HOW TO HELP YOUR CHILD STAY DRY AT NIGHT

by: SONAL SHAH, M.D.

Bed-wetting, also known as enuresis, is a common problem.  It is a source of a lot of emotional stress for both parents as well as children.  Bed-wetting can be daytime (diurnal enuresis) or nighttime (nocturnal enuresis) or both.  It is about twice as common in boys than in girls.  About 7% of boys and 3% of girls over age five have nocturnal enuresis, and about 1% of 18-year-old males still have nighttime bed-wetting.

There is a strong genetic predisposition for bed-wetting.  If there is positive history in both parents, the child has approximately 70% chance of being affected.  There is some scientific evidence that these children are difficult to arouse, have small bladder capacity and cannot concentrate their urine as well.  Some children over 10 who have enuresis also have symptoms of attention deficit hyperactivity disorder.

When a child who has been dry for a while starts wetting the bed again, it is know as secondary enuresis.  It is frequently associated with emotional stresses in life like the birth of a new sibling, moving to a new house, parental divorce, or a death in the family.

Daytime wetting can be caused by urinary infections, vaginal infections or irritation from bubble baths or soapy tub baths, diabetes and constipation.

Parents should discuss treatment options with the pediatrician if their child continues bed-wetting beyond age 5 or 6 and it becomes a significant source of embarrassment.  Treatment begins with a thorough history and physical examination to rule out other underlying problems including a urine test.

The first line of treatment is behavior modification including avoiding drinks especially caffeinated beverages after supper and voiding before going to bed.  Children should be encouraged by keeping a star chart with stars earned for each dry night.  Small rewards can be given for 1-2 dry nights with bigger rewards for longer periods of dryness.  Older children should be expected to launder their own soiled bedclothes and pajamas.

Children who fail behavior modification can be tried on other treatments.  Bed-wetting alarms are designed to arouse the child as he/she is just beginning to wet the bed and ultimately to train the child to recognize the sensation of a full bladder and wake up in time.

Two different medications can be used to treat enuresis, too.  They have small incidence of side effects and about 70% success rate.  There is high incidence of relapse when medications are stopped.

Most important, do not make your child’s bed-wetting a source of shame or criticism.  Chances are he or she wants to resolve the problem as much as you do.