Bedwetting Myths Debunked (cont.)
While babies produce urine around the clock, toddlers start to go to the bathroom on a daytime and nighttime schedule once their bodies start to produce a substance called 'antidiuretic hormone' (ADH) that inhibits urine production. In addition, as kids mature they become more sensitive to the feeling (produced by stretching of the bladder walls) that they need to urinate.
Children who continue to wet the bed beyond the age of 6 may not be producing enough ADH hormone at appropriate times or may not yet be attuned to their bodies' signals, or both, says Greene.
Parents should start looking into formal treatment sometime between the ages of 6 and 7, according to the National Enuresis Society or sooner if the child seems troubled by the bed-wetting.
"Older kid are not as likely to outgrow it and these are the kids that deserve specific help -- whether an alarm, medication, or a combination," he says. "With help, most kids will be dry within 12 weeks," he says.
I will never sleep through the night again.
If parents like Terry's find themselves setting their own alarm to wake their children during the night to urinate, they should purchase a bed-wetting alarm. "They really do work," says Shubin. Enuresis alarms sound in response to wetness and can be purchased at drugstores for as little as $60. They have a cure rate of 75%, according to a study published in the journal Pediatric Psychology. And when combined with medication such as desmopressin (DDAVP), which acts on the kidneys to reduce the flow of urine, the urine alarms are even more effective, the study says.
Just don't give up too soon, Greene says. "Many parents say, 'I tried it for a couple of weeks and it didn't work' but enuresis alarms often takes up to 12 weeks to make a difference." Be patient.
Before resorting to an alarm or medication, try using a "star chart," where you give a child a star for every dry night and a prize for a few dry nights in a row. But "if this doesn't work in two weeks, it won't and continuing it may only discourage the child," Greene says.
Behavioral changes too play a role in achieving dryness, he says. Try decreasing the amount that kids drink before bed. "This will make a difference and may just be enough for some kids," Greene says. Limit fluid intake to 2 ounces in the last two hours before bedtime and cut out caffeine, which is a natural diuretic, he says.
"Kids should not be drinking a lot of soda with caffeine anyway, but a lot of them do," Greene says.
Also consider moving bedtime up by 30 minutes, he says. "In some studies, getting just one half of an hour more sleep at night decreases bed-wetting because kids are less tired and don't sleep as soundly and are able to wake up more easily when their bladder gets full."
My son or daughter can never have sleep over at a friend's house!
Not true. Drugs such as DDAVP can be used for special occasions.
"For special situations, medication can be prescribed to make sure the child is dry to participate in social events like sleep-overs," Shubin says. "If a child is afraid to sleep at a friend's for fear he or she will wet the bed, DDAVP works," Shubin says.
The problem with prescribing this medication over the long-term is its expense. "DDAVP can be a great solution for some kids, but the disadvantage is the cost and there may be a long-term need unlike the alarm which usually works in 12 weeks," Greene says.
The other medication that doctors sometimes prescribe for bed-wetting is an older tricyclic antidepressant called Imipramine.
"This allows you to have better control of the bladder, affects the bladder musculature and may change sleep patterns, so kids wake up if they have to urinate," Wasserman says. While this drug is cheaper, it does have more side effects including nervousness, intestinal problems, and excessive tiredness during the day. And as with many medications, an overdose can be fatal.
Is It a Medical Illness
For most kids, "bed-wetting is really more an inconvenience then a medical illness," Shubin says. However, "If it's new bed-wetting after he or she has been dry for a reasonable period of time, it may mean something else is going on," Shubin says. In these cases, "children should get a urine test to see if there is a urinary tract infection or possibly, this can be a sign of type 2 diabetes."
"Daytime wetting too raises red flags and you have to assume it's due to conditions such as urinary tract infection or other kidney and bladder conditions or psychological conditions," Wasserman says.
Remember: "It's a problem if it affects a child psychologically and if it affects family dynamic or affects the child's ability to have friends over or sleep out, but you don't want to make a mountain out of a mole hill and focus on an issue that he or she may outgrow." Wasserman says.
Published March 15, 2004.
SOURCES: Alan Greene, MD, assistant clinical professor, pediatrics, Stanford University, Stanford, Calif.; author, From First Kicks to First Steps. Charles I. Shubin, director, children's health center at Mercy FamilyCare in Baltimore, Md. Michael Wasserman, MD, pediatrician, Oschner Clinic Foundation, New Orleans.
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