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                 Bed Wetting

Intro

The decision of when to involve your health-care provider can be difficult. If the child displays only nighttime wetting without any other symptoms, then when to seek medical treatment is up to the family.

When the child is aged 5-7 years is probably a good time to seek medical help.

Referral to an enuresis clinic is likely not needed for most children with no other symptoms.

A child should be checked without delay for an underlying medical problem if he or she develops any other symptoms, physical or behavioral.

Self-Care at Home

Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful.

Reduce evening fluid intake. The child should try to not take any fluids, chocolate, caffeine, carbonation, or citrus after 3 p.m.

The child should urinate in the toilet before bedtime.

Set a goal for the child of getting up at night to use the toilet. Instead of focusing on making it through the night dry, help the child understand that it is more important to wake up every night to use the toilet.

A system of sticker charts and rewards works for some children. The child gets a sticker on the chart for every night of remaining dry. Collecting a certain number of stickers earns a reward.

Make sure the child has easy access to the toilet. Clear the path from his or her bed to the toilet and install night-lights. Provide a portable toilet if necessary.

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Some believe that you should avoid using diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet. Others argue that pull-ups help the child feel more independent and confident. Many parents limit their use to camping trips or sleepovers.

The parents' attitude toward the bedwetting is all-important in motivating the child.

Focus on the problem: bedwetting. Avoid blaming or punishing the child. The child cannot control the bedwetting, and blaming and punishing just make the problem worse.

Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the bedwetting each time it happens.

Enforce a "no teasing" rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the bedwetting in front of other family members.

Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help him or her overcome the problem.

The child should be included in the clean-up process.

To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers.

Self-awakening programs are designed for children who are capable of getting up at night to use the toilet, but do not seem to understand its importance.

One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night.

Another strategy is daytime rehearsal. When the child feels the urge to urinate, he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet.

Parent-awakening programs can be used if self-awakening programs fail. These programs should only be used at the child's request.

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The parent should awaken the child, typically at the parents' bedtime.

The child must then locate the bathroom on his or her own for this to be productive. The child needs to be gradually conditioned to awaken easily with sound only.

When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms.

Bedwetting alarms have become the mainstay of treatment.

Up to 70% of children stop bedwetting after using these alarms for 12-16 weeks.

About 20-30% start wetting the bed again later (relapse), but with persistence, this method works for 50-70% in the long run.

These alarms take time to work. The child should use the alarm for a few weeks or even months before considering it a failure.

There are two types of alarms: audio and tactile (buzzing) alarms.

There are two types of alarms: audio and tactile (buzzing) alarms.

The principle is that the wetness of the urine bridges a gap in the sensor, which in turn sets off the alarm.

The child then awakens, shuts off the alarm, finishes urinating in the toilet, returns to the bedroom, changes clothes and the bedding, wipes down the sensor, resets the alarm, and returns to sleep.

Alarms are preferred to medications for children because they have no side effects.

It is generally believed that all children 7 years and older should be given a trial of an alarm.

For the alarm to be effective, the child must desire to use it. Both the child and parents need to be highly motivated.

Beware of devices or other treatments that promise a quick "cure" for bedwetting. There really is no such thing. Stopping bedwetting is, for most children, a matter of patience, motivation, and time.

Other Therapy

Bladder training exercises: These are useful for adults with bedwetting or other types of urinary incontinence. They do not usually work for children.

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Follow-up

For a child with an underlying medical or emotional cause for the bedwetting, the health-care provider will recommend an appropriate treatment for the underlying condition.

If the treatment recommendations of the provider are followed closely, the bedwetting will stop in most cases.

Keep in mind that for some underlying conditions, such as anatomical problems or emotional problems, the treatment may be complex and take some time.

Children with uncomplicated bedwetting usually "grow out of it" on their own.

If you decide to try treatment, try to follow the recommendations of the child's health-care provider. Relapse rates can be high, but retreatment is typically successful.

Your child's health-care provider will monitor the child's progress periodically. How often depends on how quickly the bedwetting improves and your comfort level with that rate. Commitment and motivation are needed if the treatment is to be successful.

Prevention

There really is no way to prevent bedwetting.

Outlook

Bedwetting can damage the child's self-image and confidence. The best way to prevent this is to be supportive. Parents should reassure the child that bedwetting is a common problem and that they, the parents, are confident that the child will overcome the problem.

Every year, 15% of school-aged children who wet the bed become dry without specific treatment.

Although 15-20% of 5-year-old children wet their beds, only 7% of 8-year-old children wet the bed.
It is estimated that 1% of adults wet their bed regularly.

It is difficult to estimate the effectiveness of treatment, but cure rates range from 10-60% with drugs to 70-90% with alarms and parent awakening.

Nearly all bedwetting problems can be cured with single or combination therapy.
Some people do, however, need to have long-term drug therapy.

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