Photo by Mokkasin
As adults we forget what learning to use the toilet was like, and we wonder why do children wet the bed? But after months of peeing whenever and wherever they want, children have a hard time remembering our porcelain friend.
The diaper phase can seem expensive and long while you’re in it and, like many parents, you may long for the day when your child is toilet-trained. Some parents start training as early as 18 months, while others wait until 2, 3 or later. Each of my children was toilet-trained at a different age, and one of my sons still struggles with nighttime bed-wetting now that he is in kindergarten, although his pediatrician seems unconcerned. Since his twin brother has been dry for more than a year, he is really bothered by it.
When it comes up in conversation, I have noticed that many parents seem to feel like children should be toilet-trained at the latest by age 4 or so, and that is part of the problem. Dr. William Sears writes on Parenting.com that “it is unreasonable to expect a child under the age of 4 or 5 to always wake up dry,” and Dr. Howard Bennett, author of Waking Up Dry says that one in eight first and second graders still wet the bed at night. WebMD reports that by age 10, 5 percent of kids still have a problem.
Bed-wetting is frustrating for parents and embarrassing for kids (affecting more boys than girls), especially the older they get. Other parents raise their eyebrows if I mention that my six-year-old still wears Pull Ups to bed. A sense of shame and secrecy surrounds nighttime bed wetting, unlike asthma or even dyslexia, yet experts say that bed-wetting has physical causes and isn’t due to laziness or obstinance as some parents believe. WebMD lists several.
Genes. Kids that wet the bed many times have a relative that also wet the bed in childhood.
Delayed bladder maturation. The brain and bladder learn to communicate and that happens later in some kids.
Low anti-diuretic hormone (ADH). It causes the kidneys to make less urine, but some kids release less ADH while asleep, so they produce more urine and wet the bed.
Deep sleepers. Research shows that some kids sleep so deeply that their brain doesn’t get the message that their bladder needs to be emptied.
Smaller “functional” bladder. Although a child’s bladder may not technically be smaller, the signal gets sent earlier that it’s full.
Constipation. Full bowels can press on the bladder and cause accidents, both at night and during the day.
Medical causes. Three percent, or less, of cases are caused by urinary tract infections, sleep apnea, diabetes, spinal cord problems or deformities of the bladder or urinary tract. Kids that were toilet-trained and then relapse could be more likely to have a medical cause.
Psychological stress. Most kids that were previously toilet-trained and relapse are more likely to have a stressor in their lives such as divorce, a new sibling or a move to a different home.
Like my pediatrician, most don’t worry about bed-wetting or diagnose it as primary nocturnal enuresis (medical term for bed wetting) until age 6 or later, since, at that age, 12 percent of kids still wet the bed.
Kids could have more than one of the problems above. My son is consistently constipated, and is also a heavy sleeper, so we have been treating those symptoms separately. He gets Miralax in his drinks, we limit fluids in the evening, make him go to the bathroom before bed and sometimes wake him up during the night to use the bathroom. It’s a work in progress, where some nights he wakes up dry, and some he doesn’t, but I know it weighs on him. Bed-wetting is still considered babyish and boys in kindergarten can be brutal.
After ruling out medical causes, some other ways to work on eliminating bed-wetting are to invest in a bed alarm (which can cost anywhere from $40-$190) that wakes your child with noise and vibration when they pee. It is a gradual learning process that can take weeks (as your child continues to have accidents), but eventually your child’s body learns to alert their brain earlier and earlier.
As we do with our son, reminding your child to go to the bathroom frequently during the day can help. If kids don’t empty their bladder completely during the day, that can cause accidents at night, says Dr. Ginger Thomas on Parenting.com.
There is medication, but it is not considered to be a long-term fix. Some doctors might prescribe a diuretic, but once the child stops taking it, the bed-wetting will return.
In some cases, as in the delayed bladder maturation, time will solve the problem. At any rate, it’s best if your child wants to participate in any attempt to stop bed-wetting. If they aren’t ready, try not to get too frustrated and let them take the lead.