Nighttime bedwetting, medically described as primary nocturnal enuresis, is a common problem affecting up to seven million children in the United States. Obviously, nobody is born with bladder control, but, usually, as a child matures, so does their ability to control their bladder. By the age of 3 to 4, most children learn to void, or inhibit voiding, voluntarily. But anywhere up to 20 percent of 6-year-olds still have regular bedwetting episodes.
Enuresis can be caused by physical disabilities, deep sleeping, irregular bowel movements, food sensitivities and more. While it's not always easy to discern which factors are affecting your child, the difficulties are compounded if they have special needs.
A Medical Solution
Research has determined a close correlation between children with ADD/ADHD and bedwetting. In fact, in a study of more than 1,800 cases, nearly half of those with classical ADD/ADHD currently wet the bed or have in the past.
Diane, whose son Timothy was diagnosed with ADD when he was 8, is one of many parents who have dealt with this problem. "Timothy wet the bed constantly until age 11, then frequently until 12 or 13, and even now at 15, it still happens once or twice a year if he gets super stressed," she says.
"Timothy seemed especially affected by emotional issues," says Diane. "If there was a change in the routine, he would usually wet the bed that night." To compensate, Diane tried hard to keep a consistent bedtime and to structure his days so that he would know what to expect.
Diane advises parents to make an individual decision based on their own child's needs. Although her doctor had mentioned getting a bedwetting alarm, Diane didn't think it was worth the cost based on the percentage of children it helped.
Because he was almost a teenager before the bedwetting stopped, the emotional side of it was the hardest to deal with. "It was just so humiliating for him," she says.
This brings up an important point about bedwetting. Realize that as frustrated as you may be, chances are your child is just as frustrated, even if he doesn't verbalize it. No child wants to wake up in a wet bed. Your child is not lazy and is not wetting the bed just to annoy you. While it's tempting to scold your child, any negative feedback such as teasing or putdowns only add to the humiliation he feels. Parents should never use shame as a motivator for change.
Susan Barton, whose organization, Bright Solutions for Dyslexia, aims to bring research-based information to parents and teachers, frequently speaks to parents of children with ADD. The first thing she advises is to eliminate all feelings of shame by educating the child that his ADD causes him to sleep harder than most – so hard that his brain misses the signal from his bladder that he needs to get up and use the bathroom. This is helpful information, not only for children with ADD, but other special needs children as well.
A Relaxed Approach
Cindy, whose 8-year-old son, Ben, has Down syndrome, has a laid back approach to her son's bedwetting. "I just don't get all that upset about it," she says. She uses disposable underpants, and most nights they are just a bit damp.
Disposable underpants alleviate the pressure on the child and allow him time to develop on his own until he reaches a state where he no longer wets the bed. They also lessen stress on parents by reducing laundry and frequent wake-ups to help keep their kids' beds dry.
Although Cindy always has Ben go to the bathroom before bedtime she has never limited his drinking. "Ben probably wouldn't understand why we weren't letting him have a drink," she says. Instead, she focuses on keeping him comfortable and the bed dry.
She agrees that parents need to be sensitive about how they handle bedwetting episodes. As a substitute teacher, Cindy has lots of experience with children. "I expect a lot from Ben," she says. "So many people try to give them (kids with Down syndrome) leeway, but I've found the more you ask of them the more they can really do. And in many cases, children with Down syndrome know when they can pull stuff over on you, just like any other kids."
Success Through Support
Not when it comes to bedwetting, however, says W.C., whose 8-year-old son, Karl, also has Down syndrome. He says that children with Down syndrome have low muscle tone, kind of like an elastic band that's been overstretched. There are neurological issues as well, and it takes a much stronger signal from the brain for the muscles to properly respond.
"Children with Down syndrome may not be developmentally able to sense the pressure on the bladder and connect it to having to go potty," says W.C. "Once they connect the thought of the warm, wet feeling, that they don't like that feeling of having to urinate that comes just before it, that's the beginning of success."
Karl was also motivated by his brother Franklin who is two years younger. "Karl would see Franklin going to the bathroom before bedtime, and it would motivate him to do it too," says W.C.
W.C. says it's also important to remember that when a child begins to excel in one area, this may be accompanied by regression in another area. Oftentimes when a child has a growth spurt in speech development, for example, they may take a step backward in potty training or bedwetting. This is normal and should not be a cause of concern.
W.C. uses a lot of verbal encouragement with Karl. He reminds his son that he can sense the feeling now and that he doesn't have to be going potty in his bed. And when Karl stays dry, both W.C. and his wife are quick to bring words of praise and affirmation.
"You want to be supportive – no matter what," he says. "Your child is going to figure it out. It will take a little longer than for a typically-developing child, but hang in there; it will happen."