Children and Sleep: Bedwetting Treatment Guide

By Vincent R. Ianelli, MD, FAAP

While most children are potty trained by the time they are three to four years old, wetting the bed at night (nocturnal enuresis) is still a common problem for many six to eight year old children (affecting about 8% of eight year olds). It is more common in boys and in families in which one or both parents wet the bed as a child.

Bedwetting may be caused by your child having a small bladder capacity (meaning it can not hold as much urine as children who do not wet the bed), not being able to tell when his bladder is full, or during times of stress. Very rarely is bedwetting caused by a disease or physical problem.

Bedwetting is defined as being primary, children who have never had dry nights, or secondary, children who are now wetting the bed, but who had previously been dry for 3-6 months.

Treating Bedwetting

About fifteen percent of children who are wetting the bed will mature out of this problem every year, but until he does, here are some steps you can take to try and increase the number of dry nights that he has:

• Reassure your child that this is normal at this age and not his fault and understand that he is not doing it on purpose. Also, do not punish or blame your child for wetting the bed and make sure that other family members do not tease him about it.
• Avoid letting your child drink large amounts of fluid two hours before bedtime.
• Have your child use the toilet just before going to bed.
• Protect the bed with a plastic cover between the sheets and mattress.
• Let your child help change the wet sheets.
• Consider practicing bladder-stretching exercises, in which your child will try and increase the time between urinating during the daytime so that the bladder can learn to stretch and hold more urine at night.
• Consider practicing an awakening routine, in which you wake your child to urinate two to three hours after he goes to bed, either at the parent's bedtime or after setting an alarm clock.

Bedwetting Alarms

If the above methods do not work and your child is still wetting the bed after he is 7-8 years old, we will consider using a bedwetting alarm that senses when your child has begun to wet the bed and sets off an alarm to wake them up. This helps to teach your child to respond to a full bladder and this method works in over 70% of children after two to three months.

One such alarm is the Potty Pager, a self-contained silent alarm that uses a mechanical vibration to awaken your child when the alarm senses wetness. It is available for $49.95 from Ideas for Living, Inc. Call 800-497-6573 to order or for more info.

Another type of alarm is the Sleep Dry alarm that also has a wetness sensor to detect when your child is wet and then wakes them with an audio alarm. It is available for $50.95 from StarChild Labs at 800-346-7283.

Medicines for Bedwetting

The medications that are currently available to treat bedwetting are Imipramine (an antidepressant) and DDAVP. They both can be effective in reducing the number of wet nights that your child has, but they only work as long as your child continues to use them. They also have possible side effects and relapses are common when you stop using them.

In general, we reserve using medicines in select children when no other treatment works. They may also be beneficial for your child to take on special occasions, such as sleepovers, camping trips, etc.

Important Reminders

Be patient. This is a persistent and frustrating problem, but one that will usually resolve as your child gets older.

Call your pediatrician if your child is also wetting himself during the day, complains of burning during urination, is losing weight, has blood in his urine, or if the problem is affecting your child's self esteem.

About the Author

Vincent R. Iannelli, MD, FAAP is a board certified Pediatrician in Dallas, Texas. He is a member of the Dallas County Medical Society, Texas Medical Association and is a Fellow of the American Academy of Pediatrics. In addition to having a Pediatrics practice in a suburb of Dallas, he is currently an Associate Professor of Pediatrics at the UT Southwestern Medical School.

Dr. Iannelli's current practice is located at Lake Ray Hubbard Pediatrics, 6900 Scenic Drive Suite #102, Rowlett, Texas 75088.

"The "Bedwetting Treatment Guide" is © 2001 by KeepKidsHealthy LLC and Dr. Vincent Ianelli, and is reprinted here by permission of the author. Dr. Ianelli's health website, KeepKidsHealthy.com offers information about all aspects of health for children from newborns to adolescents. For information on pediatric health issues, visit www.keepkidshealthy.com