Gaining consistent control of bladder and bowel functions during daytime hours is a significant milestone for a toddler or preschooler. For many children, keeping the bed dry at night is a more elusive goal, one that might not be reached until quite a bit later in life.
Children who still wet the bed at night well into their grade-school years too often take an emotional beating (and in some sad cases a physical beating) because of this problem — which is not under their conscious control. One of the greatest problems faced by bed-wetting children is a parent with unrealistic expectations that every child should be completely dry, day and night, by the age of three.
In 99 percent of children with enuresis, the problem may involve one or more of the following, but clinicians are not in complete agreement about the relative importance of each of these factors:
Delayed maturation. During infancy, the bladder automatically empties six to eight times per day when a certain volume of urine is present. As a child matures, this emptying reflex is inhibited (held in check) by the central nervous system so that he can hold larger amounts of urine and eventually release it voluntarily. In general, control is achieved earlier by girls than by boys.By the age of three, most children can consistently postpone urinating during waking hours. However, the ability of a child’s central nervous system to inhibit emptying of the bladder during sleep may lag behind daytime control by months or even years. By the age of five, as many as 10 to 20 percent of children are not consistently dry in the morning.
Small functional bladder capacity. A normal child can usually voluntarily hold urine in an amount of ounces equal to his age in years plus two. (A six-year-old child, for example, should be able to hold about eight ounces, or about 240 ml, of urine.) If a child cannot hold at least the same number of ounces as his age, this decreased capacity may contribute to enuresis.
Increased formation of urine during the night. A hormone called vasopressin, which is produced by the pituitary gland, reduces urine production by the kidneys. An increased amount of this hormone is normally secreted during the night, cutting the rate of urine production in half.
Some bed-wetters apparently do not secrete more vasopressin during the night and produce more urine than their non-bed-wetting peers. A similar result may occur, regardless of vasopressin levels, if a child consumes liquids before going to bed.
Difficulty awakening when the bladder is full. While the general patterns of sleep are similar in both bed-wetting and non-bed-wetting children, many parents observe that their child with enuresis will “sleep through anything” and seems very difficult to awaken during the night.
A family history of enuresis. Since so many of the factors contributing to bed-wetting have an inherent physiological basis, it should not be surprising that this problem often runs in families. Enuresis is seven times more common in children whose fathers were bed-wetters and five times more common if the mother had this problem. If both parents were bed-wetters, the likelihood that their child will have enuresis is greater than 75 percent, compared to roughly 40 percent if one parent was a bed-wetter and 15 percent if neither parent was a bed-wetter.
Management
Remember that for the vast majority of children, bed-wetting will eventually resolve on its own as the central nervous system matures. (Each year after the age of six, 15 percent of children who still have enuresis will spontaneously stop wetting at night.)
Bed-wetting is not a sign of disobedience or weakness of character. The child who wets the bed is already embarrassed and uncomfortable about it; ridicule or punishment for bed-wetting, including teasing by siblings, is cruel, unjust, and ineffective. Not only will it cause additional emotional problems, but it might actually delay the resolution of enuresis.
Steps can be taken to eventually achieve one of two satisfactory goals: Your child holds his urine through the night and then voids into the toilet or potty-chair in the morning, or your child awakens during the night when his bladder is full and voids into the toilet or potty-chair.
The following measures may help a bed-wetting child:
- Encourage fluid intake during the day and discourage drinking liquids after the evening meal or within two hours of bedtime. If your child wants a drink before bed, limit intake to one or two ounces (30 or 60 ml).
- Have your child empty his bladder just before he goes to bed.
- Encourage your child to get up during the night to urinate. A child who feels that his only goal is to delay emptying his bladder until morning may fail repeatedly. Giving verbal cues before bed (“Try to get up and use the toilet if your bladder feels full”), leaving the light on in the bathroom, or providing a potty-chair near the bed can help.
- To a degree that is appropriate for his age, let him participate in the cleanup process when his pajamas and bed are wet. This should be presented not as punishment but as a matter-of-fact routine.
This can include rinsing out his pajamas and underwear and taking a quick bath or shower in the morning if he smells of urine. Sheets can be left open to air-dry but should be washed if they have a disagreeable odor. A dry towel placed under the child’s bottom may help reduce the amount of laundry. - Protect the mattress with a plastic cover.
- Offer praise and perhaps a smiley-face sticker on the calendar when he has a dry night or gets up to use the toilet.
- Avoid expressing dissatisfaction, dismay, or anger when he is wet in the morning.
Mom Tips: Prevention is Key
Our son tends to want to rush through everything, urination included. So we have him practice taking his time. Whenever he goes to the bathroom, and feels like he is finished, we have taught him to do the following: clench his muscles as if he’s holding it for a slow count of five, release again, draining all that may still remain in his bladder.
This process does three things:
- It helps strengthen his pelvic floor muscles.
- It forces him to slow down.
- It ensures that he empties his bladder completely every time.
Being overly tired can also cause a child to wet his or her bed. In an effort to prevent this, we try to maintain a dependable bedtime schedule. We’ve learned that it’s not just about training our child, it is also training him training his body. He falls asleep faster because his body is expecting to settle down and is ready for sleep. This allows him better quality sleep over time, and lessens wet beds due to being overly tired.
The Art of Pre-emptive Bed Making
Occasionally, your child will still wake up wet. For just such incidents, I’ve reverted back to something I did when my son was still in the crib. I make his bed in layers. The first layer is a waterproof cover. This one slips over a mattress, often called a mattress pad, covered with a fitted sheet. Then, the next layer is exactly the same: another waterproof mattress pad topped with another fitted sheet.
If he does wake up wet in the middle of the night, I’m ready. I just strip the top layer, and the bed is clean and dry immediately.
Don’t want to keep layers of sheets on your child’s bed?
Keep a plastic tub of clean sheets stashed under your child’s bed instead. You’ll have a set ready to go whenever you need it. This allows both of you to get back to sleep without a midnight run to the linen close.
Navigate family life with grace and love!
The Goal of Sleep: Keeping Bedwetting Disruptions to a Minimum
My goal was always to keep my child in “sleep mode” as best I could. This helped ensure that we could both slip back into a sound sleep quickly.
I avoided turning on the lights in the room and used the hallway light instead. I also kept my voice soft, calm, and reassuring. Both my child and I remained as relaxed as possible.
Wake Up Wet Solutions: Cost-Effective Bedwetting Prevention
Not surprisingly, there are a number of products on the market. These range from absorbent disposable underwear to paper pads with waterproof liners. These adhere directly to the outside of a child’s fitted sheet.
Disposable underwear can help your child feel much more confident about participating in sleepovers without fear of embarrassment. Additionally, the disposable sheet liners are ideal on vacation, when having an extra set of sheets on hand is impossible.
But thinking outside of the box can help protect your child’s bed, too. Waterproof mattress pads can be expensive. Consider purchasing a few yards of waterproof material at a local craft store and cutting it down to size instead. In a pinch, a large plastic garbage bag sandwiched between the fitted sheet and the mattress pad also works.
The Future is Dry: Encouraging Your Child
Lastly, remember to reassure your child that there’s nothing wrong with him or her. Bedwetting is exceedingly common, but worry, anxiety and feelings of guilt can actually make the situation worse.
If you also struggled with bedwetting as a child, don’t hesitate to share this with your child. Knowing that you grew up and successfully overcame bedwetting will give your child the hope and knowledge that he or she will someday, too.
Regardless, your child may feel embarrassed, and this only increases with age. Reassure him or her in the middle of the night when it happens and again in the morning, letting your child know that he or she will someday overcome it.
