When a child repeatedly wets the bed, it causes significant distress for both the parents and the child.
Some parents may feel that the child is simply not trying to stay dry. However, nocturnal enuresis, or bedwetting, is mostly uncontrollable and undesired by the child. Treatment depends on:
- The initial medical evaluation
- The child’s age
Common Pediatric Problem
Nocturnal enuresis is the most common pediatric health issue that brings parents to a healthcare provider. In the United States, it is estimated that between five and seven million children suffer from nocturnal enuresis. Most of these children are boys. The condition can last into adulthood, affecting between one and two percent of the population. Before age five, wetting the bed is considered normal. By age six, most girls should be able to stay dry at night and by age seven, most boys should be dry.
Causes of Bedwetting
In the past, it was believed that bedwetting was a psychological problem, but that has been largely disproved now. The main cause of bedwetting is simply the inability to recognize a full bladder, which signals the brain to wake up. It is now believed that this is simply a delay in development and will resolve on its own as the child grows. A small bladder may also contribute to the problem. If one or both parents had problems as children, the child is also at a higher risk. There are a small number of cases where there is another underlying problem. This is usually a bladder problem or decreased production of the antidiuretic hormone.
Diagnosing Nocturnal Enuresis
For a physician to diagnose nocturnal enuresis, he rules out any underlying factors. This can be done by gathering a complete history of bedwetting incidents and performing a thorough physical examination. A urinalysis may be ordered to rule out infections. The child must be at least five years of age and wet the bed at least twice a month. If the child is mentally handicapped, the physician should determine that they are mentally age four or older. The physician will rule out any possible underlying factors such as congenital anomalies or a neurogenic bladder. If no underlying factors are discovered, no further testing is required.
Even though bedwetting may cause significant distress for the parents, no treatment is normally recommended when the child is still young. As children get older, there may be social pressures involved. Parents may be encouraged to try some behavioral or motivational methods to see if they can get the bedwetting under control. This could include a reward for staying dry a certain number of nights or the use of a bedwetting alarm. There are medicinal options as well if other methods do not work. These include desmopressin, which reduces urine output at night, and imaprim, which relaxes the bladder muscles and leads to lighter sleep. Punishing a child for a condition he or she cannot control is not recommended.