General Information

DEFINITION--Involuntary urination during sleep that occurs more often than once a month in girls over 5 and in boys over 6 years of age.

BODY PARTS INVOLVED--Urinary tract.

SEX OR AGE MOST AFFECTED--Both sexes, but more common in boys. The occurrence of bed-wetting in children is: 15% at age 5; 10% at age 6; 7% at age 8; 3% at age 12; and 1% at age 18.

SIGNS & SYMPTOMS--Bed-wetting at night. This is not significant until a child is older than 6.

CAUSES--

In most cases, the cause of bed-wetting is unknown. Following are the most-common causes or popular theories:

• Underlying illness, such as diabetes or a urinary-tract infection.
• A small or weak bladder that cannot hold one night's urine production.
• Psychological problems caused by stress or separation from the mother.
• Child who is a deep sleeper.

RISK INCREASES WITH

• Diabetes.
• Urinary-tract infection.
• Family history of bed-wetting (44% occurrence if one parent was bed-wetter, 77% occurrence if both parents were bed-wetters).
• First born child.

HOW TO PREVENT--No effective preventive methods known. Show your child love, support and understanding.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory studies of urine and blood to detect diabetes or urinary-tract infection (sometimes).

APPROPRIATE HEALTH CARE

• Self-care, bladder exercise.
• Doctor's treatment.
• Psychotherapy or counseling.
• Alarms triggered by wetting.

POSSIBLE COMPLICATIONS

• Child becomes anxious and embarrassed. Psychological and emotional problems.
• Urinary tract infection.

PROBABLE OUTCOME--Bed-wetting may continue for several years. Your doctor will want to rule out urinary-tract infections and diabetes as causes. If these are eliminated and your child is normal in other respects, consider your child's bed-wetting represents a delay in maturing that will resolve with time.

How To Treat

GENERAL MEASURES--

• Prepare the bed and the child: Protect the mattress with a heavy plastic cover. Provide the child with extra-thick underwear and pajamas. Discontinue diapers or plastic pants by age 4; they inhibit the child's motivation to improve. Put an extra pair of underwear and pajama bottoms by the bed in case the child needs them during the night.
• Don't give any liquids to the child for 2-3 hours prior to bedtime.
• Have the child urinate at bedtime.
• Awaken the child to urinate after he has been asleep for several hours. If the child is old enough, he may be able to set the alarm clock to awaken himself and empty his bladder.
• Reward the child for staying dry. Praise him, hug him and tell of his success to people who are important to him, such as brothers and sisters. Use gold stars or happy faces to mark dry nights on a calendar if the child likes it.
• Respond gently to accidents. Don't blame, criticize, restrict or punish the child who has wet the bed. This can cause him to give up or lead to emotional problems.
• Follow instructions for any bladder-stretching or stream-interruption exercises or behavior-modification devices.
• Try alarms that are triggered by wetting.
• See Resources for Additional Information.

MEDICATION--Medicine usually is not necessary for this disorder, but your doctor may prescribe antidepressant drugs or a prescription nasal spray if other methods fail and the family favors medical treatment.

ACTIVITY--No restrictions.

DIET--No special diet. Encourage your child to drink as much fluid as possible during the day. Decrease fluid intake during the 2 to 3 hours before bedtime.

Call Your Doctor If