Nocturnal enuresis, the medical term for bedwetting, is a common and frustrating problem that affects between five and seven million American children. Nocturnal enuresis most commonly affects children younger than three years of age, although it can affect older children and adults. About 15% of children aged three to five and about 1% of school age children struggle with the problem although percentage of people affected decreases as their age increases. When helping a child work through his or her bed wetting issues, it is useful to understand the causes, physiology, and possible treatments for the condition.
Many parents are as frustrated, or perhaps even more so, with their child’s bedwetting problems as their youngster is. It is important to remember that there are medical and physiological factors behind a child’s inability to stay dry at night, although the exact cause of nocturnal enuresis is unknown. Children do not wet the bed to make their parents angry and neither are they are too lazy to get out of bed to go to the bathroom, or because they drank too much before bed.
In many cases, the parents are at fault for putting nappies on their youngster at night and then expecting the child to automatically start using the toilet when they decide, at four or even five years old, that their child should not be wearing diapers any longer. Bedwetting is not a behavioral issue and it is important not to scold your child because they have ‘little accidents’ when sleeping.
The causes of nocturnal enuresis can be genetic since bedwetting tends to run in families. It can also arise because a child has difficulty waking from sleep. A child may also have slower than normal development of the central nervous system, which can make it more difficult for him or her to consciously stop from urinating at night.
Hormonal factors, urinary tract infections, and abnormalities in the urinary tract functions or the spinal cord can also cause bedwetting. In addition, some children are unable to hold urine for a long time because they have a smaller than average bladder. A healthcare professional can help diagnose and find the causes behind your child’s nocturnal enuresis.
The development of the ability to control one’s urine output at night varies by child. Most children achieve nighttime control of their bladders by five years of age, although bedwetting at the age of five is not unusual. Many physicians do not recommend treating nocturnal enuresis in children younger than five, as it is not necessary and can even harm your child’s development.
Although most children outgrow bedwetting without any interventions, if your child is older than five and is still struggling with bedwetting, there are treatment options. Discussion with your doctor about your child’s bathroom habits, physical exam, and home routines will help determine the best option for your youngster.
In general, bedwetting treatments fall into two categories: behavioral therapy and medicine. Behavioral therapy is aimed at teaching your child not to urinate in the bed. It may include using an alarm system to indicate when the child’s bed is wet so that he or she learns to appropriately recognize bladder sensations; a reward system for celebrating nights without bedwetting; and bladder training, in which your child practices holding his or her bladder for longer periods of time. If your child is over seven years of age and has not been successful using the behavioral approaches, your physician may want to try the medical approach. While the medicines do not cure nocturnal enuresis, they can decrease the amount of urine the kidneys produce or help the bladder hold more urine. The medicines do have side effects, so it is important to give the behavioral approaches a valid effort.
When helping a child work through bedwetting issues, it is important to also focus on the embarrassment and guilt that may accompany wetting the bed. While your child should take responsibility for wetting the bed, you must help them understand that it is not his or her fault. Children should not be made to feel guilty for something that they cannot control. After all, they would not wet the bed if they had the choice not to. Remind your child that many other children struggle with the problem and that what causes bedwetting is still unknown.