ParentLine

Dear ParentLine:  My husband and I are really concerned about our seven year old son.  He is still wets his bed. It doesn’t happen every night, but it does happen often enough that we can’t allow him to stay overnight with his friends. We thought he’d ‘grow out of it,’ by now, but this hasn’t happened.  What can we do? Signed, Please! The C Parents in Rockingham County, NH

 

As much as misery may love company, ParentLine knows you won’t find comfort in the fact that in the US, about five to seven million children aged six years or older suffer from primary nocturnal enuresis (NE), or the involuntary passage of urine while one is asleep, when they could reasonably be expected to stay dry.  Further, if a child wets the bed after age five or six, there’s an 85% chance he or she will still do it a year later, based on statistics from the National Kidney Foundation.  However, NE is a common problem that affects more than five million children ages 5 to 15 yrs., and rarely lasts beyond puberty. 

There are two types of NE; primary and secondary.  Primary enuresis is bed-wetting since infancy.  Primary NE is generally viewed as a delay in neurological maturation.  At five years of age approximately 20% of children wet the bed at least once a month with about 5% of males and 1% of females wetting nightly.  By six years of age only about 10% of children are bed-wetters – the large majority being boys. 

Secondary enuresis is wetting developed after being continually dry for a minimum of six months.  The causes for secondary NE are more difficult to pinpoint.  The most common reasons for secondary NE are urinary tract infection and/or stressful situations at home or school. NE is a common reaction in children who have experienced trauma and may persist even after the incidents of physical, sexual, or emotional abuse have ceased.  Even normal developmental changes in the family or the child’s situation such as the birth of a younger sibling or when the child starts kindergarten, may result in a period of secondary enuresis.

The experts at www.familydoctor.org suggest that causes of bed-wetting include the following:

• Genetic factors (NE runs in families)

• Difficulties waking up from sleep

• Slower than normal development of the central nervous system—this reduces the child’s ability to stop the bladder from emptying at night

• Hormonal factors (not enough antidiuretic hormone—this hormone reduces the amount of urine made by the kidneys)

• Urinary tract infections

• Abnormalities in the urethral valves in boys or in the ureter in girls or boys

• Abnormalities in the spinal cord

• Inability to hold urine for a long time because of small bladder

The basic problem faced by children with primary NE is their inability, while asleep, to recognize neurological messages sent by the full bladder to the sleep arousal centers of the brain.  Research confirms that arousal dysfunction is one of the primary causes of nocturnal enuresis.   The Enuresis Research and Development Center defines arousal dysfunction as the inability to awaken to normal stimuli (e.g. being cold or uncomfortable, having a bladder signal, or hearing loud noises such as a smoke detector). 

The most common symptoms of arousal dysfunction are bedwetting, sleepwalking, night terrors, sleep apnea, and head banging.  Occasionally, the child will sit straight up in bed for a moment and then lie back down and continue to sleep.  Partial arousal is occurring at these times, but with no recall the next day. 

For help to understand how primary NE can be treated, ParentLine offers information from an article title Enruesis, Doreen Arcus, PhD, UM, (Lowell Gale Encyclopedia of Childhood and Adolescence: Enuresis, http://www.findarticles.com).

Dr. Arcus says that treatment plans for NE should begin with a thorough evaluation designed to identify factors contributing to the problem. “The basic assessment should include a complete physical examination, urinalysis, and a urine specific gravity, evaluation of the urinary stream, neurological examination, assessment of bladder habits (e.g., the amount and frequency of urine produced each day, whether leakage occurs with laughter or effort) and bedtime habits (e.g., evening consumption of products such as caffeinated colas or chocolate that may act as a diuretic, and whether the child is overtired at bedtime), and urodynamic studies as needed,” Arcus says.

In an article titled How to Cope with Bedwetting (www.sleepdisorders.about.com), ParentLine found the following suggestions to help you help your child:

1. Make sure your child urinates before going to bed.

2. Keep fluid intake to a minimum in the evening.

3. Avoid foods or soft drinks containing caffeine as they increase urine output.

4. Make sure the child sleeps close to the bathroom for easy access.

5. Use a night-light so there’s no danger of his or her tripping or becoming disoriented when getting up in the night.

6. Wake the child periodically during the night and take him/her to the bathroom.

7. Use plastic pants at night to eliminate the discomfort of wet sheets.

8. If you wet your bed when you were a child, let your child know.  If he or she understands that bed-wetting may be hereditary, it can ease anxiety and help him or her cope with the condition.

9. Use a moisture alarm sewn into a pocket of the child’s sleepwear.  It will buzz at the slightest hint of moisture.

10. Discuss the bedwetting problem and methods of treatment with your doctor or pediatrician.

 

The Family Doctor (www.familydoctor.org) reminds parents that bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels.  It’s true that your child could benefit by taking responsibility for bed-wetting (by helping with the laundry for example), but your child should NOT be made to feel guilty about something he or she can’t control.  It’s important for your child to know that bed-wetting isn’t his or her “fault,” and to punish your child for wetting the bed will not solve the problem. 

ParentLine is a free and confidential service of Child and Family Services, a statewide, independent, nonprofit organization dedicated to advancing the well-being of children and families.  Call ParentLine, 1-800-640-6486;  write ParentLine, c/o Child and Family Services, P.O. Box 448, Manchester, NH; email parentline@cfsnh.org or visit our website at www.cfsnh.org.