There was a time when a child's bedwetting was a public event. With wash on the laundry line for the neighbors to see, there just were not as many secrets. Nowadays, however, with automatic washing machines, indoor dryers and disposable underpants, managing bedwetting is a condition that can stay close to home. But should it?

As medical research and knowledge about nocturnal enuresis (bedwetting) has advanced, parents are more aware of the fact that children do not wet the bed because of laziness or bad habits. Since bedwetting is now considered a physiological problem where the child's body has not fully matured and is, therefore, completely out of the child's control, children are told not to be embarrassed and are made aware of the number of children who share the same problem.

Despite that, many people are still unwilling to share this information with anyone, and many children live in dread of discovery, causing them to restrict their activities and avoid situations that might expose them.

Some parents may wonder whether being secretive about bedwetting gives the impression that it is something they, or the child, should be embarrassed about. Patricia Moylan, a child psychologist at Children's Hospital of Michigan, suggests parents avoid using the word "secret." "I don't think you should view it as a 'secret' but something that is private," she says.

She also notes that the child and others take their cues from you. "If you talk about it as if it's a weakness, an embarrassment or something that the child does 'on purpose,' you're setting the stage for disaster," says Moylan.

Ed Christophersen, Ph.D., author of Parenting That Works (American Psychological Association, 2002), says that although determining who should know about the child's bedwetting is an important issue, what the child knows and understands about bedwetting is equally as important. Seventy-seven percent of children who wet the bed have parents who did, too. "This can be a source of comfort to the child," he says.

He also calls attention to the many opportunities to support the self-esteem in children with challenges over which they have little control. "There is no limit to the number of ways that a child's self-esteem can be bolstered," he says.

There are undoubtedly a few people who will have to know about your child's problem. Moylan suggests, however, telling only those people who will be affected by the bedwetting. Christopherson agrees. "We typically suggest this should be on a 'need-to-know' basis," he says. "It is probably like many other things – there is no need to discuss it with others."

Those who "need to know" may include your child's doctor (to monitor health concerns), family members, responsible adults at a sleepover situation and siblings "old enough to be supportive."

Patrick C. Friman, Ph.D., director of outpatient behavioral pediatrics and family services for Father Flanagan's Girls and Boys Town in Boys Town, Neb., sees the question of who should know as having two phases. "Fewer people knowing while the enuresis is still present is better," says Friman, who has written a number of academic articles on enuresis. "When it is outgrown, more people is better. In other words, it makes more sense to truly normalize the problem after it is outgrown than before."

Moylan stresses the importance of privacy to help avoid teasing by peers. If the information does come out, however, Moylan says parents should step in and defend the child. These times can be an opportunity for both parties to learn.

Dr. Steven G. Docimo, chief of the Department of Urology at Children's Hospital of Pittsburgh believes in taking an individualized approach, as each child's version of privacy may vary. "Some children might be happy for a camp counselor, teacher or others to be aware of the problem so that arrangements can be made to allow overnight activities," he says. Others, he believes, will prefer to avoid activities to keep their privacy, and that should be respected.

One family of an 8-year-old girl left it up to her to decide with whom to share the information. Her babysitter doesn't know, but her grandparents do. She also chose to tell a best friend at school, but swore her to secrecy.

No matter who you or your child choose to tell, the most important thing is to keep your child's self-esteem intact. The best way to do that is by loving them and being there for them through dry – and wet – nights.