Bedwetting in children - Nocturnal Enuresis
Introduction
Thousands of children in NZ wake in the morning to a wet bed. Wetting the bed at night (nocturnal enuresis) is very common in young children. It affects approximately:
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15% of 5-year-olds
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5% of 10-year-olds
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2% of 15-year-olds
Your child is likely to have 2-3 other children in his or her class who also wet the bed.
Bedwetting occurs slightly more in boys than girls and some children also wet their pants during the day.
Bedwetting 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.
Most children grow out of bedwetting. About 1% of adults may still have occasional problems.
What causes bedwetting?
There is no universal cause of bedwetting but:
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Bedwetting runs in families. If one parent was a bedwetter there is a 44% chance of the child bedwetting. If both parents were bedwetters this increases to 77%.
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The waking response to a full bladder is not fully developed, the child has no conscious control over bedwetting.
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The bladder may be ‘overactive’ – this may lead to wet pants or urgency even in the daytime.
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Restricting fluid at night does not stop bedwetting.
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Bedwetting is rarely due to urine infection or disease.
When should I get some professional help?
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If your child is still wetting the bed at the age of 7.
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If your child is wetting during the day.
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If your child 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 will rule out urinary tract infection and constipation, and want to know about your child’s drinking pattern, how much they wet and when at night. 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 recommend referral to a paediatrician.
* Contact your local continence advisor. See the Continence Service Providers section of the NZCA website to find an advisor in your area.
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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.
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Be patient and understanding. Reassure your child especially if they are upset.
Management
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Keep a record to show progress. A fluid balance chart of how much your child drinks, and how much urine they pass is helpful.
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Praise and reward your child for getting up to the toilet.
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Respond gently if your child wets the bed even if you feel angry. Don’t punish the child for what s/he cant control.
Childhood bedwetting is not a reflection of your parenting skills
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Give 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.
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Encourage the child 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.
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Protect the mattress with a waterproof cover and/or kylie.
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Supported bed alarm programme. 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 urination occurs. Alarms have a 70% success rate and work better with professional support and a motivated child who is over the age of 7.
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A behaviour modification programme will be given.
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 him/her to learn how to recognise the senstation of needing to pass urine and to wake when the bladder is full.
Body worn and wireless alarms are also available.
Lifting
It is preferable to avoid “lifting’ the child (routinely carrying the child 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 the child learning the sensation of a full bladder and they sometimes become conditioned to pass urine as the parent approaches!
If lifting is used as a way of managing wetting avoid lifting at the same time every night. Once a behavioural management plan is in place lifting must stop.
Pull Ups
Can be a useful symptom management tool to reduce stress for both the child and their family but need to be removed before a bedwetting programme is implemented.
Pull ups 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.
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