Don’t let bed-wetting cause nightmares

Our daughter has been out of diapers at night for over a year now. She has accidents once in a while, but that is normal. Bed-wetting happens to lots of kids – more than 5 million in the United States. A child can be nearly 7 and not have consistently dry nights, or a child who has had dry nights can start wetting the bed regularly again. Either situation can be frustrating for parent and child.

Before age 6 or 7, bed-wetting is rarely something to worry about. There is no clear cause. Nighttime bladder control may be still developing, the bladder may be a bit small or your child may sleep so deeply that she does not respond to the urge to urinate by waking up.

Parents who have a history of childhood bed-wetting are more likely to have children with the same problem. If you are worried about your child being too old to still be bed-wetting, check with your parents if you can about when you had consistently dry nights. It may be a family trait that just needs to be outgrown.

Most of the time bed-wetting requires patience from you and your child rather than medical treatment. Since your child may feel embarrassed, it is important to respond calmly and reassuringly. Explain that bladder control will get easier as he or she gets older.

Some things that may help your child have dry nights are as follows:

Give more fluids in the morning and afternoon and less at night. Ask your child’s health care provider if 8 ounces of liquid in the evening is enough for your child.

Avoid caffeine such as sodas or chocolate, especially in the evening.

Have your child urinate at the beginning of the bedtime routine and again right before climbing into bed.

Praise dry nights. A gold star, a smiley face or a favorite sticker on the calendar for each dry night can help track improvement. Seeing many days in a row of dry nights on the calendar may also encourage a child and help with self-esteem affected by bed-wetting.

Offer your child disposable nighttime underpants to sleep in, but do not insist that they be worn.

A moisture alarm along with the above actions may be necessary for success. These are available at drugstores without a prescription. The alarm is connected to a moisture-sensitive pad and makes a noise just as urination begins, so that the child can wake up, stop urinating and get to the toilet. It can take up to 12 weeks to see consistent results; before age 7, a moisture alarm is not recommended.

If trying all of this does not work or your child has had six months or more of dry nights and then begins wetting the bed, there is the possibility that a medical condition is the cause. Examples include bladder infection, constipation without the usual symptoms, diabetes, sleep apnea, spinal cord problems and defects of the genitourinary tract. Medical treatment of such conditions is necessary.

Stress can also trigger bed-wetting after many months of dry nights. Is there a new baby in the house? A new school? Did you move? Has a family member died? In such cases, behavior therapy may help.

No matter what the cause, bed-wetting can be overcome, although often it just needs to be outgrown. Make sure your child knows you love him or her no matter what, that bed-wetting is a normal part of growing up and that it is not likely to go on forever.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section. Send your comments and column suggestions to drhideg@ghc.org.

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