Bedwetting and Sleep
Nocturnal enuresis is the medical term for bedwetting. Most children wet the bed occasionally or even nightly during the potty-training years. In fact, it is estimated that seven million children in the United States wet their beds on a regular basis. Controlling bladder function during sleep is usually the last stage of potty-training. In others words, it is normal for children to wet the bed while sleeping during that learning process. Bedwetting is typically not even considered to be a problem until after age 7.
Bedwetting in children is often simply a result of immaturity. The age at which children become able to control their bladders during sleep is variable. Bladder control is a complex process that involves coordinated action of the muscles, nerves, spinal cord and brain. In this case, the problem will resolve in time. On the other hand, it may be an indication of an underlying medical condition, such as obstruction of the urinary tract. If bedwetting persists beyond the age of 6 or 7, you should consult your pediatrician.
There are both primary and secondary forms of bedwetting. With primary bedwetting, the child has never had nighttime control over urination. The secondary form is less common and refers to bedwetting that occurs after the child has been dry during sleep for 6 or more months. Secondary bedwetting may be caused by psychological stress but may be the result of an underlying medical condition such as constipation or urinary tract obstruction. With secondary bedwetting, contact your doctor for an evaluation.
Symptoms of Bedwetting
Bedwetting refers to involuntary urination during sleep in children over the age of 5. Bedwetting may occur at any point during the night but usually occurs during the first few hours of sleep. Occasional bedwetting for children over the age of 5 is not uncommon but if it happens more often than 2-3 times per month, parents should consult their pediatrician.
How to Treat Bedwetting
Because bedwetting tends to happen during the first few hours of sleep, a good method of preventing it is to make sure that your child goes to the bathroom before bed. Commonly prescribed behavioral methods for treating the problem include:
- Establishing a regular bedtime routine that includes going to the bathroom
- Waking your child during the night before he/she typically wets the bed and taking him/her to the bathroom
- Developing a reward system to encourage your child, such as stickers for dry nights
- Talking to your child about the advantages of potty-training, such as not having to wear diapers and becoming a "big kid"
- Limiting beverages in the evening - even those last minute water requests
- Using a "bell-and-pad" which incorporates an alarm that goes off whenever your child's pajamas or bed become wet during an accident. These systems teach your child to eventually wake up before the bedwetting occurs
As a last resort, a doctor may prescribe medication for bedwetting, either for short or long-term use. Some examples are imipramine (an antidepressant), which relaxes the bladder, and desmopressin, a man-made copy of a normal body chemical that controls urine production at night. Although medication usually helps, bedwetting typically resumes once the child stops taking the medicine. As with any drug, it is important to monitor your child's response to the medication.
Coping with Bedwetting
There are products that parents can buy for school-aged children with enuresis:
- Disposable absorbent underpants
- Reusable absorbent underpants
- Sleeping bag liners
- Moisture alarms that go off when the child begins to wet the bed
There is no reason for punishment if your child wets the bed. Your child cannot help it. Talk to your doctor about treatment options and following these coping tips may help:
- Be patient, understanding and attentive
- Do not talk about the bedwetting in front of others
- Talk to your child about how the bladder works
- Avoid fluids in the hours before bed
Sleep in America (TM) Poll Data
According to the National Sleep Foundation's 2003 Sleep in America poll, 14% of preschoolers and 4% of school-age children wet the bed a few nights per week or more and 21% of preschoolers and 7% of school-aged children do so once a week or more.
Reviewed by Jodi A. Mindell, Ph.D., June 2010