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Bedwetting in Children - Nocturnal Enuresis

Introduction

Thousands of children in New Zealand wake in the morning to a wet bed. Wetting the bed at night (nocturnal enuresis) is very common in young children, although most children grow out of it.

It affects approximately:

  • 15% of 5-year-olds
  • 5% of 10-year-olds
  • 2% of 15-year-olds
  • 1% of adults may still have occasional problems.

Bedwetting tends to be slightly more common in boys than in girls.

It is not considered to be a problem until children reach about 7 years of age. This is a good time to introduce treatment programmes if the child is motivated to do something about it.

What causes bedwetting?

There is no universal cause of bedwetting but:

  • It tends to run in families. If one parent was a bedwetter there is a 44% chance of the child bedwetting, but this increases to 77% if both parents wet the bed.
  • The waking response to a full bladder is not yet fully developed, so the child has no conscious control over bedwetting.
  • The bladder may be ‘overactive’ or not able to hold reasonable volumes of urine – which may also result in wet pants or urgency during the day.
  • Restricting fluid at night does not stop bedwetting.
  • Wetting the bed is rarely due to urine infection or disease.

When should I get some professional help?

If your child:

  • Is still wetting the bed at the age of 7.
  • Is wetting during the day.
  • Has been dry at night for 6-12 months and then starts to wet the bed again.

First steps

  • Visit your family doctor. The doctor can rule out urinary tract infections or constipation. They will want to know about your child’s drinking pattern, how much they wet and when. The more information you can provide the easier it is for the doctor to determine where the problem lies.
  • In some cases, the doctor may also refer you to a paediatrician.
  • Contact your local continence advisor. See the Continence Service Providers section of the Continence NZ website to find an advisor in your area.
  • If your child attends school contact the Public Health Nurse affiliated with the school (ask at the school office or ring your local Public Health Unit). Public Health Nurses can help with education, resources, toileting programmes, and support for you and your child.
  • Be patient and understanding. Reassure your child especially if they are upset.

Management

  • Keep a record to show progress. A fluid balance chart of how much your child drinks, and how much urine they pass is helpful.
  • Praise and reward your child for getting up to go to the toilet.
  • Respond gently if your child wets the bed even if you feel angry. Don’t punish them for what they can't control. Childhood bedwetting is not a reflection of your parenting skills.
  • Give them plenty of fluids during the day. Aim for 6-7 water-based drinks evenly spaced throughout the day. Avoid caffeinated drinks e.g. tea, chocolate and fizzy drinks before bedtime.
  • Encourage them to go to the toilet before going to sleep and establish a good routine for daytime toileting e.g. emptying the bladder 3-4 hourly.
  • Protect their mattress with a waterproof cover.
  • It can be helpful to encourage your child to take ownership of their bedwetting, by making them responsible for taking the wet sheets off their bed.
  • Alarms that waken a sleeping child if they are wet are a good long-term treatment. Eventually, the alarm trains the child to wake up before they urinate. Alarms have a 70% success rate and work more effectively with professional support and a motivated child who is over the age of 7.

About bed alarms:

A pad in the bed is connected to an alarm, which goes off when moisture is detected. This wakes the child and helps them learn how to recognise the sensation of needing to pass urine and to wake when their bladder is full.

Body-worn and wireless alarms are also available.

Lifting

It is preferable to avoid 'lifting' your child (routinely carrying them to the toilet – usually while asleep – to empty their bladder) as this can delay the child achieving dryness independently if they are not properly awake. Lifting can prevent them from learning the sensation of a full bladder and they sometimes become conditioned to pass urine as their parent approaches!

If lifting is used to manage wetting, avoid lifting at the same time every night. Once a bed alarm programme is in place lifting must stop.

Pull-Ups

Pull-Ups can be a useful symptom management tool to reduce stress for both the child and their family but they need to be removed before a bedwetting programme is implemented.

They can be useful for school camps and sleepovers and can be placed in the end of the child’s sleeping bag when packing, for them to wriggle into discretely at bedtime.

 

New Zealand Continence Association KEEA - Kiwi Enuresis and Encopresis Association