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Bedwetting - A Parent's Guide

Most parents dread the thought of having their sleep interrupted again. Just when you thought it was over – getting up twice (or more times) in the night to deal to the new born baby or the curious or fretful toddler who has realised that they are no longer in a cot and can walk through to mum and dad’s room. You’ve managed to put all that behind you and now the baby sleeps through the night and so does the toddler.

But suddenly the toddler has mastered a new skill and is dry during the day and no longer wears nappies or pull ups. She realises that you put her into a pull up at night to go to bed, but she wants to be a big girl and not wear one anymore! Here we go – into the next phase. It’s all right, you may be lucky and it doesn’t take too long – a few disturbances in the night – your sleep is interrupted for a bit and then before you realise its’ all over and done and except for a few mishaps – you child is dry through the night. Or not!

How can you help?

• Be patient and understanding - reassure your child, especially if they are upset.
• Keeping a record will show progress.
• Praise and reward your child for staying dry or getting up to toilet.
• Respond gently if your child wets the bed even if you feel angry.
• Prepare the bed and the child - Protect the mattress with a funky Brolly Sheet, absorbent pads or towels, use a mattress protector and supply the child with extra-thick underwear and pyjamas. Merino pyjamas or thermals can stay warm even if wet.
• Give the child plenty of fluid during the day, but avoid caffeinated drinks e.g. tea chocolate and fizzy drinks before bedtime.
• Have the child urinate before bedtime.
• If you get your child up to urinate after being asleep for several hours make sure they are fully awake.
• Shower or bath in the morning before they go to school. The smell of urine may embarrass your child and lead to teasing.
• Don't punish the child for what he can't control, or put him back into nappies or use plastic pants if the child is over four or is embarrassed.
If the bedwetting is prolonged (goes beyond an acceptable age range - statistics) then medical advice should be sort. Lab tests on blood and urine may be performed to rule out any medical conditions.

Five years old and still not dry?


The vast majority of children who are not dry at night by the age of 5 years have nothing physically wrong with their urinary system. A small number may have a physical problem, such as an overactive bladder or a urine infection. If your child’s urine has a ‘fishy’ smell, if he or she has difficulty or pain in passing water, is constantly thirsty or is frequently wet during the day as well as the night, it is best to consult your GP.

Young children (5-7yr) may not yet have learnt to hold on or to recognize when they feel the full bladder sensation. They still need to develop bladder control. Here are some suggestions to help accomplish this:

1. Easy access to the toilet.
2. If the toilet is downstairs or some distance away, a potty near the bed is helpful.
3. Use a bottom rather than a top bunk bed.
4. If your child is afraid of the dark, keep the light on or position the bed near to the light switch.

Food and drink

Encourage your child to drink a reasonable amount during the whole day (about 6-8 glasses, with 2-3 during the school day).

Cutting back on drinks does not help – the bladder tends to adjust to less fluid and as a result holds less, before feelings of fullness occur. However, be careful about fizzy drinks and tea or coffee, particularly last thing at night, as these can stimulate the kidneys to produce more than average amounts of urine.

Your child could experiment to see if cutting out particular drinks makes a difference. Do make sure that your child uses the toilet before going to bed.  

Try to prevent your child becoming constipated, as this may irritate the bladder and result in more frequent urination. A diet with plenty of roughage may help, e.g. wholemeal bread, bran, cereal, baked beans and fresh fruit and vegetables.

Praise

Praise your child for dry nights, or if they wake by themselves, for using the toilet during the night Try not to show your frustration at wet beds, even though you may be feeling this way! A mattress protector or Brolly Sheet can help ease your irritation at having to change the bed.

Waking up (or ‘lifting’)

You may be lucky and reduce the number and extent of wet patches in the bed, but this method does not in itself help your child to react to the sensation that the bladder is full - and wake up or hold on. If you do lift, it is important, where practical, to remember the following:

1. Make sure that your child is fully awake
2. Wake at a different time each night
3. Even if already wet, it is helpful for your child to go to the toilet

Seven years old (and older) and still not dry?


As well as continuing to do all the things mentioned above, talking to your child calmly about the problem can sometimes uncover fears or anxieties. It may also be reassuring for your child to know that all children find their bodies are good at some things and poor at others e.g. some are good swimmers or footballers, while others are less good at these things. It is also important to reassure your child that there will probably be others with this difficulty in the school class.

You could find out whether your child really wants to become dry at night. Gently asking your child what they think are the good things about being dry can give some idea of the extent of your child’s wish to be free of bedwetting. Wanting to be dry helps your child make sense of the methods you might be trying. If your child appears to be disinterested or not bothered, although it is understandably very frustrating for you as a parent, it is perhaps best not to pressurise them at this stage, but to encourage them to think about what the good things about being dry might be for the future.

A helpful guide about Nocturnal Enuresis

Bed wetting can be extremely frustrating, especially for parents. Children consider this problem as one terribly humiliating experience. It is worse than the monsters under their beds and in their closets. The medical term for bedwetting is Nocturnal Enuresis. Involuntary bedwetting can in some cases last into the teenage years. (Statistics) The causes of nocturnal enuresis are not exactly known, but it does tend to be more common in boys than in girls.

How do you know if your child has Nocturnal Enuresis?
Just because a child wets the bed at one time does not mean that he has Nocturnal Enuresis. If you do have concerns the best thing to do is see your family doctor and discuss this possiblity with them. A doctor would complete a thorough physical examination and probably do a urine test to rule out a urinary tract infection, before reaching a diagnosis. He’d also consider the medical history of the child as well as the family history of bedwetting as it can also be genetic. If a child’s nocturnal enuresis is caused by a medical condition or problem, then treatment should be started based on the doctor’s prescription for the condition.

What causes Nocturnal Enuresis or Bed Wetting?

Knowing exactly what causes enuresis is a difficult question to answer, and very hard to pin point. There are many contributing factors and sometimes more than one might be at play. There are some definite signs of things that can trigger bedwetting and it is helpful to be aware of them.
• The absence of the hormone vasopressin, an antiduretic hormone which decreases the production of urine at night. Until this happens, it's very unlikely that your child is ready to be dry at night.
• A small or overactive bladder that can't hold much urine or empties before it's full.
• An underdeveloped bladder control. The signal from the bladder telling your child to wake up when she needs a wee fails to reach her brain.
• Anxiety or stress, such as a new baby in the house, starting school or parental separation.
• It may even be that the child is a very deep sleeper and wont wake up to go to the bathroom.
• Feeling constipated. Children who have persistent constipation often suffer with bedwetting as the hard stool irritates the bladder. Ensure that a healthy diet is adherred to, with lots of fresh fruit and vegetables, fibre and water included.
• Reaction to food. Caffeinated drinks like coffee, soda, and tea increases the production of urine in the kidneys. Avoid giving these to your children, especially just before bed.
• Hereditary. Bedwetting among children may be caused by some factors that are genetically-linked.

It is recommended to be aware of the possible causes of nocturnal enuresis and ways to help, treat and prevent it. Remember that mostly it is developmental and can be overcome. It may take a lot of time and patience on your behalf, but take into consideration it is very difficult condition for you child to deal with and impacts on nearly all aspects of his life. Give loads of encouragement and love and have the patience and understanding to ensure that your child’s self esteem remains intact until the bedwetting nights are far behind you.

Used with permission Brolly Sheets Ltd
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