When your kid wakes up with wet sheets, it can leave him feeling embarrassed and uncomfortable, and leave you sleepless, stressed and buried in laundry. Many parents try restricting water or waking their kids during the night, but the problem only persists and the whole family becomes more sleep-deprived. We called in the experts to teach us their simple but not-so-obvious strategies to eliminate bedwetting.
Your first instinct might be to cut back on your child’s fluid intake, but Lane Robson, a paediatric nephrologist at The Children’s Clinic in Calgary, says this can lead to dehydration, which can actually exacerbate the problem. He sees many parents withhold water only to find their kids are still excreting just as much urine at night, because the body, which needs water for proper functioning, learns to draw it out of other sources like the intestines. This leaves kids constipated, and the buildup in the bowels presses on the bladder, restricting its capacity. Robson recommends encouraging your child to drink plenty of water in the morning (aim for 40 percent of what he needs in a day), some water or a “treat drink” (like iced tea or chocolate milk) at lunch, and then water after school, at dinner and in the evening to keep him consistently hydrated.
Robson sees many young patients who have hard, pasty poops, which affects their bladder. Even if your child doesn’t complain of constipation, taking steps to improve her bowel health can reduce bedwetting. In addition to plenty of water, your kid needs fibre—ideally, some in every meal or snack—to promote bowel regularity. Focus on a healthy diet filled with veggies and complex carbs, and try a stool softener to improve your little one’s bowel functioning. Robson also stresses the importance of giving kids time to relieve themselves in the morning—they should have bowel movements on a daily basis—in order to ease pressure from the intestines and allow the bladder to expand.
Certain foods can impact a child’s sleep and bladder function. The Canadian Paediatric Society recommends cutting out caffeine-containing foods (think chocolate or pop), because they’re diuretics. Peter Grise, a bedwetting therapist who coaches families in southern Ontario, suggests avoiding milk before bed, because it’s a protein, which is hard to digest, and because underlying dairy sensitivities can lead to sleep problems. Citrus foods or drinks, like orange juice, which can irritate the bladder, are also on his not-before-bed list. Meanwhile, Robson looks at the sodium content in the diet of his patients if they’re obese or adolescents. “Salt intake drives pee production because the kidneys are meant to regulate salt balance,” he explains. If your child is eating a lot of processed foods, chances are his diet is high in sodium.
In addition to helping prevent constipation, getting kids into the habit of regularly drinking water and emptying their bladders throughout the day can help them build the muscle awareness and control needed to stay dry through the night. “Get your kids to go to the bathroom—whether they need to go or not—every two hours and then have them drink a cup of water,” recommends Grise. He explains that “holding it” is a bad habit for kids to get into, because it can thicken the muscular bladder walls, reducing their sensitivity to bladder fullness. He also suggests using a practice exercise to train young kids (ages three to five) to get up from bed to go to the washroom. First, give them a big glass of water an hour before bedtime. Then, have them get in bed, pretend to fall asleep and get up to go pee. They should do this exercise at least twice a night to “build muscle memory,” says Grise.
When your child goes for a pre-bedtime pee, or gives up a problematic food, offer a small reward for this good behaviour. “Kids will do amazing things to get a gold star,” says Grise. He recommends using a reward system to reinforce those healthy sleep habits—but be careful to praise their actions, not their nighttime dryness. “A child isn’t responsible for being wet, he isn’t responsible for being dry, but he is responsible for doing the stuff that makes him dry,” says Grise.
A bedwetting alarm, which is worn by the child and emits a loud sound at the first sign of moisture, is a slightly more complicated but effective approach that can work for older kids (ages seven and older). Because many kids who wet the bed are deep sleepers, the alarm may not wake your kid up at first, so you might need to get your kid up. But, with time, your kid should begin to wake up in the first moments of the alarm sounding, so he can get to the washroom. Eventually, his body will learn to wake up when the bladder is full, so he can get to the bathroom in time. Both Grise and Robson are advocates of bedwetting alarms and, according to the Canadian Paediatric Society, though it may take a few months, almost half of kids in studies stopped bedwetting after using an alarm. “It’s about recognizing the feeling of having to go,” says Grise, who explains that the alarm conditions kids to wake up when they notice that feeling. Once kids have learned to wake up, he takes it a step further and tells kids to stay in bed and focus on the sensation, then go back to sleep. That way, they can learn to control their bladder while they sleep.
There are some pharmaceutical options used to help deal with enuresis (the medical term for bedwetting), but neither Grise nor Robson recommend going that route. The most common one, desmopressin acetate (DDAVP), imitates the natural water-conserving hormone in the body that tells the kidneys to stop producing urine. Grise says if it’s used inappropriately, it could upset the water balance in your body, and it’s not a long-term solution. “It doesn’t work to stop bedwetting; it stops your kidneys.” He suggests that, by using a bedwetting alarm, your kid can actually train his body to use his own naturally occurring hormones instead of relying on a drug to have the same effect.