Once your family has learned to deal with the problem in a level-headed way, do encourage your family to seek solutions rather than wait for the problem to go away on its own. There are many solutions out there that can help your child, so that your son or daughter do not suffer needlessly.

Don’t let it become a big deal.

Of course, you want to help your child stop wetting the bed so that they can enjoy a comfortable sleep with no embarrassment in the morning, but be careful that you desire to help does not come across as a sign that there is something wrong. Don’t make bedwetting – an un-dangerous condition – become a big issue at your house.

Keep things low-key

Make sure that the approach to bedwetting is a low-key one. Point out that it is not a child’s fault and that it usually means that a child simply needs to keep growing up – there is nothing abnormal about it. It often helps if the child knows that others in the family have experienced bedwetting and have grown out of it.

Also, make sure that any treatments or remedies used are offered in a low-key, non-threatening way. There is no need to keep stressing the child’s bedwetting throughout the day. Offer some therapy during the day but allow the child to play and just enjoy being a kid.

Let the child tell you when he or she has wet the bed.

If your child wets the bed, make sure that siblings or other well-intentioned members of the household don’t announce “Johnny wet the bed -again.” This just leads to shaming.

Instead, it is often helpful to have a quiet time in the morning when your child can tell you himself or herself. Having a system (such as a calendar where the child marks wet and dry nights) can make it easier for the child to approach you, as there is a routine for sharing this information.

Let the child help.

If it will help your child feel less embarrassed, let him or her help clean up. He or she can tidy up the pillows or fold the sheets. In some cases, this can make the child feel less inept and babyish, if they can be entrusted with a grownup chore. Plus, if they can help clean the bed they may feel in control of a small part of their bedwetting.

Do not make cleaning up a punishment, but rather offer it as a way to make the child more comfortable. A comment such as “would you like to put the pillowcases on the pillows to make your bed more comfortable?” makes it clear that the child is not being punished for wetting the bed.

Stay alert for bigger problems

In the big scheme of things, bedwetting is not a big problem. Your child is not in any danger of serious injury or harm if he or she occasionally or even regularly loses control of their bladder at night. To a child, however, it may not seem like a small problem. For this reason, as a parent, you must remain alert for signs of bigger problems.

If your child shows any of the following symptoms, he or she may be struggling more than you know and should be taken to a doctor or pediatrician to get help sorting out the emotions he or she could be felling:

•Sudden and big changes in appetite (eats a lot less or far more)
•Fearful or withdrawn with others
•Does not show interest in regular activities
•Does not spend time with others and does not want to spend time with others
•Cries, gets angry or is very quiet often
•Mood swings
•Trouble sleeping
•Loss of control of bladder during the day
•Grades dramatically worsen
•Bruising on the body or favorite toys are broken (may indicate bullying or self-destructive behavior)

If you notice these problems, you will want to seek more aggressive treatment for the bedwetting and you will want to visit a doctor or counselor to help your child deal with the problems caused by bedwetting.

Make sure that no medication is causing the problem.

Check the side effects and directions on your child’s medication. If your child is taking any medications that cause extreme drowsiness or an urgent need to urinate, the medications may be causing the problem. Medications that make your child very tired may simply not allow your child’s body to wake him or her up in time to go to the bathroom.

Talk to your pharmacist or doctor about any medication your child is taking and ask whether the substances may add to the bedwetting problem. Of course, your child may need medication that does not help his or her bedwetting, but in some cases doses or medications can be changed in order to prevent such side effects.

Make sure that your child has easy access to a bathroom.

A bright night light and a bathroom that is easy to access quickly at night will go a long way towards making sure that your child can get to the bathroom in time. Not every household can arrange to provide a bathroom near a child’s bedroom, but consider sleeping arrangements closely and consider rearrangements that could make nighttime bathroom trips much easier. Even something as simple as moving your child’s bed closer to the bedroom door can save a few seconds at night, reducing accidents.

Get your child to go to sleep a bit earlier.

Children who are tired may have a hard time waking up for anything – including a full bladder. If your child gets the sleep he or she needs, they will not be so overtired that they will be unable to wake up.

Look for psychological triggers.

Emotional states often add to bedwetting or even trigger it. If your child is undergoing an upset (divorce in the family, death in the family, bullying, moving, conflicts with siblings) this may contribute to bedwetting. In these cases, you can either wait for the child to adjust (at which point the bedwetting may cease too) or you can have your child see a pediatrician or child therapist. Sometimes, even talking about the problems can help, so be sure to discuss anything that seems to be bothering your child.

Have Your child self-monitor

Once you develop a system for dealing with bedwetting, or once you and your family start trying to control bedwetting in some way, it is useful to have a child check off on a calendar which nights were completely dry, on which nights a bathroom was reached successfully, and which nights were wet. Keeping track lets your child get involved in the solution process, which will make your child feel more confident. Once your child sees any improvement, he or she will likely be encouraged to further success.

Care for your child’s skin.

Bedwetting has few serious side effects, but one of the physical discomforts it may cause is skin problems. Urine is a mix of fluid and waste chemicals from the body. When left on skin for a few hours in the night, it can irritate. Skin may appear red initially, and may turn sore and flaky if the skin is not treated. The skin will also thicken if the irritation is not treated, eventually turning wrinkled and pale. Although not dangerous, this type of skin irritation can be very painful for a child.

Skin problems can affect any child who wets the bed, but the problem is more aggravated in those who wet the bed often and in those who wear absorbent products to collect the urine. Genitals and buttocks can be affected. In those who wear absorbent underpants, the leg bands and waist bands are often the most irritated.

Once bedwetting is resolved, the rash and skin irritation it causes will disappear as well. Until your child has stopped wetting the bed, though, you can try to reduce the skin irritation the problem causes. To prevent skin rashes and soreness:

•Make sure the child washes each morning, especially after a “wet” night. The skin affected by the area should be especially well washed using a mild and moisturizing soap.

•Encourage your child to rinse the buttocks and genital area when changing absorbent underpants and after waking up after having wet the bed.

•Use a very soft sponge – not a harsh washcloth – on any irritated skin area.

•Some parents find that applying petroleum ointment to affected areas and areas affected by urine is helpful

•Choose correct-fitting absorbent undergarments, if your child uses them. Make sure that the waist band and the leg bands are not too snug. Choose the most absorbent type you can and look for a brand that offers a top layer that keeps moisture away from the skin.

•Talk to your pediatrician if skin irritation continues. He or she may be able to offer a medicated cream to soothe sore skin.

Get your child’s consent.

As you continue to read through this ebook, you will find many tips for dealing with bedwetting. Some of these will seem like great ideas to you and you will likely want to put them into effect right away. However, you should be careful about choosing bedwetting solutions, for any remedy you choose needs to have your child’s consent.

Many well-intentioned parents rush out to buy the latest gadget or device for treating bedwetting or for making it less of a problem only to be horrified to learn that their children want nothing to do with the expensive method.

It is important not to force a method on a child. It is completely ineffective as in some cases (such as behavior modification) you actually need your child’s enthusiasm and participation for a method to work. In other cases, forcing a bedwetting remedy on a child will be ineffective and can actually lead to more bedwetting because of all the stress caused by the “supposed remedy.”

Also, in saying that they don’t “like” a remedy children may be trying to say something more – such as that the remedy is uncomfortable or causes more embarrassment that the bedwetting itself.

Work with your child in resolving bedwetting.

When you approach a child with a way or resolving bedwetting, you can often ensure a better reception by approaching the subject in a sensitive and informative way. Explain to your child what the method involves, answer any questions, and express that it may help him or her with bedwetting. Make sure that you explain whether a method is temporary, as a child will be more likely to accept something new for a little while, or on a trial basis, rather than accept something for a longer time.

Imipramine

Imipramine, which is sold under the names Tofranil, Antideprin and Janimine, is a tricyclic antidepressant that is used to treat both nocturnal enuresis as well as clinical depression. This drug, under the name Tofranil, was the very first medication that was ever used to treat the problem of wetting the bed at night. This drug first appeared on the market in the late 1950’s and was used for depression before it came to be used for enuresis. This drug is not used as much today as it was in past years but is sometimes used as a back up for depression when other treatments fail to bring about the desired results. In limited quantities it has also been used to treat migraine headaches, post concussive syndrome and attention deficit disorder (ADD). As well in hospitals it is sometimes given to patients who suffer chronic pain or who are in the middle of a panic attack.

The purpose of this drug in regards to bed wetting is that it supports a child in having a restful and peaceful sleep during the night. It also helps to encourage the strength and smoothness of the bladder muscles in retaining urine throughout the night. Research studies have borne out the result that only approximately thirty percent of children who are prescribed this medication are actually helped by it. Relapse is very common once the drug is stopped. This medication can be dangerous for children under six years of age and is therefore only prescribed for those who are older than six.

Imipramine is available in both capsule and tablet form but can cause a number of side effects and therefore needs to be closely monitored by a patient’s doctor. Some of the side effects it is known to cause include dry mouth, tremors, constipation, insomnia, drowsiness, excessive perspiration, a flushed complexion, weight gain, anxiety, irritability, moodiness and loss of appetite. Sometimes this drug is prescribed for elderly people with bed wetting problems and they can suffer serious side effects as well. In the elderly the most common side effects which should be closely monitored by a health expert include confusion, delirium, agitation, and irritability.

In child patients this drug is usually started with a dose of ten milligrams daily and from there it is adjusted according to how the patient is reacting to it. If there are side effects noted then the dose with be altered and/or the drug will be discontinued all together. The weight of a patient is also taken into account at the time the drug is first administered.

In regards to bed wetting, Imipramine is safe in most cases but as previously mentioned due to its potential side effects, must be closely monitored by a doctor. If doctor supervision on a regular basis is not available, this drug should be passed over for another treatment option. This drug is reasonably priced and should be covered by most health plans. It is always a good idea to check with your insurance company before committing to any medical drug treatment. Your doctor should be able to answer any and all questions you have regarding this form of medication.

Helping to address your child’s bedwetting problem

Bed wetting, or nocturnal enuresis as it is known in the medical community, can be a traumatic problem for both children and adults alike. It is a sensitive topic that is often considered taboo, and one needs to exercise extreme caution when talking to their child about a bed wetting problem. As a parent, it can be tough to determine what you should and shouldn’t say to your child about bed wetting. In this article, we’ll address some of the commonly used techniques of talking to children about bed wetting.

Bed wetting affects approximately forty percent of all children that are three years old, and roughly five million children that are over age five. While the problem usually disappears on its own, there are some things to consider when helping your child to get through the problem. Children can be very embarrassed about their bed wetting problem, but it’s important to discuss the issue so that you can have a clear line of communication when it comes to solving the problem. One important thing to note is to tell your child that it is not their fault that they wet the bed. When parents attack their children with harsh words, they may be doing more harm than good when trying to help bed wetting. Telling your child that they are not causing the problem can go a long way when it comes to discussing their bed wetting more openly with you. If you wet the bed while you were a child, you should let your son or daughter know. This can ease much of the shame and the anxiety that is sometimes a factor in bed wetting. Also, telling your child that bed wetting is a natural process that everyone goes through to some degree may help them to ease their feelings of guilt.

One approach that parents often use with some success is to tell their child to mentally visualize a night without wetting the bed. While this approach is only of some efficiency, it can help. Another thing to consider is whether or not any anxiety-inducing events may have occurred recently. If you feel that some change in your life may be affecting your child’s level of anxiety, you may want to speak to a pediatrician to discuss ways of solving the anxiety-inducing problem.

The best way to approach a problem with your child regarding bed wetting is to let them know as much as you can about the problem while providing a capacity of warmth and love. This approach is generally agreed upon by physicians and psychologists alike when it comes to aiding the problem. If your child’s bed wetting becomes a big problem, consulting a doctor may be a good idea. Hormonal changes in the body can cause bed wetting, and there are medical solutions to the problem. Bed wetting alarms are also often used when treating the problem, which respond to any moisture on the bed with an alarm, waking the child up and creating some degree of behavioral conditioning.

Ways to Manage Bed Wetting

As a child’s body grows and his ability to control his bladder functions at night matures, bed wetting is likely to decrease. Most children who suffer from bed wetting outgrow it before their preteen years and if not, then by the time they enter their teenage years. It is estimated that only one in every one hundred adults suffers from the chronic problem of bed wetting. However until bed wetting becomes ac thing of the past it is important to be supportive of a child who wets the bed. Be sensitive to your child’s concerns and reassure him or her whenever they wish to talk about the problem. Many children are anxious, embarrassed and frightened that their friends will find out that they wet their beds and they will then become the object of ridicule.

Make sure your child knows that it is not anything he or she does that causes the bed wetting and that in time it will go away. Do not get angry with your child for wetting his or her bed and do not make too big a deal of it, otherwise it is likely to affect your child’s self esteem. Don’t allow other siblings to laugh at or tease the bedwetting child about his or her problem or this could make the problem seem worse than it is.

Help manage bed wetting by encouraging your child to not drink a lot of liquids before he goes to bed and to always go to the toilet before turning in for the night. Place a plastic or rubber cover, also known as a sheet protector between the fitted sheet and the mattress of your child’s bed. This helps keep the bed as unaffected by the bed wetting as possible by preventing the wet from being absorbed and also by preventing odor from sinking in and smelling the bed up.

If your child wants to help you change his sheets when he wets the bed then let him do so. This teaches both a sense of responsibility and also may bring some small comfort by deflecting his embarrassment at the situation.

Some doctors suggest bladder-stretching exercises as a way to manage bed wetting. What this means is that during the daytime hours your child stretches out the times when he uses the bathroom in order to encourage the bladder to be able to hold in more urine for longer periods of time. This is believed to help strengthen the bladder muscles. If you decided to go this route, make sure you carefully follow the instructions laid down by your doctor.

If a child is still wetting the bed upon reaching age seven or eight a special bed wetting alarm might be in order. Upon being aware of the presence of urine, this alarm will make the child aware that he must awaken and go to the bathroom. This helps prevent only the smallest quantity of urine from being spilled onto a child’s bedclothes and sheets. It is essential that the alarm be reset before the child goes back to bed in case the problem begins again in the night.

Bed Wetting Strategies for parents

The way a parent reacts to a bed wetting child can often make or break a delicate situation. Parents play a critical role in their child’s acquisition of self-esteem and it is important to keep in mind that during childhood an individual’s self-esteem is just beginning to develop and is very vulnerable. There are a multitude of treatment plans that can be put to use to help a case of bed wetting. It is important to speak with the child’s doctor and together to form an appropriate course of treatment. There are both behavioral techniques as well as medical treatments that can be undertaken and sometimes more than one can be used in conjunction.

There are helpful strategies that parents can put into play to encourage positive interaction with their child while he is going through this difficult period. It is important to always be positive and upbeat and to not get angry or punish your child for wetting his bed. Parents often scold their child because they don’t completely understand the bed wetting situation and feel annoyed and helpless to improve the set of circumstances for the child. Remember that bed wetting has nothing to do with a child who deliberately is trying to be bad nor does it reflect any way on a person’s ability to parent a child. Children feel embarrassed enough that they wet their bed at night, and don’t need to be humiliated further by their parents. Many doctors believe that belittle a bed wetting child, getting angry at them or making them feel inadequate can cause shaky self-esteem to be on even shakier ground. Sometimes punishing a child can lead to other problems such as wetting their pants during the daytime.

If there is more than one child in the home teasing can very likely take place. This is especially the case if the child who wets the bed is older and the younger sibling has achieved nighttime bladder control. It can also be more of a problem in the children share a room as the non-wetting child can be bothered by odor or can be constantly awakened by the parent coming into the room to check on the bed wetting sibling during the night, etc. Damage control may be in order if your bed wetting child is being ridiculed, teased and called mean names by the other child. It is important to institute a “no teasing” rule in the family. Take the time to explain to the other sibling that the child who wets the bed does not do it deliberately and that it will go away in time. If there is a family history of bed wetting, for example if mom or dad did it when they were young making both siblings aware of it might go a long way in fostering support and understanding. It might help the bed wetting child somewhat to wear disposable absorbent underpants so that he feels less shame and embarrassment and is drier more often.

Don’t make a huge deal out of bed wetting. Making a mountain out of a molehill can compound the problem and can wreck even more havoc with your child’s self-esteem.

It is so important that parents do not make a huge deal out of bed wetting. The more of an issue a parent makes it, the worse the bed wetting child will feel. It will also convey negative feelings to other siblings who might then in turn treat their brother or sister differently. Most doctors recommend that parents understand and also make sure their child understands that bed wetting is not the fault of the individual and that with time, patience and understanding it will come to an end. Children need to know that they will very likely grow out of the behavior and that bed wetting is most often caused by a bladder that has not fully yet fully developed. Try to be as patient, supportive and understanding of your child as possible as he is likely to be filled with a plethora of negative emotions including fear, anxiety, insecurity and confusion.

Although there are medications such as Desmopressin Acetate (DDAVP) and Imipramine (Tofranil) that can be prescribed for bed wetting it is wise to first try other treatment options. First try limiting your child’s intake of fluids before bedtime and waking your child up in the night to see if he has to use the bathroom. If that doesn’t work then you might want to try bladder training exercises, behavior modification, a bed wetting alarm or psychotherapy. Although they have not been proven to work conclusively, alternative therapies such as massage, hypnosis and herbal remedies can be undertaken as well. It is best to use alternative methods in conjunction with more traditional remedies and not by themselves.

There is another reason why medication should be used as a last resort and that is because of the potential side effects that accompany them. Some of the most common side effects of bed wetting include headache, nausea, chills, dizziness and constipation. Other side effects that are less common but are more serious include high blood pressure, shortness of breath, seizures and the potential for a heart attack.

No matter which treatment method you decide to try for your bed wetting child try to remain as calm as possible and be as sensitive to your child’s needs as possible. He or she is frightened and anxious and needs your love and support and not your criticism or scorn. It is a good idea to always keep your child’s doctor abreast of the situation. Always have a back up treatment plan in mind if the first one you try fails to work effectively.

Good News About Bed Wetting

All news about bed wetting is not bad. Although bed wetting is very common among children, almost all children who wet their beds on a regular basis do stop eventually. Some stop on their own without needing any type of treatment while others may try a couple of different treatments before finding the one that is successful for them. If you wet your bed or if you know someone who does, realize that there is nothing abnormal or weird about you. You have no serious physical or mental problem. In fact no one really knows exactly why some people experience bed wetting and others do not. It usually has nothing to do with your body functioning improperly or problems with your thoughts or your feelings. It is important to surround yourself with people who love you and understand what you are going through. Also it is good to be able to openly communicate with those you trust about this embarrassing problem. Do not allow yourself to get so discouraged that you stop enjoying your life and/or allow it to damage your self-esteem.

It cannot be emphasized enough- bed wetting is an unfortunate set of circumstances that often starts for no obvious reason but also ends all of the sudden with little if any outside intervention needed. Research studies have shown that in any given year approximately fifteen out of one hundred children just stop wetting their beds without the need for treatment or even a visit to the doctor. However in most cases it probably is a good idea to talk openly and honestly with your parents about this problem and then to go see your doctor just so he can help put your mind at ease and also rule out any physical problems such as a urinary tract infection or constipation.

When you go to see the doctor he or she is going to want to examine you and maybe even send you for a few tests. As well he will ask you questions about your bed wetting episodes in order to form a clearer picture of the problem you are experiencing. Try not to feel too embarrassed and keep in mind that your doctor sees a lot of children all of the time and many of then are likely to have the same problems as you. Be as honest and as clear in your answers as possible and feel free to ask the doctor questions about your condition as well. He or she is very likely to understand your anxiety and will want to make you as comfortable and relaxed as possible.

There is more good news. Although you cannot cure it completely by changing your routine or behavior, there are ways to help keep yourself as dry as possible during the night. First of all don’t drink any beverages within a window of two to three hours before bedtime and in particular avoid drinks that contain caffeine such as chocolate drinks and colas. Always go the bathroom before you go to bed, and if you feel the urge to urinate as you are slipping off to sleep then by all means throw off your covers and get yourself into the bathroom before you have an accident.

General Points to Remember About Bed Wetting

Most children begin the gradual process of potty training when they are somewhere between the ages of two and three. Before those ages bladder control is largely involuntary. Daytime bladder control is simpler to achieve and therefore tends to occur earlier in a child’s life than does nighttime bladder control. Some children master both day and nighttime bladder control quicker and easier than other children. This has nothing to do with intelligence at all. Bladder control function only becomes to be within a child’s voluntary control when they reach five or six years old.

Bed wetting before age six is not viewed as a problem but if it happens after age six and is frequent it might signal a problem. Of course it also might not. Children who wet their beds are not lazy, stupid, abnormal or unhealthy. There are many misnomers surrounding bed wetting and these are some of them that are simply untrue. There are many components that go into the process of learning bladder control and these include the synchronicity of the kidneys, bladder, nerves, spinal cord and brain. All children’s minds and bodies do not have everything working in happy harmony all at once. Some children have a bladder that takes longer to mature; other children may produce more urine from the kidneys than those in the general population and still other children may simply have a small bladder that can only hold a small percentage of urine at once. As a rule of thumb most doctor suggest that it is time for intervention if your child is six years of age or older and wets his or her bed an average of two to three times (or more) during a weekly basis.

It is not often the case but sometimes bed wetting is the result of a medical problem. The most common include kidney infections, bladder infections, constipation and the onset of juvenile diabetes. If your child suffers pain or discomfort upon urination, has very dark or foul smelling urine or experiences pain in his abdominal area or lower back it could be the result of a physical problem. If the doctor suspects that this is the case, he or she will send the child for a urinalysis (a urine test) and perhaps even x-rays to help isolate the cause of the pain, which could in turn be causing the bed wetting to occur.

Bed wetting is extremely common in children, although it is more widespread in boys than it is in girls. It is estimated that on average five to seven million children experience bed wetting on a regular basis in the course of a year. The likelihood that a child will wet his bed decreases with age. For example studies show that while ten percent of six year olds wet their beds, only three percent of thirteen and fourteen year olds do so. In the meantime if the problem is bothersome enough there are a variety of treatment options and these include everything from bladder retraining exercises, moisture alarms, medications such as Desmopressin Acetate (DDAVP) and Imipramine (Tofranil) and behavioral treatments such as behavior modification and psychotherapy. As well there are alternative therapies such as massage, acupuncture and hypnosis that can be used in conjunction with more traditional treatments.

Forms of Behavior Modification Treatment for bed wetting

One of the most beneficial ways to treat bed wetting from a behavioral perspective is by way of a bed wetting alarm or moisture alarm. These useful devices can be purchased for anywhere from fifty to one hundred dollars and should be carried by most drug stores as well as medical supply stores. There are also ways to purchase the alarms from catalogues available over the Internet. Research into moisture alarms has shown that they have tremendously helped children in remaining dry night after night. It is important to have a patient and supportive family unit when undertaking this form of treatment for bed wetting as it could take anywhere from a few short weeks to many months for the alarm to be successful in its goal. It is important to note that moisture alarms show very few relapses as opposed to other forms of treatment and their projected long-term success rate is high.

A moisture alarm is basically a clip-on sensor probe that is attached to the outside of underwear, pijama bottoms, a nightgown or is strategically placed under the bed sheet close to a child’s bottom. When a child begins to urinate in the night, the sensor sets off the alarm, which then wakes the child up and lets them know that they need to go to the bathroom and empty their bladder. After this the child can return to bed and reset the alarm in case the urge to urinate again later in the night arises. After being awakened enough times by the alarm, the brain becomes conditioned to respond as promptly as possible when the brain sends out the signal that the bladder is full and needs to be emptied as soon as possible. There are some cases where children, especially toddlers, sleep so soundly that they do not hear or feel the alarm going off at all. In this case it would be necessary for a sibling sleeping in the same room or a parent to wake the bed wetter up. If this happens on too many occasions then it is not likely to be the best form of treatment for this particular problem.

Hypnosis is another form of behavior modification that has met with a great deal of success. The adult or child who bed wets on a regular basis spends time repeatedly listening to a special hypnosis tape. This helps to “re-program” the bladder and by so doing will allow the child to be as aware of a full bladder at night as they are during their daytime hours.

Psychotherapy (which is often a fancy word for counseling) is sometimes used for children who suffer a great deal of angst and anxiety in coping with their bed wetting. Also if this stress is interfering with treatment methods, psychotherapy might be in order. Psychotherapy is defined as “A set of techniques intended to improve mental health, emotional or behavioral issues of individuals, group, or family interactional climates.” Psychotherapy cannot only help those suffering from primary enuresis, but those suffering from secondary enuresis that relates to stress and/or a stressful event or situation, as well.

Many doctors recommend a combination of therapies for optimum results, such as combining simple behavior modification in the form of positive reinforcement with hypnosis and a bed wetting alarm.

Enuresis (bed wetting) in the U.K.

It is believed that in the United Kingdom there are approximately half a million youngsters ranging in age from six to sixteen who wet their beds on a more or less routine basis. A higher percentage of these children and teenagers are male as opposed to female. Most parents begin toilet training their children around the age of two or three but it is important to remember that learning to control bladder function is a process and does not happen at the exact same time for everyone. Some children are ready to be toilet trained (or potty trained) by age two while others are not ready until they are three or three and a half. Enuresis or bed wetting very rarely is indicative of a physical or emotional/mental problem although sometimes it can be. Most doctors and researchers cannot say with one hundred percent knowledge what causes enuresis and why some children experience it and others do not.

The main feature of enuresis is that there is repetitive urination on bed sheets and clothing during the night (often described as involuntary urination). From a clinical standpoint a child is defined as a bed wetter if they are at least five years of age (or are the equivalent in developmental terms) and the bed wetting episodes take place for a period of at least twice per week and continue for a length of at least three months in a row. As well bed wetting has developed into a problem if it infers in any way with the child’s scholastic abilities, social performance and /or ability to function in any way in a personal sense (such as interacting with family members and friends). Other medical conditions such as diabetes, spina bifida and the possibility of seizures must be ruled out by a doctor, as does the use of a particular substance such as in the case of a person who uses a diuretic. In the United Kingdom (UK) enuresis is broken down into three types- nocturnal only, diurnal only (meaning daytime only), and lastly, nocturnal and diurnal. It is also often described as functional enuresis instead of simply enuresis or bed wetting.

Most children in the UK who suffer from functional enuresis do not have any “coexisting mental disorders.” However in relation to the population in general, more children who suffer from coexisting mental disorders also suffer from functional enuresis. Some of the most widespread mental disorders include sleepwalking disorder, sleep terror disorder, and functional encopresis. Encopresis is defined as “The repeated uncontrolled or involuntary passage of feces not as a result of a physical disorder but for psychological reasons.” Other psychological problems that can be related to functional enuresis include a lack of self-esteem, a limited quantity of social interaction, anger and punishment being doled out by parents, ridicule and rejection from peers, problems with conduct and behavior both in and out of school and underachievement in regards to scholastic abilities and other pursuits (such as sports, music, art, etc.). Keep in mind that children who suffer from enuresis need all of the encouragement and support they can get as bed wetting carries with it a social stigma that is difficult for many to cope with by themselves.

Do’s and Don’ts of Bed Wetting

There are many do’s and don’ts that parents should be aware of in regards to their children who suffer from bed wetting. Let’s take a look at the do’s and don’ts of this common childhood problem.

First of all do speak with your child’s pediatrician at the first sign that bed wetting has developed into a problem. Never keep this kind of information from the doctor as he or she can be a wealth of information, advice and can also serve to put your mind, as well as your child’s mind, at ease.

Do explain to your anxious or frightened child what is taking place in regards to his or her bed wetting situation and be open and honest with all of the questions that your child wants to ask you.

If you were a bed wetter as a child, do share your experience with your experience with your youngster so he or she feels less alone. It is comforting to know that someone you love once experienced what you are presently going through.

Do educate yourself as best you can in regard to your child’s bed wetting. There is plenty of information to be found on the Internet, plus your local library should also have some books. As well talk to your doctor and he might be able to direct you to a support group. The more armed with information you are, the better you will feel in coping with the situation.

Do remain as patient and as calm as possible under the trying circumstances. You are upset enough by the situation; just think how your child must feel.

Do be understanding and supportive of your bed wetting child. He likely feels a great deal of shame, self-ridicule and fear at his bed wetting problem. Try to diffuse the situation as best as you can.

Do reward your child for dry nights on a consistent basis. The consistent basis is very important. Being inconsistent in parenting in any area will not get you very far and it accomplishes little.

Do everything you can to make your child feel as comfortable and secure as possible (both physically and emotionally). For example you might suggest that your child wear thicker underwear or pajamas to bed at night.

Do try as many different kinds of treatments as possible for your child until you find one that works.

Do make an honest attempt to alter habits your child has that can contribute to the problem, such as drinking fluids right before bedtime or consuming too much caffeine.

Don’t criticize your child or make him feel ashamed of bed wetting. He probably feels bad enough already without you making him feel worse.

Don’t blame your child for his condition. This can damage his vulnerable self-esteem tremendously.

Don’t scold or punish your child for bed wetting. He is not doing it deliberately to be bad and it does in no one reflect negatively on your parenting skills.

Don’t prohibit your child from spending the night at a friend’s house or going camping because of his condition. Instead encourage him to enjoy the activities he enjoys and take steps to end the bed wetting problem for good.

Discussing Bed Wetting with Siblings

Childhood is a difficult period for anyone and it is also a time when a problem that makes an individual different from the norm can result in teasing, ridicule and even alienation from the peer group. Siblings in a household notice things that are going on in their home, such as how their mother is always doing laundry, or how their mother often reminds their brother to use the bathroom before he goes to bed at night, or how their brother never stays over at friends overnight. Also the odor of urine first thing in the morning in the hallway is often unmistakable and unsettling.

There are mixed views on whether or not siblings should be told about their brother or sisters bed wetting problems. Some children are so concerned about it that they swear their parents to secrecy and don’t want a word of their condition breathed to their siblings. If this is the case with your child then respecting your child’s express wishes is more important then informing the siblings of the situation. However some experts believe that bed wetting should not necessarily be a family’s “best kept horrible secret.” Secrets often give rise to feelings of humiliation and shame and the child who suffers from enuresis already feels bad enough already without being made to feel worse.

If you do choose to discuss bed wetting with the siblings do it in a straightforward and “matter-of-fact” manner making sure your children understand that it is not caused by anything bad their brother did. Let them know that bed wetting is considered a “developmental problem” meaning that the bed wetting child’s bladder has not caught up in its level of maturity to the rest of the child’s body. Also let them know that through treatment the child will be able to get rid of the problem and that in the meantime it is important to be kind, supportive and understanding.

Take the confusion and mystery surrounding bed wetting away from your children’s thinking by explaining that everyone is met with different obstacles or challenges in life. Point out that some people have trouble learning to add and subtract, while other people have trouble learning to ride a bike or swim and their sibling has problems with bladder control during the night. The bed wetting child may want to be present for your talk with their siblings or he may not. Proceed according whichever is the case.

If you or any other family member was ever a bed wetter share this knowledge with your children. Tell your children that bed wetting is often something that is inherited and no body really knows why. Explain that it is something that has to be dealt with just like any other problem in life. Don’t make a mountain out of a molehill when explaining the matter to your children. If you make it seem small then they will likely see it that way.

Establish a “no teasing” rule in the family and tell your children that they are not to treat the bed wetting child any differently nor are they to tell their friends about their sibling’s situation. Make them understand that the child’s feelings matter and that he needs support and encouragement and not criticism and scorn.

Bed wetting & Using a Bed Wetting Alarm

Bed wetting alarms have a very high success rate and are a great deal safer than are medications. Sometimes they are called moisture alarms or “conditioning” alarm units as they condition the brain to let the sleeping child know that they have to wake up and empty their bladder. Let’s look at some directions that need to be followed in order for the alarm to work properly.

First of make sure your child realizes that the bed wetting alarm will only work if it is used in the way it is supposed to be. Emphasize that its purpose is to wake the child up at the first sign of urine in order that the child can make it into the bathroom to finish wetting and not soak the bed instead. It is essential that the child is tuned into the alarm and responds when it begins to vibrate or ring. Ignoring the alarm, sleeping through it or simply turning it off will defeat the purpose of it entirely.

Practice using the alarm with your child in the daytime so he or she will know what to expect when it rings at night. For example let your child help you when it comes to setting the alarm. Try it out beforehand by having your child gently touch the moisture sensors of the alarm with a finger dabbed in water to hear what the sound the alarm will make. Then have the child practice getting out of bed and quickly making their way to the washroom to finish urinating in the toilet, instead of the bed.

It is a good idea to not have your child sleeping in the pitch black dark, seeing as he will have to jump up in the night (perhaps more than once) to use the bathroom. Having a flashlight near the bed or putting in a strong night-light to help your child find their way to the bathroom is a good idea. Also remember that most people’s minds are a bit fuzzy when they are awakened suddenly and you don’t want your child to stumble and fall and perhaps even hurt himself.

Educate your child on how to “self-awaken” himself during the night when the need to urinate arises. In other words, encourage your child to “beat the buzzer” and recognize the signs of a full bladder before the alarm has a need to let him know. By so doing this should cause no urine to end up being spilled anywhere but where it should be- in the toilet. There may be occasions when your child can “beat the buzzer” and other times he cannot. Be supportive and understanding in these instances. If the child doesn’t know ahead of time and the buzzer does go off to tell him, teach your child how best to wake himself up and then as swiftly as possible leave his bed and go into the bathroom and use the toilet.

The child then needs to return to his bedroom and turn off the alarm. Once all this is done the child should change into dry underwear or a dry pajama bottom and then rest the alarm. As far as the wet fitted sheet goes, it can be decided ahead of time whether it is to be changed in the night or whether a dry towel or pad is to be placed over the spot that is wet and the sheet then changed in the morning.

More Things to Consider about the Bed Wetting Alarm

Keep in mind that even with practice in the daytime the majority of children do not wake up right away when they first begin using a bed wetting alarm. Often children need to be coaxed to hear it and any help that a parent can give them can prove useful. It may mean some more or less sleepless nights for a parent but it would prove beneficial for a parent to go into the child’s room periodically throughout the night and listen for the alarm and/or wake up the child to see if he has to use the bathroom. Children can be disoriented in the night so if the child does need to urinate it would be wise to help your child to the bathroom. Doing this a few nights should get your child into the habit and pave the way for them to help themselves for that point on. Keep in mind that the aim of a bed wetting alarm (or moisture alarm) is to encourage a child to wake him or herself up before the buzzer goes off or to be able to hold in urine throughout the night and be dry upon waking in the morning.

Don’t allow your child to drink fluids right up until it is lights out and turn the radio, television and/or computer off fifteen minutes to a half an hour before the child crawls into bed. Having a bright strong night-light in the child’s bedroom can help facilitate a better response time to the moisture alarm and a safer trip to the washroom.

Keep a special bed wetting calendar for your child to record his or her progress. Every morning when he gets up have him write entries in the calendar according to what kind of a night it was. For example use the word “dry” to describe a night that the child successfully slept through the night and did not wet the bed at all and “wet” to describe a night when he did not get up and also for whatever reason did not hear the alarm or failed to respond to it. Other entries you could use include “dry, woke-up without alarm” and “wet spot” meaning that the child was woke up by the alarm and did get up to go to the bathroom.

Diagnosing Bed Wetting

Bed wetting is a very widespread problem in children that can cause a great deal of strife for both the bed wetting child as well as his or her family members. After exhausting all basis methods for ending bed wetting, many parents decide to take their child to the doctor for a more professional opinion and help. It is important to realize that occasional bed wetting before the age of five is not considered a problem but it defined as such after that age when it happens on a consistent basis.

A doctor will need to ask specific questions of the parent of the bed wetter regarding family history and the child’s past medical history. The doctor will ask- Did you experience any medical complications when the child was born? He or she will also want to know if your child has ever had a problem with his central nervous system. Did either of the child’s parents ever wet the bed as youngsters and/or was there anyone else in the family that did? A doctor will also inquire as to whether a child has ever undergone any type of surgery and whether he or she has ever sustained any injury to the abdominal area, which could encompass the kidneys, bladder and genital area.

Recent studies into bed wetting have should that an estimated fifteen to twenty-five percent of children at five years old wet their beds but as they grow the percentage of children who wet their beds decreases by an estimated fifteen percent. Approximately eight percent of twelve-year-old males experience bed wetting whereas only four percent of females at the same age do so. Among teenagers a small percentage wet suffer from nocturnal enuresis (approximately one to three percent). There are two kinds of bed wetting or enuresis- primary enuresis and secondary enuresis- and while primary enuresis is more common, approximately fifteen to twenty-five percent of bed wetters suffer from secondary enuresis (or enuresis that is stress related).

One of the ways a doctor distinguishes primary enuresis from secondary enuresis is by asking of the parent, “At what age was your child consistently dry at night?” If the answer is “My child was never dry at night” then the child suffers from primary enuresis, as secondary enuresis is when bed wetting begins or starts again after a child has been free of it for a period of at least six months.

Enuresis can be considered complicated or uncomplicated. If your child suffers from nocturnal enuresis and daytime incontinence then he is likely to have uncomplicated enuresis. If your child suffers pain in the lower back or abdominal area upon urination then a urinary tract infection is likely the cause of the bed wetting problem. If your child does not have regular bowel movements then he likely suffers from constipation and constipation can cause bed wetting to take place. As well if your child has a difficult time passing a bowel movement then constipation is to blame and the child therefore requires more fiber in his daily diet to alleviate this health problem.

A Look at Desmopressin Acetate (DDAVP)

One of the most commonly prescribed medications for primary nocturnal enuresis is Desmopressin Acetate (abbreviated to DDAVP). This drug is a man-made form of an antidiuretic hormone in the body known as vasopressin and it can be administered either in tablet form or more commonly as a nose spray. This medication decreases the amount of urine manufactured by the kidneys and therefore decreases how much urine exits the body.

It is important to take this medicine right before bedtime and if you are using the nasal spray, to blow your nose before you use it. It is important to familiarize yourself with the directions before using the nasal or nasal solution and always use as directed. This medicine should not be used on children who are under six years. This medicine starts to work promptly and is considered fairly safe to use although it does have a few possible side effects. The most common three side effects are headaches, nausea and stomach pain. If you develop a headache taking a mild pain reliever is likely to bring relief from the discomfort. To avoid nausea eat small but frequent meals instead of large meals. As well chewing gums or sucking hard candies can lower the chance of nausea.

For adults taking this medicine there are precautions you should be aware of in regard to it. First of all alcohol should be avoided while taking this drug. This means all kinds of beer, wine and any hard liquor. Alcohol may interfere with the proper functioning of the drug. If you are pregnant presently or are trying to get pregnant make sure your doctor is made aware of this. As well women who are breast-feeding are not advised to use this drug. If you are allergic to anything it is important that your doctor or health care provider knows this, even if it seems insignificant to you. Explain how the allergic reactions you suffered in the past affected you, such as if you experienced any of these symptoms- itching, rash, hives, cough, shortness of breath, wheezing, swelling of the face, throat, lips, tongue, etc.

If for some reason you forget to take a dose at the specified time then take it as soon as you remember. However if it is close to the time for the next dose then opt for the regular dose and just skip the one you missed. Go back to your regular schedule of taking the dose at the appropriate time and don’t worry about it too much. Whatever you do never take two doses at once or extras as this can over load the body and be harmful to the system.

DDAVP is considered to be safe and effective for most patients and has a success rate that is somewhere between twenty-five to sixty-five percent. This drug is fast absorbing and if it is helping the patient then it can be administered every week for three to six months and then on a gradual basis it can be decreased. For example it can be dropped down to four or fives doses a week and then down to two or three and finally it can be dispensed with all together. There are sometimes relapses with this drug but for the most part it does what it is supposed to for the bed wetter.

Pediatricians & Bed Wetting

Your pediatrician will be an important part of dealing with bedwetting. However, since medical health professionals are so busy today, you will want to make sure that you approach your child’s physician in a way that ensures maximum cooperation. Here are some tips that can help you communicate with your child’s pediatrician in a way that will ensure better treatment options for your child:

Keep a diary

One of the best ways you can help your doctor treat your child is to keep a diary of your child’s bedwetting. Starting from the time your child seems to be bedwetting more frequently, keep notes in a small notebook. In this notebook note:

•When your child wets the bed (dates and times, if possible)
•Any family history of bedwetting
•Any results of bedwetting (crying, problems at school, teasing)
•Any medications your child is on or any medical problems your child has had or is having
•Any questions you have about bedwetting
•Any questions or comments your child makes about bedwetting
•Any comments that your child makes before bedtime that may indicate a problem (aches before bed, emotional upsets during the day)
•Any bedwetting products (disposable liners, moisture detectors) your child is using and how effective they seem to be
•Any other symptoms your child seems to be experiencing
•Notes on any resources or information about bedwetting that you encounter that seems helpful

Health care professionals are busier than ever today and keeping such a diary can be a big help to a busy physician. Go over the notebook with your doctor and together look for patters, and possible causes. Get answers to the questions you have written down.

Keeping a diary can also be useful for you and for your child. If your child shows improvement (wetting every few days rather than once a night) you can show your child this improvement. If you yourself have any questions, you can easily refer to the resources and information you have collected in your notebook for more information.

Explain any underlying problems

Sometimes, doctors will not pay attention to bedwetting once they have ruled out an underlying condition, because they assume that it is not a very threatening situation.

If your child’s self-esteem, grades, or social development is affected by bedwetting, you need to let your doctor know because at that point bedwetting has moved from a non-threatening problem to a problem that is affecting your child’s development. Discuss with your doctor the steps that must be taken to stop bedwetting or at least cope with the problems your child has developed as a result of it.

Did your child’s bedwetting develop at the same time as other symptoms?

If your child has developed bedwetting and snoring or extreme fatigue at the same time, you should mention this to your pediatrician.

In rare cases, something called Obstructive Sleep Apnea (OSA) may contribute to bedwetting. OSA means that some blockage – such as enlarged lymph glands called adenoids – block flow of air to the lungs.

In some cases, this problem causes snoring while for some children OSA causes brief periods where breathing is entirely interrupted. OSA is thought to cause enough to seriously interfere with breathing. The most common cause of OSA is restless sleep, early morning headaches, and fatigue.

Some researchers have also linked this condition to bedwetting. Bedwetting caused by OSA is very rare, but can be treated, usually by removing the tonsils or adenoids. Your doctor can run a special test to determine whether your child’s bedwetting is related to OSA.

Get a Second opinion

If you are not happy about your doctor’s response regarding your child’s bedwetting, don’t be afraid to seek more help, possibly from a specialist. Get the care for your child that makes you feel comfortable. Every doctor has a different approach to child bedwetting. If your doctor is satisfied that your child will overcome the problem while you want some form of treatment, you may seek a physician who will help you.

However, you are the parent and you should take responsibility for your child’s health. If your instinct tells you that something is wrong, seek a second opinion. Consider the following problems that can easily be mis-diagnosed or overlooked:

•bladder reflux – This illness can contribute to bedwetting and can require surgery to correct
•constipation – If your child does not empty his or her bowels regularly or completely, remaining waste can press down on the bladder and cause bedwetting.
•Malfunctioning of the urinary sphincter – The sphincter muscle is responsible for controlling urine flow. In those people who do not have a functioning sphincter, bedwetting is chronic and will not go away by itself.
•Kidney diseases – Some kidney diseases cause bedwetting as well as other symptoms. Without resolving the kidney problem, there is not much chance in successfully beating the bedwetting problem.
•Undiagnosed underlying problems – Some children may wet the bed due some serious problem such as abuse, diabetes, epilepsy, OSA, or other problems. If medical avenues are not carefully explored, these conditions will remain undetected and untreated, putting the child at risk.

Build a team.

There are many people in your child’s life that can help ensure that bedwetting is a solvable and un-stressful problem:

•Teachers: You do not need to tell your teachers about your child’s bedwetting, but you should be in contact with your child’s instructors to make sure that your child’s grades or social development is not suffering. An alert teacher can also often be your first alert of bullying or teasing that is taking place.

•Pediatrician: Your child’s doctor should be one of your first stops when bedwetting becomes a problem, as your child’s pediatrician can run tests to determine whether there are any physical or underlying causes behind the bedwetting.

•Therapists/Child Psychologists: If your child’s grades, self-esteem, or social skills are affected by bedwetting, you may need to help your child develop a team of emotional support. Therapists and others can discuss your child’s feelings with him or her and can help your child develop coping strategies for teasing and other problems.

•Pediatric nephrologist or urologist (kidney or urinary system specialist): In some children, a medical problem such as a badly working urinary sphincter can cause bedwetting. Kidney specialists and urologists can tell you whether your child’s urinary system is fine or whether there is some underlying medical problem or physical problem behind the bedwetting.

If bedwetting persists very late (such as into adolescence) or is a nightly problem even by age eight or so, medical or physical reasons should be explored very carefully as they are a likely culprit.

Work with your team

You should choose the specialists who work with your child carefully, choosing those who seem to see the problem in the same light as you, and choosing those whose treatment options agree with you. When looking for health care professionals to treat your child’s bedwetting, you will also want professionals who listen to you and your concerns.

Once you have found a team you trust, however, it is just as important that you work effectively with them. This means following instructions to the letter (asking for clarification when needed) and being very frank about other treatments you are using and about which treatments seem to be working and which do not.

Do Your Own Research

While a doctor can be very useful in helping you deal with your child’s bedwetting, health care workers today are busier than ever and no one doctor can keep up with all the research and new information coming out each day. You may want to contact organizations such as the National Kidney Foundation or the American Academy of Pediatrics for more resources and then raise the information you find with your doctor.

You can contact some key resources about bedwetting yourself:

•The American Academy of Pediatrics (AAP) provides lots of useful information, and pamphlets about a variety of conditions, including bedwetting…

American Academy of Pediatrics (AAP)
141 Northwest Point Boulevard
Elk Grove Village, IL 60007_1098
Phone: (847) 434_4000
Fax: (847) 434_8000

Alternative address:

The American Academy of Pediatrics
Department of Federal Affairs
601 13th Street, NW
Suite 400 North
Washington, DC 20005 USA
Phone: (202) 347_8600
Fax: (202) 393_6137
Email: kidsdocs@aap.org
Web Address: http://www.aap.org

•The PottyMD is a great resource about toilet training and bedwetting. Since this groups focuses only on this problem, you are sure to get information that is pertinent to the topic. Many parents swear by this resource.

PottyMD
2216 White Avenue
Knoxville, TN 37916
Phone: 1_877_POTTYMD (768_8963)
Web Address: www.pottymd.com

•The National Kidney Foundation has recently launched a number of resources about bedwetting. Their website has lots of information and even video clips about the subject. Plus, if your child’s bedwetting is caused by a kidney problem, this group can help you get information on that issue, as well.

National Kidney Foundation
30 East 33rd St., Suite 1100
New York, NY 10016
Phone: 1_800_622_9010
Web Address: www.kidney.org

•The National Kidney and Urologic Disease Information Clearinghouse provides all sorts of information about conditions that affect the kidneys and urinary system. Not surprisingly, they have several resources just about bedwetting.

National Kidney and Urologic Disease Information Clearinghouse
3 Information Way
Bethesda, MD 20892_3580
Phone: 1_800_891_5390
Web Address: www.kidney.niddk.nih.gov

Curbing a bedwetting problem

Bedwetting is referred to within the medical community as nocturnal enuresis. This problem occurs relatively often in infants, and as age and development increase, less and less children face the issue. When the problem persists for years on end, it can be a source of shame and embarrassment by the sufferer, who may feel incompetent due to the problem and may face self-esteem issues. The problem may be more widespread than you know; approximately 1 in 3 children wet the bed at age six. Some studies have also shown that between 5 and 10 percent of all teenagers wet the bed, showing that the problem is a universal one that affects many. While bedwetting isn’t a chronic illness, it’s effects on a child’s mental health can be vast. To that end, it’s important to know the methods of treatment employed when trying to help those with a bedwetting problem.

One type of treatment commonly used when trying to help a child to get over a bedwetting problem is Tricyclic antidepressant drugs. These drugs have a anti-muscarinic property that allows them to help children to curb their bedwetting problem for up to three months. Desmopressin is another drug that is often prescribed. It is a synthetic hormone that provides an alternative means for children’s bladders to control the amount of urine released. Some children that have bed wetting problems do not have this hormone naturally produced in their bodies, so their bladders may be filled with urine throughout the night whilst those with the hormone present don’t experience a filling of the bladder until morning. It can be used on a nightly basis to maintain the level of the hormone, and can be discontinued with no cumulative effects on the patient’s functioning.

Another non-prescription treatment used to treat those with a bedwetting problem is a simple alarm device. The device employs the use of behavioral conditioning, with an alarm sounding whenever any moisture is detected while asleep. In this manner, children can unconsciously learn to anticipate waking up when they sense a urinary release is about to occur.

One solution that is debatable when it comes to aiding a bedwetting problem is the use of absorbent diapers or pants. While they do not actually help the child to solve the bedwetting problem, they may be useful when it comes to taking the stress away from your child when it comes to damaging sheets. Some doubt the potential of diapers, however; they feel that the child may feel more ashamed of wearing the diaper than the bed wetting problem in the first place.

From a psychological standpoint, it’s important to let your child know that bedwetting is not their fault. Studies have shown that taking this stress away from your child increases the child’s desire to help treat the problem. Punishments regarding bedwetting should be avoided, as they often are counterproductive to the treatment process. Whatever solution you choose when it comes to dealing with your child’s bed-wetting problem, it’s important to show compassion and understanding when helping hem to get over their issue.

Deep Sleeper = A Wet Bed??

It was the long held view by the medical community that children who were five or six years old who wet their beds on a regular basis did so because they suffered from a sleeping disorder. More recent up-to-date studies have shown that this is not the case. However it is the case that many bed wetting children are deep sleepers who fail to awaken when their brain sends the message that their bladder needs to be emptied.

Many controlled studies in laboratory have shown that while deep sleeping can play a role in bed wetting it is not the primary cause of why it takes place in the first place. Studies done on children at the Albert Einstein College of Medicine in Bronx, New York have carefully recorded their EEG patterns (electroencephalography), which means that electrodes are attached to the head that monitor the electrical activity of the brain during sleep. In children who suffered from a variety of sleep disorders, abnormal patterns were noted in their EEG’s. However in those who suffered only from enuresis no abnormal patterns were noted. Being a deep sleeper and needing a little extra nudge to awaken does not constitute a sleep disorder just a small deviation from the norm.

Most doctors are not completely clear as to what causes enuresis however it is important to bear in mind that the ability to control one’s bladder functions is a gradual process that takes time for children to master. Not all children manage it effectively all at once. For some it is a smooth process and for others there are plenty of bumps along the road. As well daytime bladder control is usually achieved first as the person is alert and awake and therefore able to immediately answer the call of a full bladder.

The process of controlling urine involves many aspects of the body working in sync, including the bladder muscles, the nerves, the brain and the spinal cord. When the bladder is full and requires emptying it sends a message to the brain. However if the person is in such a deep sleep that they don’t respond to the brain’s message then the brain makes an attempt to contain the urine in the bladder until which time the person is awake and able to empty it. In the case of bed wetting however, all of the parts of the body are not yet cooperating enough to make this happen.

Some children simply have a smaller bladder than other children and it has not fully matured to make nighttime bladder control a reality. In other cases children may simply manufacture more urine than those in the general population. In yet other cases a physical problem such as diabetes or a urinary tract infection is to blame for the enuresis.

Bed wetting has also been found to have a genetic link. In fact according to a report by the National Kidney Foundation, a child who have parents who were both bed wetters has a seven in ten chance of becoming one as well. For one parent this drops to a four in ten chance.

Bed wetting – some conclusions

Now that you have pondered more than one hundred ways to help your child with bedwetting, the time has come to choose which methods to use in helping your child.

You may have chosen some methods to put into practice already or you may be wondering where to begin. You will notice that the methods of dealing with bedwetting fall into a few broad categories:

• Time and patience: Often the most-recommended method, this means that parents and children wait until the body on its own learns to stop losing bladder control at night. This can be a frustrating method, but tends to be an effective one, as most children tend to outgrow the problem on their own with time. All methods require at least a small dose of time and patience to work.
• Behavior Modification: This method works by trying to “teach” the body to wake up in time in order to go to the bathroom. Various methods are used in this treatment. Moisture detector alarms, making bathroom access easier, visualization, and other techniques are all used.
• Reduction of Mess or Problem: Some parents simply see bed wetting as a natural part of childhood, and work to simply reduce the mess and inconvenience. A number of products on the market today exist to help with this goal, including mattress liners, sleeping bad liners, disposable absorbent underpants, non-disposable absorbent products, and many others.
• These can all make mornings more pleasant until the child learns to sleep “dry.” In many cases, you should use one of these methods no matter what method you are using, as “accidents” may occur.
• Medical Treatment: Some parents seek doctor help with bedwetting. This can be a good idea if a parent suspects an underlying cause may be the real problem behind bedwetting. Even if the cause is not medical, doctors can prescribe medication that can control bedwetting.
• Holistic Treatment: A number of alternative treatments exist which help children with bedwetting. Eating honey, hypnotherapy, and other such treatments have been found effective by some parents, even though these treatments do not work for everyone and even though in some cases not much research has been done about the efficacy of these treatments.
• Proxy Treatment – Rather than treating the problem, some parents choose to treat the problems caused by the problem. This can mean helping a child cope with teasing or clean-up or discomfort. The idea is that if the problem is more bearable, the child will be able to wait for the problem to clear up on its own.
• Also, proxy treatment acknowledges that it is often not bedwetting itself that is a problem, but rather it is the problems caused by it that seem unbearable.

Most parents use at least a few treatments, if not several. They may use a few remedies to control the mess of bedwetting, for example, and use others to actually resolve the problem. Different parents use different methods, just as different doctors will suggest different ways for dealing with bedwetting. Whatever treatment system you choose for your child should have a few basic qualities. It should:

• Be accepted by the child
• Not make the problem worse
• Be safe
• Be effective
• Be affordable for your family
• Cause a minimum of disruption in the home
• Not require so much time that other family activities or responsibilities suffer
• Be a system that both the child and the parent feel comfortable with
• Suit your child’s and family’s specific circumstances
• Not interfere with normal child development and activities

Enuresis (bed-wetting) and ADHD

Enuresis is a very widespread problem among children and so is attention deficit hyperactivity disorder (often abbreviated to ADHD or AD/HD). ADHD is a very widespread disorder with both developmental as well as behavioral manifestations. ADHD is “characterized by poor concentration, distractibility, hyperactivity, and impulsiveness that are inappropriate for the child’s age.” Both children as well as adults who suffer from attention deficit hyperactivity disorder are “easily distracted by sights and sounds in their environment, cannot concentrate for long periods of time, are restless and impulsive, or have a tendency to daydream and be slow to completes tasks.” It is estimated that approximately three to five percent of children of school age suffer from either attention deficit order, hyperactivity or a combination thereof.

Enuresis is more common in children who suffer from ADHD than it is in the general population. While most of these children note that the incidence of bed wetting has decreased dramatically or halted all together by the time they are seventeen or eighteen years old, many still suffer from problems of impulsivity, inattention and a problem with organizational skills well into their adult lives.

Children who suffer from ADHD and also enuresis generally have a more difficult time adjusting and coping with both problems then do children who just experience enuresis. This often goes for then parents who care for them as well. A child who only experiences enuresis and not ADHD often responds more favorably to behavioral modes of treatment and is not ridiculed or treated as badly by his or her peers. Often an ADHD youngster is already aware that he is different from his peers and therefore his impulsive tendencies as well as his inattention and disorganization cause him to be rejected further. As well his shame because of his bed wetting is magnified when he suffers from ADHD. One problem is difficult enough for a child to cope with but more than one can cause multiple problems in a child’s life and is likely to affect his developing sense of self even more.

A child who has both enuresis and ADHD should be taken to the doctor for a thorough physical exam. Behavioral treatments often work well for children who suffer from both problems however avoid anything with negative or punitive consequences. Children with combined enuresis and ADHD suffer enough teasing and ridicule from their peers that they don’t need anymore from their doctor or their loved ones.

When it comes to treating both disorders there are both behavioral techniques as well as medical treatments. It may be necessary to prioritize which symptoms of which disorder are the most serious and need to be addressed first. It is also important to think of back up treatment plans if the first one you undertake does not work. This is often the case in many situations. Be aware that some medications prescribed for ADHD can make enuresis worse. Desmopressin acetate (DDAVP) has been known to improve bed wetting in some bed wetting children and teenagers while tricyclic depressants (such as Tofranil) work better for others.