The age at which children achieve consistent dry nights is variable. Research on bedwetting (or Nocturnal Enuresis as it is technically known) suggests that most children achieve dry nights by the age of four. Often it is easier for the toddler to stay dry during the day and so it can be much later before dry nights are possible. About 60% of three year olds are dry by night, going up to 80% by four years and 95% by age 8. 90% of children who are wetting the bed at 7 years will have stopped by their early teens.
Here are some facts about bedwetting:-
- For the vast majority of children wetting the bed is simply an indication that their bladder control is slower to develop
- Bedwetting often runs in families
- Boys are twice as likely as girls to have this problem
- Bedwetting is associated with physical problems in only 1% of cases
- By puberty the vast majority of children who have had this problem will have grown out of it
- Bedwetting is not usually an indication of an emotional problem
As you will see from the above bedwetting is not usually related to any emotional factors - there are however some events have been associated with bedwetting:-
- Major changes in family due to death, separation or divorce
- Temporary separation from mother for one or more months
- The arrival of a new sibling
- Move to a new house
- Repeated admissions to hospital
- Excessive pressure from parents to have dry nights leading to negative reactions when wet
- Teasing from siblings over wet nights
- Major trauma the child may have suffered or witnessed
For the majority of children who wet the bed no major treatment is necessary - rather a practical and supportive attitude from parents will help them while they naturally outgrow this problem. However those children who are slow to achieve dry nights are acutely aware of the problem, especially older children.
Many of these children would admit that this problem is making their life a misery and would be very keen and motivated to get help with the problem. There are a number of methods that have been developed that could help children in these circumstances.
Approaches to bedwetting
The main methods of helping a child achieve dry nights are:-
Night-time wetting can be helped by exercises to strengthen and increase the capacity of the bladder. Some children who bed wet have been found to have small bladder capacity. Training the child to resist the immediate urge to go to the toilet and gradually increasing the times between visits to the bathroom can help to increase bladder size. Stopping urine in midstream can help to strengthen the bladder muscles. These exercises should be done under the guidance of your GP.
Changing eating and drinking habits can also have a positive effect. Foods and drinks containing caffeine can be avoided before bedtime e.g. chocolate, cola. Also limiting the amount of fluids in the few hours before bedtime is sometimes recommended.
This is where parents bring the child to the bathroom sometime during the night . This does help some children but not all. There isn't agreement on the usefulness of this approach as some argue that children can become dependent on their parents waking them and that it does not encourage the child to take responsibility for waking themselves. Also it has been suggested that rather than teaching the child to inhibit urinating at night it encourages them to urinate.
These are usually two pads of wire mesh that are placed on the child's bed between two sheets. They are attached to an alarm and when the child wets at night the circuit is connected which activates the alarm. The child should get up and go to the bathroom and then remake the bed with the help of parents before going back to sleep. The rationale behind this method is that eventually the child will come to associate the sensation of urinating with waking up.
More recently smaller alarms have come on the market. This small portable alarm is placed in the child's underwear, or if prefered it could be sandwiched between two pairs of underwear and is attached by wire to a top unit clipped to
the neck of the child's pyjamas.
Alarms are useful with the older age group 6+ and have been found to have a good success rate and fewer relapses than medication. However the child and parents need to be motivated and patient as they can take months to work. Before using the alarm it will help if your child gets to hear what the alarm sounds like so they won't be frightened the first time it goes off during the night.
Medication can be helpful and there are a number of drugs used with this problem. However it is not an appropriate long term solution and it has been found that many children will relapse after stopping taking the medication. However if a child is anxious about a holiday or overnight trip away from home the use of medication can help. Contact your GP for more information on this option.
A special chart is made showing the days of the week and the child either colours in or puts a sticker on each dry night achieved. The child receives praise for each dry night achieved and some suggest that after an agreed number of dry night they receive a reward. Star charts emphasise the child's achievements rather than the failures and they provide a record of progress. These charts can be useful for the 3 - 6 age group.
If your child is one of those many normal children who is suffering a crisis of confidence and is depressed about their bedwetting it might be worth discussing the problem with your GP. It may be that your child is too embarrassed to attend this appointment with you and if so don't force them to attend - rather take the time with your GP who will advise you on the best approach with your child.
Older children with this problem are often reluctant to discuss it even with their parents and need reassurance that none of their friends will be told about it. Often they might feel they are the only one in the world with this problem which is most definitely not the case
This is one problem that does not respond to negative reactions by parents. Disapproving or punishing a child for being wet can make the problem worse and damage the child's self esteem. Praise and encouragement is very important in dealing with this problem.