Child Development Institute

Most doctors consider a bedwetting child to be any girl older than age four and any boy over age five who wet the bed. Bedwetting generally declines with age. About 10% of all six year olds and about 3% of all 14 year olds wet the bed. In a very small number of cases, bedwetting can continue into adulthood. Bedwetting (enuresis) is considered to be PRIMARY if the child has never been dry at night or only is occasionally dry at night. SECONDARY enuresis refers to bedwetting episodes that occur after a child has been dry at night for a considerable length of time.

Primary Enuresis: This is the main topic for this page and will be considered in depth. When the problem continues into the school years, appropriate intervention can usually correct the problem. This page will review the causes and treatments for Primary Enuresis.

Secondary Enuresis: Children who have been dry at night for a considerable period of time may have occasional episodes of bedwetting. These are usually related to stresses in a child's life and clear up on their own. Three of the more common events likely to cause bedwetting in young children are: hospitalization, entering school and the birth of a sibling. Children can also experience stress from such family problems as divorce, parental alcoholism, financial pressure as well as abuse and neglect. If the symptoms persist, you should consult your child's doctor because the cause may be a physical problem which may require diagnosis and treatment.

Primary Functional Enuresis (Chronic Bed-wetting)

Cause: Chronic bed-wetting is thought to be related to (1) a physically and/or neurologically immature bladder and/or (2) a deep sleeping pattern. Apparently these children often sleep so deeply that they are not aware of the message the bladder sends to the brain saying it is full. It is presumed that bed-wetting is an inherited condition. Usually a parent, aunt, uncle, grandparent or other family member(s) will have had the condition. Also, children with attention deficit disorder, learning disabilities or allergies seem to be more likely to be bed-wetters than children in the general population.

Effect of Bed-wetting on the Child and Family: By the first grade, most children are embarrassed by their bed-wetting condition. They tend to withdraw from social activities that require sleeping outside their home. They also often suffer from low self-image. These children's feelings can be greatly affected by the attitudes of their parents, who may feel that their efforts to end the bed-wetting have failed. Parents may also feel frustrated, angry and embarrassed about their children's bed-wetting condition. Parents can help their children reduce negative feelings about their bed-wetting condition and speed up the process of overcoming it, by offering positive support, understanding and encouragement.

Treatment:

First of all, almost all children outgrow their bed-wetting habit. As children mature, their muscles become stronger and their bladder capacity increases. They tend to sleep less deeply and to become more sensitive to messages the bladder sends to the brain. There are two approaches to treatment: Medical or Behavioral. The medical treatment usually consists of the use of one of two drugs:

Imipramine (Tofranil) This drug is a tricyclic antidepressant. It is thought to either improve the child's sleeping pattern to improve the functioning of the smooth muscles found in the bladder. This medication brings some improvement to about 30% of the children who have tried it. Often, the symptoms return when the medication is discontinued. The drug can cause serious side effects and needs to be closely monitored by the prescribing physician.

Desmopressin acetate This drug is a synthetic form of the antidiuretic hormone and is administered as a nasal spray. It helps the child's body make less urine, and thus lessens the risk that the child's bladder will overfill during sleep. The medication often works quickly. However, the condition may return after discontinuation of it's use. While this medication is much safer than Imipramine, it still can cause some side effects.

Behavioral treatment is often more effective and certainly is safer than medical treatment. While behavioral treatment may take somewhat longer to show results, the improvement usually continues indefinitely. There are several methods that may be helpful:

• Retention Control Training: The child is asked to control urinating during the day by postponing it, first by a few minutes and then by gradually increased amounts of time. This exercise can extend the capacity of the bladder and strengthen the muscle that holds back urination. Parents should always check with a doctor before asking their child to practice retention control.
  


• Night-lifting: This procedure involves waking your child periodically throughout the night, walking your child to the bathroom to urinate, and then returning your child to bed. By teaching your child to awaken and to empty his or her bladder many times during the night, it is hoped that he or she will eventually stay dry.
  


• Moisture alarm: Moisture alarms are considered a useful and successful way to treat bed-wetting. Medical research has shown that moisture alarms have helped many children stay dry. This treatment requires a supportive and helpful family and may take many weeks or even several months to work. Moisture alarms have good long-term success and fewer relapses than medications.
  
  An alarm consists of a clip-on sensor probe that attaches to the outside of bed-clothing. An alarm is set off when the child begins to wet the bed. The alarm wakes the child, who will then go to the bathroom to finish and then go back to sleep. This slowly conditions the brain to respond appropriately during sleep to messages from the bladder.

• Hypnosis: Hypnosis has been found to be a very effective form of treatment for bedwetting. By repeated listening to a hypnosis tape, the brain is re-programmed so that the child will be able to respond to a full bladder while asleep the same way he or she does while awake.

Guidelines for Seeing a Doctor:

• Your child is at least 6 or 7 years old and has never been able to stay dry overnight.


• Your child is troubled by wetting the bed--even if the child is younger than 6 years.


• Your child was once able to stay dry but has begun bed-wetting again.


• You are troubled and frustrated by the bed-wetting.