Still wetting the bed

Tends to run in families

The research says that bedwetting tends to run in families, and Karen Martin* sees plenty of evidence in her own household. She remembers wetting the bed occasionally until she was 10, and knew that one of her nephews was 13 before he was dry at night.

So she wasn’t shocked when her son James (now 14) and her daughter Gabrielle (now 10) continued to wake up to damp sheets from time to time until just after their 10th birthdays.

While the majority of children will be dry at night by the time they are five or six, about six to eight percent are still wetting the bed at age eight. The percentage goes down each year, leaving two percent still not dry every night at age 15. What may not have been a big deal with a five-year-old can be an awkward and embarrassing situation for a preteen.

“I have tried to handle the situation with tact, discretion, respect and dignity,” Martin says. “I have always been very matter-of-fact about it. Kids don’t wet the bed because they want to.”

Martin is absolutely right, says paediatrician Mark Feldman of Toronto’s Hospital for Sick Children. “Bedwetting is not a disease or bad behaviour. There’s nothing wrong with these kids and they aren’t doing it on purpose — it’s not in their control.”

*Names changed by request.

Primary enuresis

Feldman is talking about what doctors call primary enuresis — a condition where a child has never had a period of six months straight where he was dry at night. “I tell these kids that they are just deep sleepers and that they will outgrow it,” says Feldman, citing research that compared children who wet the bed to those who didn’t, and had both groups wear headphones while they slept in sleep labs. The researchers then played music through the headphones and gradually increased the volume. The non-bedwetters woke up; the others just kept on sleeping. (Secondary enuresis — when a child starts wetting the bed again after being dry every night for at least six months — is more likely to be related to a medical problem, and your doctor may recommend some tests to evaluate this situation.)

In most cases of primary enuresis, Feldman says he suggests no treatment at all — just patience. If a child wants to go to overnight camp or have sleepovers with friends, though, he might prescribe a medication called DDAVP (desmopressin acetate), which can decrease urine production overnight. It’s only for occasional use, and children taking this should not drink anything an hour before or eight hours after the treatment. Try it out before the overnight outing, he adds, because it doesn’t work for everyone.

Martin didn’t use the medication, and found that her children devised their own strategies to handle overnight visits. “Gabrielle would take a training pant tucked inside her pillowcase and put it on when she changed into her pyjamas. Once she forgot and peed in her sleeping bag. She told her friend’s mom that she’d spilled a drink and it was no big deal. James found he usually didn’t wet the bed on sleepovers because he didn’t sleep as deeply.”

The alarm systems that used to be recommended have been shown to be less effective than previously thought, says Feldman. They are designed to wake the child up as soon as he begins to pee, with the goal of teaching him, over time, to wake when his bladder is full. “They only work in about 40 percent of cases,” he explains.

Sleepovers

While sleepovers tend to be the biggest worry for children who wet the bed, parents often struggle with the day-to-day challenge of smelly wet sheets and PJs. Martin says she found it especially difficult at first with James. “I was feeling quite resentful about having to wash his sheets every day.” Then she read an article about bedwetting that changed her perspective. “The author talked about seeing this as one more stage of childhood, and talked about changing and washing the sheets as an ‘act of love.’”

What about having the child deal with washing and changing the sheets? Feldman says it’s fine to involve the child as long as it isn’t punitive in any way. “You could say, ‘You can just throw the sheets in the hamper here, if you like,’ but don’t make it a big deal,” he suggests. Rewards for dry nights are also not helpful, he adds.

Martin says she got used to the daily routine of checking the beds, stripping the sheets and tossing them into the washing machine. She says: “What kids need most when they are still wetting the bed is your understanding and confidence that they are just fine and will outgrow it when their bodies are ready, and that, honestly, it’s not a big deal.”