Bedwetting (Enuresis) is common and considered normal in the five and under age. Primary bedwetting is defined as bedwetting in a child who is at least six years old and has never been dry for more than six months previously. The bedwetting must occur at least twice a week on average. It is more common in boys than girls and very frequently runs in families. It occurs in 10% of 6-year-olds, 7% of 7-year-olds, 5% of 10-year-olds and 2% of 12-year-olds.
Secondary bedwetting, conversely, is the reappearance of enuresis once a child has been regularly dry for at least six months.
Primary bedwetting may be viewed as a maturational problem inasmuch as some children mature at earlier ages than others. Secondary bedwetting may indicate stress, psychological problem or an underlying physical problem such as sleep apnea, sleep-related epilepsy a urinary tract disorder or diabetes to name a few. Children with secondary bedwetting should have an appropriate medical evaluation which may include a sleep study.
Bedwetting can be a disruptive force in the family, but it need not be so. Therapy for primary bedwetting is often very successful, but needs to be a committed family effort. First of all, the child should not be blamed or made to feel shame for the bedwetting. It is an involuntary event. Positive reinforcement should be the rule e.g. praise for dry nights or charting dry nights. Behavioral therapies include:
1. Restricting fluids in the late afternoon and early evening.
2. Scheduled awakening. Initially, depending on the age of the child, the parent may need to assist with this, but later the child may be awakened by an alarm.
3. Alarm therapy also called “bell and pad” therapy. This involves a moisture sensitive pad which activates an alarm. This method works best in older children who tend to be more motivated. It is successful in a large majority of children.
The child usually sleeps through the alarm, but will often stop urinating. The child should be changed, dry sheets placed on the bed and the alarm reset. Eventually, most children sleep through the night without urinating or will awaken to go to the bathroom unassisted.
Whatever approach you choose patience should be the order of the day (and night). It is important to understand that the time to respond to therapy is highly individual and could take some months. A steady persistence will pay long-term dividends. Having spare sheets and bedclothes ready will make things go more smoothly. Gently telling your child not to cry or worry and that this will eventually pass can go a long way toward making him feel better.
Above all, remember that everyone outgrows bedwetting.
P. Terrence Moore, M.D.
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Wake Up to Life Again
8722 Greenville Ave #102
Dallas, Texas 75243