Children's Health: Beating the Bed-wetting Blues (cont.)

On the other hand, if there is secondary enuresis and the child has been dry for a while, we know that he or she is capable of being dry and wonder what might be causing the recurrence of the wetness. In that case it's especially important to look for a medical problem. Stress can also be an inducer for the enuresis to recur.

In your child's case, since he is dry all night, it's possible that stress has something to do with it, but it's hard for me to understand why the wetting only occurs in the morning.

I almost never think that bed-wetting is due to 'laziness'. Almost any child is going to stay dry when they can -- it's such a sign of maturity and being a big boy or girl. To wet the bed voluntarily, or because one is lazy, is really rare. I think some children get a bad rap from their parents because the parents believe that the child is doing it on purpose. That's always the last on my list.

Why your little guy waits until morning to wet the bed is not clear to me. Most kids who wet the bed do so a couple of hours after they have gone to sleep at night, when they are in a very deep sleep and in the first few stages of sleep. Perhaps his bladder is filling up a lot and exceeds its capacity to hold it by the morning, but this doesn't happen earlier on in the nighttime.

I would suggest if he is wetting at a certain time every morning, that you try awakening him a half hour or hour before that time and getting him up and letting him pee and see if you can short circuit the whole thing by pre-empting the morning wetness through waking him up and having him go on his own. Good luck and let me know how it goes.

Could we talk a minute about parents' attitudes? You touched a bit on that in your answer. Parents can do a lot of harm or a lot of good to their child who is having problems with bed-wetting by their attitude.

Absolutely. In fact, I think the one thing I worry most about with bed-wetting is the parents' attitude and therefore the child's self esteem when he or she has a bed-wetting problem. This, as I mentioned, is almost always something the child can't help and occurs during sleep. But it's also somewhat humiliating and a sign of "a baby."

If the parents are not positive but also negative about it -- they call the child lazy, ask why the child is such a baby, why can't he or she stay dry, what's going on, and if they are very angry about the whole thing (which many parents understandably are) that can really have a devastating effect on the child's self-esteem. This can continue long after the bed-wetting stops -- the child still thinks of himself or herself as not an adequate child and having these major problems.

So, I think the parental attitude is in fact the most important aspect of all of this because the odds are 98% that no matter what you do your child is going to stop wetting the bed at night. The key more is the process you go through and how your relationship is changed by dealing with this issue in those early years. That's why I think punishment has no place in the treatment of bed-wetting because one, it does not work, and two, it just makes the child feel terrible.

One of the methods that is talked about to stop bed-wetting involves the opposite of punishment -- it's a rewards system with a chart with stars. How would that work?

Let me say that punishment does not work, and frankly, rewards don't work that well either.

Think about it: If I offered you a million dollars to stop snoring at night, it wouldn't work -- you're asleep, you can't help it. If I offered you a million dollars to not sleep with your mouth open, you couldn't do it. The reason is, of course, when you're asleep, you're not responsive to rewards or punishments and neither is your child. So rewards are an adjunct.

You can use sticker charts and rewards to reinforce your child, help them and motivate them through the bed-wetting blues, but it's not going to have nearly as big a result as many parents would like to think. There are much more effective techniques which I'm sure we'll talk about later, than rewards and punishment. So sure, keep your sticker charts, encourage your child with rewards for success, but don't expect that rewards are going to do the trick either.

"It's really a parents' choice and child's choice about when and if to deal with nighttime bed-wetting."

My daughter is 7 years old and would like to go to sleepovers but is embarrassed by her bed-wetting. Is it all right to use those pull-ups or do they simply allow her to continue to bed wet? I'd like to make her feel better about having sleepovers.

I think for sleepovers, you have a number of options. One is that you can try to use the medications that are sometimes effective for nighttime bed-wetting. These medications, such as desmopressin or DDAVP can work quite well. The problem is that once you stop the medications the bed-wetting resumes. For that reason, they can be quite helpful for children who are going for overnights with friends or to camp for a summer -- it gets you through the time and avoids the child's being embarrassed by bed-wetting during the time when it would be most difficult for them to bed-wet. The problem is that once you stop the medication, and I don't recommend children staying on these medications for a long time, then the bed-wetting will come back. So you certainly could try one of those medications when your daughter goes for an overnight, and only use them at those times.

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