There are few problems in childhood that are more mortifying than this one. But the silence that surrounds the condition, even among moms, can make it even worse. Here's what really keeps kids from staying dry – and what you can do to get them through.
Inviting friends over to play at her home is one of Bethany Spencer's* favorite things to do. But when two girls visited on a recent Saturday, Bethany, seven, was uncharacteristically out of sorts. It started when she hid a headband inside her house and challenged her friends to find it. When her pals started searching close to Bethany's room, her mom saw her tense up. “Don't look in those two drawers under my bed,” Bethany anxiously ordered. “It's not in there. Nothing's in there.”
Actually, Bethany was hiding a big secret under her bed: her nighttime diapers. Bethany's mom, Aileen Spencer, audibly sucks in her breath as she recalls the hide-and-seek game. “I saw then how much the bed-wetting was upsetting her,” says Spencer. “It made me feel awful that at this young age, my daughter already has an embarrassing secret. Kids shouldn't have to worry about secrets.”
Nocturnal enuresis, the medical term for nighttime bed-wetting, is actually more common among school-age kids than you might think. While many children are able to hold their urine all night by age five, up to 1 in 8 first- and second-graders are still dealing with this embarrassing condition, says Howard Bennett, M.D., author of Waking Up Dry. The percentage drops steadily as children get older (thank goodness), but 1 in 20 10 year olds still wets at night and an unfortunate 1 to 2 per cent struggle with the problem until age 15.
For most kids, the problem is neurological. The child's brain isn't sending signals to their bladder to hold their urine while they're sleeping. “It reflexively empties while he's asleep, just as it did when he was a baby,” says Dr. Bennett. Genetics plays a role, too. About 3 out of 4 children who suffer have a sibling, parent, aunt, uncle or cousin who also wet the bed during childhood. Occasionally, sudden-onset wetting can be psychological, triggered by upheaval, like a move, a new baby or a divorce.
As many as 1 in 8 first- and second-graders still wake up wet in the night. But despite how common bed-wetting is, even parents tend to keep the problem under the covers. Once these big kids are past what is normally the diaper stage (by around age four), bathroom issues are no longer prime-time conversation among mom friends. For one thing, you may feel like you've flunked 'Parental Potty Training 101.' Plus, who wants to hear others' criticism (“You're too easy on her! Take away those Pull-Ups!”), or naive advice (“Just have her pee before bedtime”)? News flash: For most bed-wetters, neither of those things works.
Parents often don't volunteer bed-wetting information at the pediatrician's office, either. They may not want to embarrass their child or they consider it a 'home problem.' And, unfortunately, doctors rarely ask about bed-wetting, says Dr. Bennett. “Most docs just assume you'll tell them if it's a problem,” he says; which isn't really that big of a surprise.
Helping Kids Cope
Because bed-wetting is primarily neurological, punishing or shaming a child won't help and can actually make the treatment process take longer. Instead, a good place to start is to simply explain to your child what's happening to his body, says Lawrence Balter, Ph.D., a psychologist. You can say something like this, suggests Balter: “When you sleep, your brain can't control your bladder. It's not something you do on purpose or because you're babyish. Eventually, as you get a little older, you won't wet the bed.”
Of course, knowing that bed-wetting is developmentally common or tied to a stressful experience doesn't make the day-to-day reality any easier. Because of her 'problem,' for instance, Bethany is extremely private about her hygiene. When she sleeps over at a relative's house, she secretly slips on her own diaper at night. In the morning, she often wakes early to change, wash up and throw away her diaper before anyone would notice. “I feel like it wears on her self-esteem to know she can't control her own body,” says her mom.
The Stephenson* family can totally sympathize. Like Bethany, Gunnar Stephenson was seven when the pee hit the fan, so to speak. At the grocery store, Gunnar suddenly noticed that the disposable pull-up underwear he wore at night was sold in the baby aisle. “He demanded to know if his Pull-Ups were just diapers for older kids. What could I say? He's a smart kid,” says his mother, Kathryn Stephenson. “After that, he refused to wear them anymore, even though he was still wetting the bed.”
Around the same time, Gunnar started getting sleepover invitations. He desperately wanted to join in the fun, but couldn't take the chance of soaking a sleeping bag in front of his friends. After almost two years of bedtime arguments over wet sheets, Stephenson talked to their pediatrician. The doctor referred the boy (by then, age nine) to a pediatric enuresis program at the Nemours/Alfred I. Dupont Hospital for Children.
Major metropolitan areas usually have children's facilities with urology-related programs. That's a good thing. “Most pediatricians don't have the specific expertise [or the time] to tackle ongoing nocturnal enuresis,” says Ginger Thomas, R.N. Even better: Kids generally need only one appointment, with a follow-up session a few months later. So even families who don’t live near a children's hospital sometimes make a special trip, she says.
Getting Kids Dry
The first step is pretty simple: Doctors have patients follow basic techniques like eliminating caffeine from their diets and limiting fluids at night. Those things help, for sure, but the general consensus is that a bed alarm is the number one way to keep kids dry. An alarm usually costs $100 or less and is readily available online and at some medical-supply stores. The best ones include both an audible tone and a vibrating sensor. How do they work? Your child wears a very sensitive wetness sensor in their underwear. The sensor connects to the alarm, which goes off when the child pees, waking them. Although your child has already wet the bed, over time the alarm trains their brain to wake earlier and earlier. Eventually, their brain will wake them up at the first drop so they can stop the flow; and then, before any pee escapes. This process can take up to two months, though, so it's not something to try a few nights before a sleepover.
If you try the alarm, you'll be pretty involved in the process; you'll need to sleep in your child's room or set up a baby monitor for a week or so (as Gunnar's mom did) so you hear the alarm.
“At first, I had to help wake him up and get him to the bathroom because he was so groggy,” explains Stephenson. “Within a couple of weeks, he was already in the bathroom by the time I got up. In four weeks, he was dry two or three nights a week – that was huge progress.” By the eight-week mark, Gunnar wet his bed only once a week. Then: Dry, dry, dry!
Gunnar, who's now 10, has been dry at night for almost a year, with no set-backs. “We're so happy for him – it takes a lot of pressure off of him and us,” says Stephenson. Plus, Gunnar's younger brother is now entering the potty-training phase. “If he has trouble with bed-wetting, it won't have to be a big embarrassing thing for him. Now we know exactly what to do.”
4 Tips for Pee-Free Nights
1. Rule out health problems. Have your health care provider screen your child for any medical conditions - though they're pretty rare - that could cause bed-wetting. Same goes for a child who has been dry at night but suddenly starts wetting; she may have a bladder infection.
2. Be on daytime potty patrol. Some kids pee at night because they're constipated all the time; a full rectum can interfere with bladder function. In this case, offer your child plenty of water and fiber-rich foods, and talk to your doctor about an over-the-counter laxative. Also, encourage your child to try using the bathroom (even if they don't have the urge) every two to three hours during the day. "A bladder that is not emptied completely or often enough during the day can respond by completely letting go at night," explains Ginger Thomas, R.N.
3. Use medication sparingly. In truly extreme cases, doctors may prescribe an anti-diuretic, but it's a very short-term fix. These drugs temporarily shut off the body's ability to create urine, so they might prevent your child from bed-wetting at camp or a sleepover. However, as soon as your child stops the medication, they'll wet again.
4. Make sure your child is ready. Your frustration isn't the key here. Your child has to be motivated to stop wetting the bed. If they're not bothered, stick with disposable nighttime undergarments for a while longer. Your child will let you know when it's time.
Teri is a freelance writer and contributing editor for Parenting magazine. She lives with her husband and two daughters. *Families’ names have been changed.
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