A fluid situation: Bed wetting

Bedwetting can stress out kids and their parents — but it doesn’t have to. Here are some tips to help the whole family cope

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Until five-year-old Rachel Hart* wakes up in the morning to a wet bed, the Brampton, Ont., kindergartner doesn’t even know she’s had an accident.

Her doctor says not to worry — Rachel is a deep sleeper and she will eventually outgrow the nighttime wetting. “There is no point getting upset,” agrees her mom, Kim. “You have no control over it unless you’re lying beside them, waking them up every half-hour.”

This is the right attitude, says Toronto paediatrician Mark Feldman, who chairs the Canadian Paediatric Society’s Community Paediatrics Committee. Bedwetting is quite common: 10 to 15 percent of all five-year-olds and six to eight percent of all eight-year-olds experience enuresis, as doctors call it. And in most cases, he adds, “there is nothing at all wrong with the child emotionally, medically, physically or psychologically.” Usually it happens because kids are sleeping so deeply they miss their body’s cue to get up and go to the bathroom. As Rachel’s doctor pointed out, bedwetting almost always cures itself in time — and while you’re waiting, there are ways to minimize its impact on your child’s life.

Put it into perspective

Bedwetting can cause anxiety and embarrassment for kids. But it doesn’t have to. When you treat it as no big deal, says Feldman, kids will follow your lead.

Pauline Duncan* of Edmonton can attest to that — her son Ryan wet the bed almost every night until he was 8½ years old. “We never spoke of the bedwetting negatively, and I never complained about the extra laundry,” recalls Duncan. “We treated it as a non-issue in our house and it was only really discussed occasionally.” The result? Now 15, Ryan is a happy teenager who no longer has nighttime accidents.

If your child is troubled by her bedwetting, you can try giving an age-appropriate explanation for the problem, like pointing out that just as some kids have a harder time learning to swim, others have a harder time staying dry at night. Or tell her about a relative who wet the bed as a child, suggests Barbara Tredger, a child and family therapist in Vancouver. That will help your child see that someone she looks up to faced the same problem and turned out just fine. (See What is bedwetting?)

*Names changed by request.

Avoid punishment and rewards

Laying out consequences or punishments won’t decrease the frequency of nighttime accidents: Kids can’t control whether they wet the bed. Worse, says Tredger, “even if the shaming does not impact the child’s self-esteem, it will give the child the message that she has to do something she may not be able to in order to gain her parents’ approval.”

Similarly, Duncan steered clear of offering rewards or using sticker charts to motivate Ryan. A child can’t stop wetting, she says, just because he wants to go see that new 3-D movie or get a skateboard. And he’ll feel bad when he doesn’t succeed. As Feldman puts it: “If you congratulate a child for a dry night, then wet nights are a big deal too.”

In a few cases, however, a dangled carrot can be just the motivation a laid-back kid needs to get in gear. “There is some evidence that, for certain children who do wake up and can’t be bothered to get up [and go to the bathroom], rewards might work,” says Paul Thiessen, a clinical professor of paediatrics at the University of British Columbia. But it’s up to parents to judge whether that’s an appropriate approach to take. “You have to know your child,” Thiessen says.

Find tools for coping

It seems the strategies parents find most helpful aren’t aimed at preventing bedwetting, but at making it easier to live with.

Tredger says giving your child a sense of control over the problem will help ease his anxiety. She suggests the two of you form a plan together, so your child has a way of dealing with the wet sheets on his own. “Teach him how to take the sheets off the bed, to put his pants in the laundry — not in a punitive way, but so he feels that he is doing something to deal with the issue.”

To make cleanup easier, Saint John mom Sandra Olson* likes the machine-washable waterproof pads from Priva (priva-inc.com), which are sized to fit across the bed, on top of the sheets, and are simply whisked away after an accident. When her nine-year-old son, Parker, a nightly bedwetter, is at sleep-away camp and wants to be without the conspicuous sheet protector, he uses a neat trick Olson taught him: He tucks a pair of training pants and a plastic bag inside his sleeping bag so he can discreetly slip on the pants when he gets in at night. In the morning, he puts the pants in the bag and carries it with his toiletries to the washroom where he puts it in the trash.

While some parents worry that using training pants overnight will prolong their children’s bedwetting, Lida Jones, a registered nurse at McMaster Children’s Hospital in Hamilton, scoffs at that idea. She says children don’t wet the bed because they’re lazy, but because they have no control over what they do while they are asleep. Training pants at least save the sheets from getting wet. “Some children like to wear training pants or Pull-Ups because they contain the wetness so the whole bed doesn’t get wet and it makes it easier on the child and parent,” says Jones.

Drawing on more than a quarter of a century of experience working with children who have enuresis, Jones notes that if an older child feels humiliated by wearing training pants, it might be time to phase them out.

A child over the age of seven who is bothered by enuresis and wants treatment might be ready to try a bedwetting alarm. The way it works is quite simple: A buzzer, sometimes accompanied by vibration, will go off when a sensor pad placed on the child’s bed detects even a few drops of moisture, rousing the child from deep sleep. (She may sleep through the alarm at the beginning and need a parent to come in and wake her up.) Over time, if she’s really motivated and the family is fully committed, says Thiessen, she’ll learn to wake up first to the alarm, then to the sensation of a full bladder without the alarm’s help. Alarms cost $50 to $100 and are available at pharmacies.

Thiessen isn’t a fan of treating enuresis with prescription meds. Tofranil, an antidepressant, seems to work in some cases, although researchers aren’t sure exactly why. Thiessen warns it can cause irritability, anxiety and, sometimes, irregular heartbeat. “I think it is highly ill advised to use Tofranil — it is a powerful drug that can cause cardiac arrhythmia when taken in overdose.”

Thiessen is more comfortable with the short-term (two to three weeks) use of a drug called DDAVP (desmopressin acetate), which can decrease urine production overnight and can be used for the occasional trip to camp or sleepover.

For Tredger’s money, the most important thing parents can offer a child doesn’t cost anything at all: their support and understanding. “Being able to work on this with your child will not only build the parent-child relationship, but will help him build coping skills,” says Tredger.

Pauline Duncan agrees, recalling the day her son Ryan told his doctor that he’d stopped wetting the bed. “She said it was obvious to her that [the bedwetting] hadn’t affected his self-esteem and the way we dealt with it was probably why. He honestly never seemed bothered by it.”

Duncan encourages parents to take a similar approach and accept that, for children like her son, bedwetting is just a normal part of their development. And she offers this perspective: “Childhood bedwetting doesn’t define him any more than being an early walker did.”

*Names changed by request.

What is bedwetting?

As defined by the Canadian Paediatric Society (CPS), bedwetting (or enuresis, as doctors call it) is when a child older than five has more than two accidents a week. So a three-year-old who regularly wets the bed or even a six-year-old who has an accident once a month isn’t considered to have enuresis.

If a child has never had a six-month period of being dry at night, he has primary enuresis. It’s often hereditary and usually goes away on its own over time.

If a child starts wetting again after being dry every night for at least six months, that’s called secondary enuresis. The trigger could be a disruption in the child’s routine caused by, say, a separation, move or even something as minor as dropping naps. There’s usually not any reason to be alarmed, says Mark Feldman, chair
of the CPS Community Paediatrics Committee, but it’s still a good idea to see your child’s doctor to rule out diabetes, a bladder infection or other medical condition.

The word on water

Limiting your child’s after-dinner intake of fluids can help reduce nighttime accidents, but not always, says Lida Jones, a registered nurse who worked in the enuresis clinic at McMaster Children’s Hospital in Hamilton for 25 years. It may also help for your child to avoid caffeinated and carbonated beverages altogether, as they seem to increase the need to go. At the same time, she says, it’s important to offer plenty of healthy fluids throughout the day to prevent dehydration, and also to be careful about how you handle the new policy on beverages in the evening, as your child may think you are taking away something she enjoys as a form of punishment. Offering one drink between suppertime and bedtime is a good compromise.

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