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Advice for Parents

Bedwetting and Age: When Parents Should Seek Help

Between 5 and 7 million children in the U.S. age 6 and over still sometimes wet the bed, according to the Children's Center for Bladder Control. Bedwetting (also known as nighttime wetting) is not considered abnormal, however, until a child reaches the age of 5. If the child is still wetting the bed at age 6, parents may then want to seek help.

When to Intervene

"Children over the age of 6 who are engaged in sleepovers often want to be treated for social reasons, and I believe that is a good reason to start treatment," says Dr. James M. Cummings, a urologist practicing in St. Louis, MO.

It may not be medically necessary to treat nighttime wetting — also called enuresis — after the age of 6, but Dr. Cummings says peer pressure plays a strong role in a child's behavior. "Six is around the age at which social forces seem to become more paramount in a child's life," says Dr. Cummings.

How to Help

Because the medications currently prescribed for nighttime wetting have many side effects, urologists and pediatricians alike recommend a change in the child's routine. Experts say the safest form of therapy, which is also most effective, is altering habits to encourage dry beds.

Dean Cloward, a child psychologist practicing in Rigby, ID, offers a few suggestions. Parents can start with the basics by monitoring fluids after dinnertime. This may be sufficient for some children, but even if it is not successful, it is a good idea to continue this routine when other treatment programs have begun. The child should also empty his bladder just prior to bedtime.

"Other approaches can be designed, but should be created and initiated by a child psychologist," says Cloward. "This assures that other damaging effects of the enuresis do not impact the child and that the intervention helps, not hurts." For extreme cases, Cloward also suggests finding a child psychologist who specializes in nocturnal enuresis.

While you are working on nighttime wetting, it may be helpful to use disposable absorbent products, such as GoodNites® NightTime Underwear or GoodNites* TRU-FIT* Underwear. These undergarments, which resemble regular underwear, prevent the embarrassment of waking to damp sheets and eliminate frequent laundering. Being saved from the shame of wetting can help kids' self-esteem.

Medication as a Last Resort

Some families who have exhausted the less radical approaches to treat enuresis may choose to try medications. "I don't like using medications on children under 6 years of age," says Dr. Cummings.

There are currently three recommended medicines on the market.

The use of a type of antidepressant may help a little more than 50% of the children. Side effects may include mood changes and nightmares, and according to Dr. Cummings, side effects can be serious, including poor sleep and irritability."There is also a potential for cardiac arrhythmias," he says.

A bladder antispasmodic is also effective in half of the children but may cause facial flushing, irritability and even heat exhaustion. While taking this medication, children must drink plenty of water in the summer months.

Doctors may also prescribe a synthetic version of vasopressin, an important regulatory hormone that our bodies normally produce. This drug recycles water from the urine back into the bloodstream so children make less urine at night. Children should be monitored carefully when on any of these medications, and dosages should not be increased without careful instructions from the doctor.

Dr. Vera Loening-Baucke of the Pediatric Clinic at the University of Iowa Hospital cautions parents about medications. "None of these drugs are effective in all patients," she says. She believes parents are better off trying changes in routine before giving their children medications.

When Therapy Fails

Dr. Cummings says failure of therapy is not an indication of a major problem, since none of the therapies work more than about half of the time. The worrisome symptoms he looks for in children with enuresis are:

  • Daytime incontinence
  • Onset of symptoms after a long period of normalcy
  • Presence of urinary tract infections

If a child has a history with these problems, Dr. Cummings recommends an evaluation by a urologist, but, he says, surgery is not usually needed for uncomplicated enuresis.

Five to seven million kids in the United States age 6 and over experience this each year, and they eventually outgrow it. One day the child will wake up dry. Until then, stay calm, implement a few changes and stay focused on the most important thing in life — your family.

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