Bedwetting Advice
Dear readers,
First, I would like to thank all the parents who read last week’s article “Text Less –Live More”. I hope that through these reminders, our kids will get the love and attention that they deserve. This week’s topic was a “special request” by one of my readers. It is a subject that is a frustrating and often embarrassing one for parents and children alike.
The Wonders of Our Body
Have you ever wondered why it takes children so many years to gain control over their bladder? The reason for this often slow process is that the nerves that innervate the bladder are not completely formed at birth. If you pause and think about the action of urination, you will appreciate what a sophisticated and miraculous system you have in your body.
Parasympathetic neuronal signals have to travel instantaneously between the distended bladders to our brains. Depending on availability of a restroom, our brain has to command the bladder to “hold it in” or release its contents. During stressful situations, our Sympathetic Nervous System (remember the old “fight or flight” from high school biology?) automatically shuts down this bladder emptying option until the circumstances are more tranquil and serene. At nights, our brains must keep a full bladder from emptying for hours at a time. Or signals from the bladder must be powerful enough to awaken us immediately and send us to the toilet.
As such, it is not surprising that 40% of preschoolers, 20% of 5 year olds and 10% of First Graders regularly wake up wet each morning. Their nerves have to be fully coated with a special fatty insulation known as a “Myelin Sheath” in order to conduct those vital signals in a super-fast speed. This process of insulation is completed in most children between the age of 3 and 6 years of age.
Causes of Bet Wetting (Nocturnal Enuresis)
Many parents fear that a dangerous disease is causing their child’s bed wetting. However, most cases of Primary bed wetting (which means that the child never gained control of their bladder at night) are not caused by any disease. They are simply a sign of delayed maturation of bladder control. The age a child may gain bladder control is often related to the child’s genetic background. Therefore, when frustrated parents complain about their child’s enuresis, I smile and ask them to inquire at home how many years it took them to achieve bladder control? Secondary Enuresis may be more complicated. Disease such as Diabetes Mellitus (high blood sugar) and Diabetes Insipidus (insufficiency or ineffectiveness of the Oxytocin Hormone) should be ruled out by your child’s physician. In these instances a child may have day time wetness as well as extreme thirst. But psychological stress such as the birth of a younger sibling may be a common precipitating factor. Emotionally and physically abused children often lose control of their bladders as well.
No Pressure Necessary
Sometimes parents may pressure a child to develop bladder control before the child’s body is ready for the task. These parents may incorrectly view bedwetting as a malicious or oppositional act by their child, and thus they may try and coerce him to change his behavior by punishing or intimidating him. This may lead the child to be discouraged and depressed when he wets his bed. As hard as he may try, this task is totally out of his control.
What Can You do to Help Your Child
I often suggest simple recommendations that ultimately turn out successful in attaining earlier bladder control.
Fluid restriction – if your child is above 4 years old and still wets his bed, try and give him plenty of fluids before and during dinner, but keep them away from drinking as their bedtime nears.
Bedtime Routine – at every toddler physical exam, I encourage parents to train their children. Proper hygiene includes routinely brushing their teeth and emptying the bladder before bedtime.
Bed Wetting Alarms – if the top two suggestions fail, an alarm may be helpful. Studies show that alarms may work in 50% of kids.
Medical Therapy – DDAVP pills will keep your child dry for a period of 8-12 hrs. These pills could be very dangerous if they are overdosed (may cause seizures). The pills will not resolve the problem permanently. I often would use this option when an older child needs help staying dry in camp or on a “sleep over”.
Be Supportive
A child who suffers from bed wetting needs supportive and encouraging parents. They should be sensitive to the child’s discomfort and embarrassment, and offer reassurance and hope. As parents we should remember that bladder control is another miracle that we take for granted. As painstaking as it is to deal with this issue, you will see your child’s ultimate success and the great confident smile on their face.
Wishing you a healthy winter,
David Elazar Simai M.D.