Night wettings are not the result of psychological or behavioral issues but are a physiological growth phenomenon that most children will grow out of with time and patience
By: John Cotton, M.D.
It used to be that you could only find diapers for infants
and toddlers. Now, if you walk the aisles of almost any supermarket or drugstore,
you will find bedwetting protection for older children, with most brands providing
protection to children who weigh up to 125 pounds.
Urination during sleep, or nocturnal enuresis, as it is called
by the medical profession, is a fairly common but silent condition that nobody
wants to talk about. The children are usually too embarrassed or feel guilty.
For many parents, bedwetting beyond a certain age is a scenario that causes
anxiety as their children grow up and they feel should be outgrowing certain
behaviors.
A child is diagnosed with nocturnal enuresis if he or she
is 5 to 6 years old and has two or more bedwetting experiences a month. A child
over the age of 6 is enuretic if he or she has one or more bedwetting episode
a month.
Just how common is bedwetting? It affects as many as 7 million
children over the age of 5, the age by which most children no longer urinate
in their sleep. At age 5, between 20 to 40 percent of children urinate in their
sleep. A smaller number wet their beds with some regularity, while a greater
number of children may have intermittent episodes. By age 8, that percentage
drops to 15 percent. By age 10, 1 percent urinates when sleeping. Boys outnumber
girls in this category by six to one. Each year, about half of those who wet
the bed at night will outgrow it.
There are many causes of bedwetting. One theory blames a small bladder size relative to the amount of urine produced and an infantile bladder-emptying pattern. Another reason is difficulty waking up from sleep children
who wet at night sleep so soundly that they do not sense the need to urinate.
Hormones could be another factor. The amount of urine a child makes at night
depends on production of a hormone called anti-diuretic hormone (ADH). Production
of ADH increases with age at a rate that is probably genetically determined.
This is why bedwetting tends to run in families. The point in time when a child
outgrows nocturnal enuresis is also a family trait.
There are two types of nocturnal enuresis. Primary nocturnal
enuresis means bedwetting without ever having been dry at night. Secondary,
or acquired, nocturnal enuresis means bedwetting after being dry at night for
a minimum of six months.
Because primary nocturnal enuresis is a natural phenomenon,
there is no need for medical intervention. Reassure your child that there are
reasons for wetting at night and that they are beyond his or her control. Wearing
night-time protection, morning bedding changes and discussion of bedwetting
should be open, matter-of-fact, and without either shame or blame. With this
understanding approach, your child’s developing psyche will not be wounded.
Limiting fluids at night and waking your child to urinate
during the night are generally fruitless. Fluid limits are also inadvisable,
as children are active and need extra fluid to replace their daytime losses.
Bed alarms, rewards and punishment are typically unsuccessful and can have
harmful psychological effects on the child. Night wettings are not the result
of psychological or behavioral issues but are a physiological growth phenomenon
that most children will grow out of with time and patience.
Secondary nocturnal enuresis can sometimes have a basis that
requires treatment. Bedwetting that is accompanied by any of the following
symptoms may indicate a medical problem:
Bladder symptoms such as urgency (the
need to urinate immediately to avoid an accident), dysuria (painful urination),
and frequency (urinating very often or constant wetness);
- Head trauma;
- Constipation;
- Excessive food or fluid intake,
and/or - Systemic illness (fever, diarrhea, vomiting,
rashes, abdominal pain).
If your child is experiencing any of these symptoms, advise
your pediatrician so he can undertake appropriate diagnostic studies and
help you design a therapeutic approach that is right for your child.
Pediatricians do not worry about primary nocturnal enuresis
unless there is some atypical factor in the child’s history or the child
is still wetting at age 10. Your pediatrician can help with a physical exam,
including a urine test. Most children who wet the bed are healthy, but this
will allow the doctor to check for problems in the bladder and the urinary
tract. Your doctor will also ask you questions about your child’s life at
home and school, mainly to help determine the best course of treatment.
Children generally do not become concerned with nighttime
wetting until 7 or 8 years of age and they become more socially conscious
and fearful that their friends might find out. If your child wants to seek
help, your doctor may recommend one of two different kinds of medicines available
for the temporary treatment of enuresis, one that helps the bladder hold
more urine, the other that helps the kidneys make less urine. However, these
medicines could have side effects.
To find out more about enuresis or to find a physician with Princeton HealthCare System, visit www.princetonhcs.org or call (888) 742-7496.

