As Kids Age, Bedwetting Can be a Challenge for the Entire Family
By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital
Take a moment to think about the average kindergarten classroom, probably 20 to 25 kids, right? At least two or three of those kindergartners – so about 15 percent – face a medical issue that causes their families plenty of anxiety and likely affects the children's confidence: bedwetting.
Unfortunately, bedwetting isn't a topic that is openly discussed, which makes the situation even harder on families and can cause children who experience it to feel isolated. Dr. Stephen Canon, my colleague at Arkansas Children's Hospital where he's chief of Pediatric Urology, says that the stigma of bedwetting is often the reason that families seek help for it.
"Kids need to know they're not alone," he says. "It's surprisingly stressful for these families and knowing it's more common than they realize can be helpful."
The Urology program at ACH sees dozens of children every year who are coping with bedwetting. Dr. Canon explains that there are a few schools of thought about why some children wet the bed while they sleep. Many of them produce more urine at night than during the day. Some may have bladders that are more irritable in the evening. And others may be deep sleepers who are difficult to arouse, meaning they sleep through their body's signals that they need to use the bathroom.
If a child who is potty-trained and doesn't have incontinence issues during the day is wetting the bed at night by age 5, it's probably time for his or her parents to discuss the problem with the child's pediatrician. Their physician will be able to perform a thorough exam to rule out any underlying problems. Rarely, a child's bedwetting might be linked to a condition like diabetes, chronic urinary tract infections or a complex abnormality.
Parents might try a couple of basic strategies at home if the child is otherwise healthy. First, they can stop giving the child liquids in the evening. They also should ensure that the child is urinating regularly every two to three hours during the daytime and regular bowel daily bowel function, too.
A child who hasn't made progress by age 6 or 7 and has been under the care of a primary care physician for bedwetting will likely need a referral to a specialist like Dr. Canon.
"At this point, the entire family is impacted significantly," he says. "Changing soaked sheets every morning can be upsetting for the parents, and so is watching your child's self-perception suffer."
The good news is that with some basic modification therapy, most kids will age out of bedwetting. About 99 percent of bedwetters no longer face the problem by the time they're 15.
The first recommendation for kids who do not have an underlying medical condition causing overnight urinating, is to use a bed alarm. These are clipped on the child's undergarments and either emit a loud beep or a startling vibration if a sensor detects that a child has begun to wet himself. This arouses the child and begins the process of teaching the patient to awaken when his or her body signals the need to urinate. Most families will begin to notice progress in three to five months.
Using a bed alarm does require some work on the family's behalf and a true commitment from the child. That motivation is more likely to be present in older children who have begun to understand that their peers don't wet the bed at night.
Another option for bedwetters involves using a medication called desmopressin that reduces the amount of urine their bodies make at night. Unfortunately, using a medication like this only offers short-term results that are noticeable while the child is taking the prescription. For this reason, the best candidates are usually children who have persistent bedwetting after using a bed alarm, children who are having any psychological impact, or children who want an extra layer of security for events like slumber parties.
"In these kids, it's become a really big problem socially," Dr. Canon says. "We get them used to taking the medicine, make sure it works, and then they'll use it for the sleepover, and they can be secure."
For families who opt to use desmopressin, it is especially important to stop giving liquids at night after the child has taken the medication. There are rare but serious side effects when children consume fluids overnight while on desmopressin.
Parents can rest assured that their child will likely stop bedwetting as they grow older. But the problem is truly frustrating in the meantime. Dr. Canon says it can also be helpful for parents to know that bedwetting runs in families. In those cases, bedwetting will typically resolve around the same time it did for other family members.
"We really want to underscore with kids that this is a common problem and not something they should be ashamed of," Dr. Canon told me. "We want them to know they're not any different and that it will get better."
Here's another tip: Be sure to download the new MyACH iPhone app, free from Arkansas Children's Hospital in the App Store. Everything a busy parent needs – from a health library to storage for your child's health info, insurance, medications and more.
Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email firstname.lastname@example.org.