Bedwetting and Age
Up to seven million children in the United States wet the bed, according to the Children's Center for Bladder Control. Bedwetting is not considered abnormal, however, until a child reaches the age of 5. If the child is still wetting the bed at age 6, parents may then want to seek help.
When to Intervene
"Children over the age of 6 who are engaged in sleepovers often want to be treated for social reasons, and I believe that is a good reason to start treatment," says Dr. James M. Cummings, a urologist practicing in St. Louis, Mo.
It may not be medically necessary to treat bedwetting – also called enuresis – after the age of 6, but Dr. Cummings says peer pressure plays a strong role in a child's behavior. "Six is around the age at which social forces seem to become more paramount in a child's life," says Dr. Cummings.
How to Help
Because the medications currently prescribed for bedwetting have many side effects, urologists and pediatricians alike recommend a change in the child's routine. Experts say the safest form of therapy, which is also most effective, is altering habits to encourage dry beds.
Dean Cloward, a child psychologist practicing in Rigby, Idaho, offers a few suggestions. Parents can start with the basics by limiting fluids after dinnertime. This may be sufficient for some children, but even if it is not successful, it is a good idea to continue this routine when other treatment programs have begun. The child should also empty his bladder just prior to bedtime.
Waking the child at night and taking them into the bathroom to empty their bladder may help, but this should be done only if it does not disrupt sleep patterns for the parent and child. Cloward explains that often the child will wet at close to the same time each night. You might try waking your child just prior to that time and taking them to the bathroom. Often the child is too sound asleep to wake up to an alarm, and occasionally, the child is too asleep to even arouse to urinate, but it can work for some children.
"Other approaches can be designed, but should be created and initiated by a child psychologist," says Cloward. "This assures that other damaging effects of the enuresis do not impact the child and that the intervention helps, not hurts." For extreme cases, Cloward also suggests finding a child psychologist who specializes in nocturnal enuresis.
Cloward believes positive reinforcement can help children remain focused on staying dry, but may not work in every situation.
For some children, the ability to control their bladder will come with teaching. In these cases, reinforcement is the best means to intervene. Creating a chart that the child can add stickers to on each dry morning is a good start.
While you are working on bedwetting, it may be helpful to use disposable absorbent underpants. These undergarments, which resemble regular underwear, prevent the embarrassment of waking to damp sheets and eliminate frequent laundering. Saved from the shame of being wet can help kids' self-esteem.
Medication As a Last Resort
Some families who have exhausted the less radical approaches to treat enuresis may choose to try medications. "I don't like using medications on children under 6 years of age," says Dr. Cummings.
There are currently three recommended medicines on the market.
The use of a type of antidepressant may help a little more than 50 percent of the children. Side effects may include mood changes and nightmares, and according to Dr. Cummings, side effects can be serious, including poor sleep and irritability. "There is also a potential for cardiac arrhythmias," he says.
A bladder antispasmodic is also effective in half of the children but may cause facial flushing, irritability and even heat exhaustion. While taking this medication, children must drink plenty of water in the summer months.
Doctors may also prescribe a synthetic version of vasopressin, an important regulatory hormone that our bodies normally produce. This drug recycles water from the urine back into the bloodstream so children make less urine at night. Children should be followed carefully when on any of these medications, and dosages should not be increased without careful instructions from the doctor.
Dr. Vera Loening-Baucke of the Pediatric Clinic at the University of Iowa Hospital cautions parents about medications. "None of these drugs are effective in all patients," she says.
Dr. Loening-Baucke believes parents are better off trying changes in routine before giving their children medications.
When Therapy Fails
Dr. Cummings says failure of therapy is not an indication of a major problem since none of the therapies work more than 50 to 60 percent of the time. The worrisome symptoms he looks for in children with enuresis are:
- Daytime incontinence
- Onset of symptoms after a long period of normalcy
- Presence of urinary tract infections
If a child has a history with these problems, Dr. Cummings recommends an evaluation by a urologist, but, he says, surgery is not usually needed for uncomplicated enuresis.
Parents and children dealing with enuresis can be comforted by the fact that young bladders are slowly maturing. Five to seven million kids each year experience this and eventually outgrow it. One day the child will wake up dry. Until then, stay calm, implement a few changes and stay focused on the most important thing in life – your family.