Bed Wetting (AKA Nocturnal Enuresis)
Night time laundry washing.
The little-known, and little-bragged about nocturnal hobby of a vast number of parents around the world. Unfortunately for us, it is neither a team nor a social sport (*face palm*).
Bed wetting is not an unusual presentation to general paediatricians. It can be a real problem for school age kids AND their parents.
It is a hugely common problem, and perhaps this fact alone is a testament to the fact that in the vast majority of cases – it is developmentally normal. Lots of children neglect to tell their classmates that they wet the bed, but more often than not, they are not alone. A few blog-followers have asked me to post on this topic – so I hope some of you out there find this both reassuring and helpful.
As many as 1 in 3 children still wet the bed at age 4 years, about one in 10 by age 6 years and around 1 in every 20 by age 10-11 years. Most children have no long lasting problems from bed wetting. My advice would be just go-with-the-flow and don’t worry too about night time toilet training if your child is under 6 years of age. My 4.5 year old daughter still wears pull-up that are very heavy in the morning and I am not even thinking of toilet training her until those become more dry (and not until the weather gets a bit warmer too).
Which children are more likely to bed wet?
- Children who have a family history of bed wetting (eg parents, siblings etc)
- Children who sleep deeply and are difficult to wake
- Kids who have demonstrated they have a small bladder capacity (and need to go to the loo a lot through the day) or who produce MORE urine overnight rather than less.
There are some MEDICAL causes of bed wetting (and day time wetting too) like, urinary tract infections, constipation, diabetes mellitus or diabetes insipidus (they sound similar but are actually two very different conditions), pelvic floor muscle dysfunction – so it is important that you seek medical attention to exclude treatable causes.
In general if your child is very upset by the bed wetting, you should take them to see a doctor. Medical interventions for bed wetting do not usually work well in children under the age of 6, and in any case most children under this age become dry in their own time without treatment. If there are other symptoms occurring in the context of the wetting, for example,
- constipation or soiling
- day time wetting
- excessive fluid intake during the day
- unexplained weight loss
- an increase in frequency of urination during the day
– these are all reasons why you might need to see a doctor earlier. Bed wetting is not a behavioural problem (ie kids don’t do it deliberately) and punishing children will only make things worse. They may already feel embarrassed or ashamed and need support and patience, not criticism.
There are a few steps to treatment – the first few you can initiate yourself at home.
- Make sure your child drinks enough fluid throughout the day. The helps to increase the bladder’s holding capacity. Restricting fluid in the evening has NOT been shown to help with treating night time wetting, but certainly common sense tells you the extra drinks and fluid (especially ones containing caffeine) at bedtime will not help your cause.
- When you make the decision to finally toilet train at night, get rid of pull ups and nappies – they will only prolong the process and your child will not realise they are wet and will hence not wake up (and eventually become dry).
- Mattress protectors – a trick I learnt from my sister is to DOUBLE MAKE THE BED. We use “brolly sheets” – an absorptive mattress protector slung horizontally across the bed to stop the fluid seeping into the mattress itself. I bought mine on eBay (on sale!) but they are widely available online and in bedding stores. Double making the bed involves a fitted sheet, a brolly sheet, a fitted sheet and a brolly sheet. This means that if you have a night time accident, instead of having to change the bed, you just rip the top 2 layers off and chuck them in the machine, with the bed then already freshly made underneath.
Bed wetting alarms
These are the most successful way to help children become dry (>80% success rate) and have both better long-term success AND fewer relapses compared to medication.
You can hire bed wetting alarms from certain pharmacies, hospitals or buy your own online. Different alarms have different formats. Some are a sensor sitting between 2 pairs of undies, connected to an alarm that clips to the child’s pajamas. Others are a mat that the child sleeps on that is connected to an alarm that sits at the end of the bed.
The way they work: When your child passes urine, the alarm goes off and the child needs to get up and turn it off, go to the toilet and finish emptying their bladder. They then dry the mat (or change their undies etc), turn the alarm back on and get back into bed. Usually dry nights start to appear within a week or two of starting the alarm.
- Usually we use an alarm for 6-12 weeks
- The aim is for 7 dry nights in a row; once they have 2 weeks in a row – you can try leaving the alarm off altogether.
- some kids need to use it for a few cycles for long term effect
- If helps to demonstrated to the child how the alarm works (with a glass of water) and run through the routine a few times initially; reiterate this routine before they go to bed each night. You might need to help to wake them in the night if they sleep deeply, but they should be doing the rest of the routine themselves.
There ARE medication that can be used to help children stay dry at night, but most children with bed wetting do not need to take them.
This is sometime that would need to be discussed with and instituted by your doctor, and usually is not done until AFTER there is a failed trial of a bed wetting alarm. If you get to this point, then you need to make an appointment to see your GP or paediatrician.
There are also “Bed wetting clinics” run by specially trained therapists for children with difficult to treat bed wetting or more complicated medical problems. Your doctor can refer OR you can self refer to clinics like this (eg the MARS clinic – Brisbane South (Woolloongabba), Brisbane North (Wavell Heights), Gold Coast (Hope Island), Ipswich (Brookwater) ).
Until next time,
Good luck getting dry at night!
xx Dr Megs
For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/