As a pediatrician, I am frequently asked about a solution for the dreaded problem of bed wetting. It is usually a child over the age of 5 that has suddenly been made aware either by siblings or friends that it is NOT normal to wet the bed or to wear a pull-up at night. This can be very disconcerting and can have some major implications on your child's self esteem.
This week, my 6 yr old had his first slumber party with some friends from the neighborhood. One of his friends just turned 5, and the other was 7. Both of them are dry through the night every night and my son just couldn’t believe that they didn’t also wear pull-ups at night. Once he realized this, he suddenly shut down and became very quiet and I immediately felt awful for him. Luckily, they are great friends and didn’t say a word to embarrass him, but I’m sure that will come in the near future, as he gets older. Oh, also, did I mention that my 4 yr old is already dry through the night most of the time? That certainly doesn’t help the situation but he does still wear pull-ups for the occasional accident.
So, why does this happen? Well, the reasons it happens are multi-factorial, but the problem does tend to run in families, especially with males. It is also associated with evening fluid intake, which should be stopped after dinner. Children who wet the bed at night (also called nocturnal enuresis) are very deep sleepers and have difficulty associating the sensation to urinate with the need to either hold it or wake up.
So what can you do about this problem? First of all, you should have your child evaluated by your pediatrician to be sure that there are no problems found on physical exam and that there is no evidence of a urinary tract infection. If your child is cleared from a medical standpoint, then you have several options. If your child is under the age of 7 and not bothered by this problem, then you can simply restrict fluid intake after dinner and wake your child up to urinate several hours after they have fallen asleep. If your child is over the age of seven or is extremely embarrassed or bothered by it, then you can consider a “potty alarm” which is a device that clips to the underwear and attaches to a unit that you put on the shirt collar, near the collar bone that vibrates and makes a very loud beeping sound to bring your child out of the deep phase of sleep. The device should have a two-step process to turn it off so that your child cannot simply turn it off without waking up completely. Over time, your child should begin to associate the sensation of needing to urinate with the desire to wake up, to avoid that noisy alarm going off! This process often takes several weeks to months to complete, but it is one of the most effective methods available. Another option, which you must discuss with your pediatrician, is a medication called DDAVP. This medication is a synthetic form of ADH (antidiuretic hormone) that causes the kidneys to retain fluid (water) in the body, thus significantly reducing the amount of urine produced, which stops bed wetting. This medication cannot be used with many underlying medical conditions but in healthy children, it can be given every night. However, most pediatricians do not prefer to use this medication long term for obvious reasons and it is usually only used for special occasions such as slumber parties, etc. when embarrassment is likely to occur.
