Bedwetting and Special Needs Children
Many parents struggling with a child's bedwetting may wonder at what age they should start to worry or when they should go to the doctor. There are no hard and fast rules when it comes to bedwetting, especially when you're talking about children with special needs, who come with a variety of different challenges.
"Overall, it's a very mixed bag," says Dr. Eric Jones, assistant professor of urology at Texas Children's Hospital in Houston, Texas. "It really depends on the nature of the underlying special need."
One thing that he can say for sure, however, is that enuresis – or bedwetting – is not abnormal before the age of 6 for any child. "Nighttime is usually the last part of continence to develop."
For many children, especially those with more severe disorders, incontinence is simply caused by their disability. In this case, parents know the cause and usually whether it can or cannot be fixed.
For example, children with spina bifida often have difficulty with wetting during both the day and night. According to Dr. Jones, these kids don't have the normal architecture of the nervous system to allow control over wetting.
This often requires surgery, which takes place " ... when the family is ready socially to undertake surgery, and when the patient is ready to take care of themselves," he says. After surgery, the child has to use a catheter several times a day, so it is appropriate to wait until they are developmentally ready to help in the process. Usually, this is around 8 to 10 years old.
In children with less severe disorders such as mild Down syndrome or ADHD, development of nighttime continence is usually slightly delayed, just behind those children without special needs.
Katie says her 10-year-old daughter, Rachel, who has Down syndrome, wet the bed until recently, but she never worried about it. "I knew that it was fairly common with Down syndrome kids," says the 38-year-old mom. "I didn't get real uptight about it. It wasn't a major issue."
Instead, she put Rachel in PULL-UPS® Training Pants when she was younger, and GOODNITES® Disposable Absorbent Underpants when she was older, woke her up a few times during the night to use the bathroom and hoped that the problem would go away on its own. "I just felt like when she was ready, she would stop," says Rogers. And she did.
W.C., 40-year-old father of Karl, a 7-year-old boy with Down syndrome, felt the same way. As a respite coordinator for Family Connection of South Carolina, a network of parents with Down syndrome children, he was educated about the issue.
W.C. says it takes longer for signals to go from the brain to the appropriate muscle in Down's children and that they also have weaker muscles, making it more difficult to control urination. "That muscle doesn't have the same strength that you and I have," he says. "Quite often it takes several years for a kid to get [muscle control]."
Since he understood the cause, he didn't push Karl in any way, and the two are now starting to experience dry nights.
When bedwetting is an isolated problem in children with milder disabilities and no physical problems, Dr. Jones tells parents not to do anything before the age of 5, because enuresis is completely normal.
Around 6 or 7, parents might bring it up with their doctor, where they usually will be counseled that it is a common problem and that it most often goes away on its own. Dr. Jones offers suggestions on fluid intake such as trying to have the child drink the majority of liquids before 8 p.m. Though, he stresses, parents should never restrict fluid intake.
W.C., however, says he never felt comfortable modifying Karl's liquid intake in any way, because he feels it is too easy for children to become dehydrated, especially in the hot summer climate.
Other treatments for bedwetting include dietary adjustment, disposable absorbent underpants and alarms that wake the child at the first sign of moisture. If bedwetting continues beyond 6 or 7, Dr. Jones says he would discuss these additional treatments with the parent and let them decide if they would like to give them a try.
But, he advises, "In general, enuresis – with time – will go away on its own." In the meantime, the use of disposable absorbent underpants can help you through it.
It's most likely that your child won't have to worry about bedwetting that long; however, if you have any concerns, speak with your doctor. Since every child is different, a doctor will be the best judge of what to do for your child at any given age.