Waking up in the middle of the night to the dreaded words, “My bed is wet,” or finding a pile of wet pajamas tucked in a corner on the bathroom floor are challenges many families face daily. While bedwetting can be frustrating for the parents and the child, understanding this condition can help with its management.
Bedwetting is common and considered normal in children 2-4 years of age. Staying dry consistently every night may not occur until a child is 4-5 years old. Enuresis is the condition when bedwetting continues in children over 5. Most children will outgrow enuresis with maturity. While 20% of 5 year olds wet their bed, by age 10 it drops to about 5%, with about 1% of children still struggling with enuresis at puberty.
Why does my child wet their bed? There are many reasons why bedwetting occurs in older children. It is important to note that is it is not your child’s fault that they wet their bed. One common cause is genetics. Studies indicate that children whose parents or grandparents suffered from enuresis are more likely to wet their beds. Other medical reasons include urinary tract infections, underdeveloped bladder, overactive bladder, diabetes, and hormone imbalance. It is not uncommon for diabetes to first present as enuresis. A frequently overlooked cause of enuresis is sleep apnea. In sleep apnea, the child’s sleep is disrupted, and may be the result of enlarged adenoids and tonsils.
While medical causes need to be investigated, a child’s eating, drinking, and voiding routines during the day may contribute to bedwetting at night. Though it may seem counterintuitive, not drinking enough during the day can lead to excessive fluid intake in the evening. This can result in an overly full bladder during sleep. “Holding it” too long during the day, may also result in bladder leakage at night. Stressful events or changes in the household (like the birth of new sibling or changing schools) may be a trigger for some children.
What can I do about it? Carefully choosing the language and tone used to speak to your child can preserve their self esteem and improve treatment outcomes while working on staying dry. Substitute the word “Accident” for a more neutral phrase like, “ladder leaking.” Create a zero tolerance policy for siblings making fun in the home. Lifestyle modifications such as ensuring your child drinks enough during the day and decrease fluid intake before bed may be helpful. Avoid caffeinated beverages such as soda and teas, as they can cause an increase in urine production. Lastly, make sure your child uses the bathroom immediately prior to bedtime.
When should I seek professional help? If the above strategies don’t result in improvement, or if any of the following exist, it is time to seek out professional help:
Child is older than 5 years
Child experiences leakage during the day time
Bedwetting is keeping your child from participating in social opportunities, like sleepovers or trips
Child is suffering embarrassment and decreased self esteem
Bedwetting has started abruptly after months of being dry at night
Child experiences pain or burning with urination
Sudden change in appetite or thirst
Urgency during the day, with sudden unexpected needs to void immediately
Frequent constipation or straining when moving bowels
Discuss your concerns with your pediatrician. There are many treatment options available to help families overcome this challenge. Studies have found that successful treatment for bedwetting results in improvements in self-esteem, self-image, and socialization. Bedwetting may be effectively treated by a physical therapist experienced and trained in this area. Pharmaceuticals may be prescribed by a physician when necessary. With appropriate intervention, you and your children will sleep better.
Rivki Chudnoff MS,PT is a NY/ NJ licensed physical therapist with more than14 years of experience working in both pediatrics and women’s health. She can be reached at rivkichudnoff_gmail.com
By Rivki Chudnoff
