Try Not to Cry When Your Child’s Not Dry
Finding Solutions to Bedwetting
What is Primary Nocturnal Enuresis (PNE)?
Primary nocturnal enuresis is the medical term for bedwetting. Bedwetting is a very common problem, and parents are often wondering how best to approach it for their child. While many parents report that their child wets the bed because he or she is a very deep sleeper, the validity of this has been debated. There is an association between children who wet the bed and those who spend more time in deeper stages of sleep but nonetheless, bedwetting can occur at any time during the night.
You’re not alone…
While the prevalence of PNE is approximately 13-16% in 5 and 6-year-olds, it decreases with age. By age 7-8, only 7-10% are bedwetters, and by age 10, only 5%. In teenagers, PNE is reported as low as 1-3%. It is more common in boys and is also highly genetic. You have approximately a 40-45% chance of having PNE if one parent had it and a 75% chance if both parents had it.
What are common misconceptions about PNE?
Although it is easy to want to blame your child, bedwetting is not your child’s fault and is not under his or her full control. It should never be punished. Bedwetting will often resolve without intervention, usually around the age a family member outgrew their bedwetting.
Treatment options for younger children
Most experts agree that children can start to be part of the treatment process at the age of 5. Parents can limit fluid intake after dinner, remind children to void (use the bathroom) before bed, and incentivize using the bathroom in the middle of the night by developing a reward system. Involving children in the cleanup process can help motivate them to use the toilet instead of wetting the bed by demonstrating that it requires more effort to clean up after themselves than to use the bathroom when they need to go.
Treatment options for older children
As children get closer to 7 or 8 years of age, a more definitive treatment approach can be added. While medications are sometimes used, we suggest they be used sparingly. Due to potential side effects and limited long term benefits, medications should be reserved for special occasions such as an overnight camp or a sleepover at a friend’s house. The enuresis (bedwetting) alarm is the most effective treatment for this condition when a child is motivated.
How does the alarm work?
The bedwetting sensor is attached to the child’s underwear, while the alarm is fastened to the child’s pajama top. When the sensor gets wet, the alarm goes off. Once this occurs, the child is encouraged to hold his or her urine in an attempt to finish voiding in the toilet. Over time, the brain learns to associate the contraction of the bladder sphincter with the alarm and ultimately the brain will contract the sphincter before wetting ever occurs.
Because you can start to see improvement within 2 weeks, children are often motivated to continue its use. Best outcomes are seen in children who have used the alarm for 3 successive months and achieved 21 consecutive dry nights. While older children and teenagers can be completely independent with the alarm, younger children might require the help of a parent at first. Ultimately, the bedwetting alarm has a 75-80% cure rate with regular use.
When should you call your doctor?
Consult your doctor if your child’s bedwetting is accompanied by any neurological signs such as weakness, numbness, bowel incontinence, or signs of infection such as fever or burning with urination. You should also contact your doctor if your child has a period of dryness of 6 months or more but then reverts back to bedwetting. If the bedwetting alarm goes off more than once a night, medication in conjunction with the alarm may be helpful. Always consult your doctor If there are any other signs and symptoms that seem concerning.
Authors: Cheryl Tierney, MD, MPH, Taylor Aves, Eugenia Gisin, Alexandra Lazzara, Megan Veglia
Cheryl Tierney, MD, MPH is a Board-Certified behavior and developmental pediatrician who has been in practice since 2002. She is a native of Brooklyn, New York and completed medical school at Tufts University in Boston. Her pediatric residency was at Carolinas Medical Center in Charlotte, North Carolina. She completed Fellowships in Health Services Research, where she received her MPH at Harvard School of Public Health as well as Behavior and Developmental Pediatrics in 2002. She is an active member of The Society for Developmental and Behavioral Pediatrics (SDBP) as well as the Academic Pediatric Association (APA). She enjoys participating in outdoor activities with her family.
President, ABA in PA INITIATIVE
Associate Professor of Pediatrics
Section Chief, Developmental Pediatrics, Penn State Hershey Children’s Hospital