What’s up with Bed Wetting?

My child is dry in the day but is still bedwetting; should I be concerned?

PERCENTAGE OF CHILDREN WHO BED WET FROM AGE 4-15

30% of four year olds are bedwetting but by age six about 10% are still bedwetting.   The rate decline in bedwetting is rapid from ages 4-6 and then declines slowly so that by aged 11 there are still 5% or 1:20 children who are bedwetting.  So, the vast majority of children will just grow out of bedwetting if you do nothing.  However, bedwetting can cause embarrassment and social problems. My advice, then is that if your 6 year old is still bedwetting it is time to engage in some strategies to help your child achieve nighttime dryness whilst maintain a calm and positive attitude to your child and their desire to be dry at night.  You may want to consult a doctor to rule out medical causes like neurological conditions (rare) or bladder infections (not so rare).

What causes bedwetting in children over 6 years of age?

The main known cause is genetic i.e. 75% of children who are bedwetters have a parent or sibling who is or was a bed wetter. In fact some of the genes for bedwetting have even been found.
 
Compared with children who have achieved night time dryness bedwetter's are more likely to:

1. Have a smaller bladder capacity
2. Sleep really deeply so don’t wake up when the bladder is full
3. Produce more urine at night (due to not concentrating urine as well).
4. Are constipated.

How do children feel about bedwetting?

Even though your child may not tell you how they feel, no child likes to wet the bed. Here are some things that kid say about their bedwetting:
 

"I get really angry with myself."
"I feel like a baby."
"I can't stay over at friends' houses."
“I can’t invite anyone to stay over at my house”
"I can’t go on school camps."
"I pray before I go to sleep that I won’t wet the bed."
 

What can I say to my child who is bedwetting?

1. Tell them it is not their fault and that they will grow out of be wetting.
2. Talk about the frequency of bedwetting with reference to the graph above. Say something like, “in your grade one class (of 30 children) there are 2 other children who are bedwetting so you are not alone”.
3. Talk to your child about your own (or your partners) experiences of bedwetting and the age at which you achieved nighttime dryness.
4. Encourage your child to drink 6 glasses of water or other fluids during the day.
5. Discourage your child from going to the toilet 'just in case' (it reduces bladder capacity).
6. Tell you child that delaying bladder emptying during the day (when they are at home and able to go to the toilet when needed) as this will help enlarge their bladder and improve bladder capacity.
7. Tell your child NOT to rush to the toilet: use whatever works and then wait for the urge to pass and then go calmly to the toilet.
8. Tell your child to take their time each time they go to the toilet so that their bladder can fully empty.
9. Ask your child’s permission to tell selected other adults who may be able to assist your child if they want a sleep over at the house of the other adult.

What can I do to help my child who is bedwetting?

1. Together with your child develop a plan to cope whilst waiting for your child to grow out of bedwetting. (Avoid blaming or trying to control; work together).
2. Have a clear aim of no wet beds. That may mean going all night without weeing or your child waking up when their bladder is full so that they can go to the toilet.
3. Advise your child to avoid fizzy or caffeinated drinks after 4 pm but DO NOT restrict fluids (it does not work and it feels controlling).
4. Avoid constipation by increasing fruit, vegetable and whole grain bread and cereals in their diet.
5. Try a night-light and make sure your child can get to the toilet easily and safely alone.
6. Do NOT wake your child up to take them to the toilet: that will further reduce bladder capacity and can delay natural continence.
7. Avoid disposable nappies or pull-ups as they prevent your child from feeling wet when they start to wee; thus actually prolonging nighttime bedwetting.
8. Have a minimum of 2 Conni Kids bed pads and keep them in your child’s bedroom where they can reach them. (It is important that the child feels wet and will wake up naturally; thus learning the association between a full bladder and bedwetting).
9. If your child is sometimes dry at night a motivational star chart (such as the one that comes with our Conni Kid’s bed pad) may be just the extra incentive your child needs to achieve night time dryness. (Avoid using a star chart, however, if your child has never had a dry night as this is not under their control and failing to win the stars and rewards may actually make things worse for your child emotionally).
10. Allow your child to go to bed in a pyjama top and snug fitting undies on the bottom only; that makes it easy for your child to change their own pants. If your child is a boy get them to point their penis down inside their pants to help prevent wetting the upper bed linen.
11. Encourage your child to change their own Conni bed pad and wet pants.
12. Encourage your child to have a shower or bath before they go to school to avoid your child smelling of urine and being bullied and/or embarrassed.
13. Be persistent, be positive.

What is the medical approach to bedwetting?

If you have concerns about your child’s health or just want to make sure that they have no underlying health conditions and your child is older than six then you might want to see a doctor.  The doctor can rule out medical conditions and may prescribe a medication to increase the concentration of nighttime urine thus reducing the amount.
 

References

 Royal Children’s Hospital (2010) Bedwetting Fact Sheet. Available at; www.rch.org.au/kidsinfo/. Accessed 20/11/2011