Many
Older Children Struggle With Bedwetting
But
treatments can correct the problem, experts say
If
you have been washing your child's urine-stained bed sheets every morning
for far too many years, do not punish him—he may have a condition
called nocturnal enuresis.
That is the medical term for bedwetting, a common problem that affects
an estimated 5 million to 7 million older children in the United States.
Children
generally stop wetting the bed by age 3, says Dr. Marc Cendron, a professor
of surgery (urology) and pediatrics at Children's Hospital at Dartmouth
in Lebanon, N.H.
Though
kids may have the occasional "accident" up to about age 5, children
who are still wetting the bed on a regular basis after that probably
have nocturnal enuresis. The problem, which is more common in boys than
in girls and can run in families, can sometimes persist throughout the
teen years.
Bedwetting
Is Treatable
What
many parents do not realize is that bedwetting is treatable, Cendron
says. Unaware that something can be done about it, many parents do not
think of raising the issue with their child's physician. And pediatricians
may not routinely ask whether bedwetting is an issue with the child,
Cendron adds.
They
should. Nocturnal enuresis is very common in older children. About 20
percent of 5 year olds wet the bed, according to the American
Academy of Pediatrics, as do about 10 percent of 6-year-olds
and 3 percent of 12-year-olds.
"What
I find almost outrageous is there are treatments out there and kids
can get help and support and they're not offered by doctors," Cendron
says. "There are a lot of kids out there who have this problem, and
it's not addressed as well as it should be."
Factors
That Contribute to Bedwetting in Children
Two
factors can contribute to bedwetting in children. The first is underdeveloped
internal signals to wake the child when he or she needs to urinate.
"Bedwetters
are in a situation where the bladder is not communicating with the brain,"
Cendron explains. "The bladder empties spontaneously without the brain
knowing it."
One
method of developing these internal signals is by having the child wear
pajamas or underwear that have a moisture sensor, which sets off an
alarm when the child starts to urinate.
Because
most children with nocturnal enuresis are deep sleepers, there is a
good chance the child will sleep right through the alarm—but the
rest of the family will wake up.
Even
if the parents have to then wake the child and take him to the bathroom,
repeating the process night after night can help the child learn to
wake himself, Cendron says.
A second
option is medication.
One
type decreases the amount of urine produced at night. Children who wet
the bed tend to have low levels of a hormone called antidiuretic hormone,
which regulates urine production by the kidneys, Cendron says.
The
hormone helps the kidneys retain water, thereby reducing the amount
of urine filling the bladder. Low levels of the hormone means a child
tends to produce a lot of urine at night.
A medication
called DDAVP can reduce the amount of urine the kidneys produce at night.
It may also help a child wake more easily at night, Cendron says.
Another
option is imipramine, an anti-depressant that can have a similar effect.
But imipramine can cause nausea, insomnia, and dry mouth. In high dosages,
imipramine can also cause irregular heartbeats and even death, Cendron
says. For those reasons, he rarely prescribes it.
What
is certain is that punishing or berating the child is never the solution,
says Dr. Edward Goldson, a professor in the department of pediatrics
at the University of Colorado Health Sciences Center.
"It
simply doesn't help, and it can be counterproductive," Goldson says.
"By blowing it up and embarrassing the child, you will not accomplish
what you want, which is nighttime dryness."
Parents
can understandably get extremely frustrated by a child who wets the
bed, mistakenly believing the child is "acting out" and wetting on purpose,
Goldson says.
Making
matters worse, siblings can tease. And the child can be too embarrassed
to go to sleepovers or to camp. Wetting the bed can also damage the
child's self-esteem, especially if parents blame him.
"As
the child gets older, it can be a huge psycho-social stressor," Cendron
says. "It can cause some real psychological difficulties."
Wetting
the bed runs in families. If both parents wet the bed when they were
kid, their child has a 70 percent chance of being a bed wetter, according
to the National Kidney Foundation.
The
good news is about 15 percent of children who wet the bed stop wetting
spontaneously with each successive birthday, Cendron says.
Only
about .01 percent of adults still wet the bed, he says.
The
best thing for parents to do is reassure the child that he will stop
wetting the bed in time and, if it persists, to get treatment.
One
final note: It is important to differentiate between what is known as
"primary" nocturnal enuresis from "secondary" nocturnal enuresis. "Primary"
means the child never had control of his bladder at night.
With
primary nocturnal enuresis, less than 1percent of the cases are caused
by some underlying medical problem, such as diabetes or kidney or bladder
infections, according to the American Academy of Pediatrics.
But
if a child has control of his bladder and then starts wetting the bed
later in life—a condition called "secondary" nocturnal enuresis—you
should take the child to a pediatrician for a check-up, Goldson says.
While
it is usually nothing serious, it could in some cases mean a bladder
infection or some emotional trauma that is causing the problem, he adds.
Always
consult your child's physician for more information.
Online
Resources
American
Academy of Pediatrics (AAP)
National
Kidney Foundation
Proceedings
of the National Academy of Sciences
|
