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Understanding Bedwetting

Shedding Some Light on Bedwetting

A child wakes in the middle of the night, removes her sheets from the bed and places them in the laundry, then returns to sleep on the floor to avoid embarrassment, ridicule or humiliation. This child also avoids attending sleepovers with her friends and does not invite others to spend the night at her home.

Although for most children it is not an every night problem, the unpredictability of bedwetting, or nighttime wetting, can be enough to affect self-image and self-esteem, confidence, and social interaction. But what can be done?

What is Nighttime Wetting?

Nighttime wetting is when a child involuntarily wets the bed after an age by which bladder control should have been established. According to Taber's Cyclopedic Medical Dictionary, bladder control is normally presented by the age of 5. Most commonly, the involuntary discharge of urine occurs at night, while the child is sleeping, causing them to wake.

According to the National Kidney Foundation, nighttime wetting affects between 5 and 7 million children in the U.S. The condition is more common in boys than in girls and tends to occur more frequently in first-born children than in younger siblings. A distinct family connection or inheritance tendency is also present.

Causes of Nighttime Wetting

"The most common causes of bedwetting continue to be issues involving bladder control, infection, fluid intake, stress and trauma," says Dr. Stephen Sheldon, director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago, IL.

In addition to these factors, the role of family inheritance also can play a part in the presence of nighttime wetting. According to Dr. Sheldon, the reason for the family trait of nighttime wetting is not clear, although the passing of the condition from parent to child is. "If one or both parents wet the bed when they were younger, then it is more than likely that their child will wet the bed as well," he says. There are lots of conditions or diseases that also run in families that could be a contributing factor of bedwetting, which is one of the reasons why it is so difficult to say why it runs in families — but we know that it does."

"My son is 10 and he has always wet the bed," says Denise of Mays Landing, NJ. "His father and several of his aunts wet the bed until they were in their teens. We feel it's hereditary. We've always treated it as no big deal and we've let him know that it's quite common."

Nighttime wetting may be caused by one or more factors. These factors include poor bladder control, spastic bladder conditions, stress, trauma, urinary infection, increased fluid intake, diabetes mellitus or, in a small percentage of cases, a serious disease or illness involving the spinal cord or muscles of the pelvis. The most common cause of nighttime wetting, however, may typically be due to a child's bladder not growing as fast as the rest of his body.

Effects of Nighttime Wetting on Children

Children who wet the bed are often overcome by feelings of embarrassment and humiliation. These children know that they are old enough that they should be able to sleep through the night without wetting the bed and may feel out of control when an "accident" occurs. In addition, a child may feel ashamed as a result of the nighttime wetting episode. Any or all of the feelings related to nighttime wetting can cause a child to see himself as a failure, affecting his self-esteem and self-image.

According to Dr. Sheldon, the feelings that stem from episodes of nighttime wetting can carry over into other parts of a child's life. "A child that wets the bed may feel all kinds of emotion," he says. "Whether embarrassment, fear of someone finding out or failure, these feelings do not stay confined to the bedroom. A child who wets the bed may feel they are a failure or that they cannot control their own body and this can inhibit participation in other areas such as sports, friends or outings. Bedwetting — and especially the feelings a child may have accompanying an episode — can affect more than a child's sleep."

"My daughter is 5 years old now and will often have bedwetting incidents when upset or stressed," says Crystel of Clemson, SC. "The stress and feelings she feels when she wets the bed are obvious in other areas of her life as well. We are just patient. She is a sensitive child and we have to keep that in mind when dealing with her in any aspect of her life. All we do is dry the bed and put on clean sheets. It'll all come out in the wash and a hug and kiss will help with the rest."

Reacting to the Nighttime Wetting Episodes

One of the most important aspects of dealing with nighttime wetting episodes is the way a parent or caretaker reacts. According to Paul Coleman, author of How to Say It to Your Kids (Prentice Hall, 2000) reacting harshly can often cause the problem to worsen. "It is important to teach a child about the problem without causing any more humiliation than is already there," says Coleman. "As a child may be feeling stress already — and the stress may be the cause for the bedwetting incident — adding more stress will only make it worse, getting both the parent and the child into a vicious cycle with no end in sight."

So how should parents react to their child's nighttime wetting? Coleman suggests reacting with reassurance. "Empathy is crucial," says Coleman. "Let the child know that you understand that he/she is upset and help them to understand that they are not alone in having this problem. Reassure him or her that they are just as normal as other kids. Offer to help. After the bed is wet say, 'OK, you pull off the sheets and I'll get a fresh set.' It is fine if the child prefers to make the bed alone — they may be embarrassed. It is also fine if the parent tells the child that he/she is to make it by him/herself if they are tired or very busy. However, making the bed should not be viewed as a punishment. The tone should not be scolding. Having to make a bed will not motivate a child to overcome enuresis."

Nighttime Wetting Help

Nighttime wetting is a different problem for different kids. There are things a parent can do at home in an attempt to work through nighttime wetting.

Making it routine that a child use the bathroom immediately before going to bed is an intervention parents can do at home. According to Dr. Sheldon, by emptying the bladder before going to bed, children may reduce the incidence of nighttime wetting by one night a week.

Using disposable absorbent underpants like GoodNites® NightTime Underwear is our recommended strategy. Waking up dry may have positive effects on the child's self-esteem, ease stress, and allow parents and children to cope during the nighttime wetting period. Additionally, using disposable underpants may allow the child to attend sleepovers or host them at his own house, without fear of embarrassment.

"Parents should attempt to do what they can for their child at home with simple interventions," says Dr. Sheldon. "Oftentimes little things work wonders in decreasing the frequency of bedwetting. But, if the parental intervention doesn't work, don't be afraid to ask for help."

Should your child need more assistance to overcome nighttime wetting, consult your doctor.

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