Bed-Wetting Myths Debunked
What to do and not to do if your child wets the bed.
Mornings are a whole lot brighter at Terry Packer's (not his real name) Long Island home these days. Terry, now 16, hasn't wet the bed in a year.
But there was a time that his parents did not believe a morning would ever start without changing sopping wet sheets.
Terry and his family are not alone.
In the U.S., about 5 to 7 million children aged 6 years or older suffer from primary nocturnal enuresis also called nighttime bed-wetting or the involuntary loss of urine at night when they could reasonably be expected to stay dry. If a child wets the bed after age 5 or 6, there is an 85% chance he or she will still do it a year later, based on statistics from the National Kidney Foundation (NKF).
Terry started wetting the bed age 4 and continued to do so until he turned 15. His family was at their wit's end and didn't know where to turn for help.
That's because myths abound when it comes to bed-wetting and they often prevent children from getting the proper help, says Alan Greene, MD, an assistant clinical professor of pediatrics at Stanford University in Stanford, Calif., and author of several books including the forthcoming From First Kicks to First Steps.
WebMD talked to leading pediatricians to debunk some of the more common myths and address parental concerns about bed-wetting. Here's what we uncovered:
There's something wrong with my 3-year-old!
"Bed-wetting is very common in younger kids, in fact, it is so common that it is even considered normal before age 5," Greene says. "Nighttime dryness is the last part of toilet learning that kids achieve," he adds. At ages 6 and below, bed-wetting only needs to be addressed if the child is feeling really bad about himself as a result, he says.
"As adults, when the bladder gets full, it sends a signal to brain to wake up or you start dreaming about water or going to bathroom and then you wake up, but for kids the signal isn't quite strong enough to get them awake," Greene says.
That's why "it is normal for kids to wet the bed," agrees Charles I. Shubin, director of the children's health center at Mercy FamilyCare in Baltimore, Md. "By age 6, one out of six or seven will do it."
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He adds that bed-wetting is "a developmental issue and therefore the treatment is time, so for kids age 6 or under, they will most likely grow out of it."
Parents need to realize that "to some extent this is a social problem and in a more primitive setting, it would not matter," Shubin tells WebMD.
In other words, "if a 3-year-old is not bothered by wearing a pull-up at night, then don't bother him about it," says Oschner Clinic Foundation pediatrician Michael Wasserman, MD, of New Orleans. But "if it's a 6-year-old and he or she is afraid that a buddy will make fun of him because of bed-wetting, then it becomes an issue."
Don't Blame the Victim
"It makes matters worse when parents yell and scream at their children for what they do in their deep sleep," Shubin says.
And some parents still believe that bed-wetting is the child's fault. In fact, the NKF estimates that 35% of bed-wetters are punished by their parents for wetting the bed and that's the worst possible response.
Stanford's Greene agrees: "Many parents feel like it's their fault or their kids fault or that their kid is lazy and children often feel very guilty and ashamed and what this leads to is punishment and that only makes bed-wetting worse.
"For kids that are under 5 or 6, it's normal, they are not doing something wrong and it won't last forever," Greene says. "Kids need reassurance and encouragement, not punishment."
Such reassurance can be based on the fact that bed-wetting tends to run in families, Wasserman points out.
"Calm down and reassure your child and do things to help his or her self esteem," he says. "If it's true, you may even say 'daddy used to do this,'" he suggests.
He or she will grow out of it. This is usually true, Greene says.
Consider that about 25% to 33% of 4-year-olds wet the bed and about 15% of 5-year-old children wet the bed. From age 5 on, about 15% of children who wet the bed become dry each year. About 5% of 10-year-olds still wet the bed and about 1% of 15-year-olds -- like Terry -- wet the bed. About 1% of adults continue to wet their beds, according to the NKF.
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.
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"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.
© 2004 WebMD Inc. All rights reserved.
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