Nocturnal enuresis is the medical term for bed-wetting. This is common in young children who have yet to gain control of their bladder.
Most bedwetters are boys and the condition may even persist into adulthood. Parents often become concerned about bedwetting when they believe that their son or daughter is "old" enough to control the problem. But the fact is, there is no consensus among doctors as to when enuresis should end.
"We know that bedwetting is a problem in all societies and has been recorded down through history. Although figures differ somewhat between cultures and among various groups within a culture, approximately 15 percent of all five-year-olds and five percent of all ten-year-olds still wet their beds. Even by adolescence, one to two percent of children are not consistently dry. About 60 percent of all emuretic children are boys," according to Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders, Boston Children's Hospital, in Solve Your Child Sleep Problems.
What causes bedwetting?
No one knows for sure. At first it was thought that the problem was psychological and brought about by stress or the child's separation from the mother.
Today, we know that most bedwetters have little or no psychological problems that could contribute to the condition. But it is a fact that the act itself can cause emotional problems, especially in children who might consider themselves "abnormal" because of this.
"Even when bedwetting is not psychological in origin, it can cause emotional problems. The situation is undeniably embarrassing and uncomfortable. It may prevent a child from enjoying such peer activities as a pajama party or cause him or her to be the subject of ridicule from friends," added Drs. Donald S. Fernfeld and Philip R. Muskin in The Columbia University College of Physicians and Surgeons Complete Home Medical Guide.
In infants, bedwetting may be caused by an immature system which controls urination. During infancy, your child does not recognize the signs of a full bladder nor does he or she perceive the "need" to urinate. Urination is simply the result of a reflex action when the bladder is full. But as the child grows older (often between the ages of 1 1/2 to 2 1/2) he or she becomes aware of the sensation of urination although it may take a while before he or she learns to control it.
"By the age of three or perhaps four, your child will be able to urinate at will, even when her bladder is only partially full. Also, she will soon be capable of interrupting her urinary stream after it has started. When this occurs you can expect your child to have urinary control at night too, or at least that her nervous system has developed sufficiently for her to be able to be dry all day and night. If she continues to wet despite this degree of maturation, other causes are probably responsible," Ferber said.
Diseases linked to bedwetting
An underlying illness like diabetes or a urinary tract infection may be the reason why your child wets the bed every night. This is true if other symptoms are present such as frequent or painful urination or a dribbling flow of urine. The same should be suspected if bedwetting suddenly occurs after many months of dryness.
"All enuretic children five years of age or older should have a thorough physical examination before non-medical treatment begins. Even though medical factors are only rarely responsible for bedwetting, your child should also have a urine examination to determine whether she has an infection that needs attention. Urinary infections are more common in enuretic children, especially girls, and should be treated even though in most cases the bedwetting is not caused by the infection and may persist after the infection has cleared up," said Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders, Boston Children's Hospital, in Solve Your Child Sleep Problems.
Some researchers suspect that certain foods may cause bedwetting but this association has not been clearly established nor does the problem respond to dietary changes.
Bedwetting is also not related to one's dreams. Many people believe that if someone dreams of water, that person is more likely to wet the bed. But the opposite actually occurs: the dream is triggered by bedwetting not vice versa.
Much more important is the role of heredity. A family history of bedwetting will increase your child's risk of having the same problem.
"I believe heredity is the single most important contributing factor in children with enuresis. There is a significant incidence of wetting in children whose parents were also bedwetters. For example, while only 15 percent of all children are bedwetters, this figure increases to about 45 percent if one parent used to wet the bed and 75 percent if both parents did. It is not known what is inherited, but it may be some of the factors described above, such as a small functional bladder capacity," Ferber explained.
Rather than scold the child who wets the bed, parents should be more supportive and treat the problem with sympathy rather than hostility. Remember that bedwetting is beyond the child's control; he or she is asleep and is unaware of his or her actions.
Therefore, scolding the child will only aggravate the problem. Instead, show the child that you care about the condition as much as he or she does. A child who wets the bed is just as bothered about enuresis as you are. A caring attitude will go a long way in erasing whatever doubts the child has and will help him or her cope with the ridicule he or she may face from friends.
"Your reactions as well as those of your child to her bedwetting episodes are very important. She needs you to be understanding and supportive or she will surely suffer. But even if you are fully supportive, even if you really don't mind changing the sheets, and even if you can be emphatic, perhaps because you used to wet the bed yourself, your child may still feel ashamed, embarrassed and babyish. She may be reluctant to have friends sleep at her house and she may refuse to sleep at their homes or attend overnight camp. If her brother or sister tells friends that she wets the bed, she may be teased at school. The impact of enuresis can be very far-reaching then because it may affect your relationship with your child, her own self-image, and her interactions with ether children," Ferber said.
Ways to control bedwetting
Most kids eventually outgrow bedwetting when they learn to control their bladder. This is great news for many parents, especially if the child is young and bedwetting does not occur every night. But if the child is older and he frequently urinates at night, parents may turn to the following solutions provided bedwetting is not caused by medical problems.
Reinforcement and responsibility training - this means giving the child responsibilities that suit his or her age. Discuss ways in which the child can help around the house - from clearing the dishes to taking out the garbage.
More importantly, train the child to be in charge whenever he or she urinates at night. You can teach the child how to change wet pajamas and even the bed sheet when he or she is old enough. Reward the child for these efforts. Mark each day on the calendar that he or she stays dry and give the child prizes afterwards. This will encourage him or her to be aware of the need to urinate and teach the child to act in the appropriate manner.
"You must treat your child in a manner that is appropriate for her age. Do not treat her like a baby. Under no circumstances should she be left in diapers and she should sleep in a regular bed. Use waterproof pads under the sheet to protect the mattress. Do not restrict her in any way because she still wets; instead give her extra privileges for taking on the new responsibilities," said Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders, Boston Children's Hospital, in Solve Your Child Sleep Problems.
"Also, most children should avoid drinking large amounts of fluids after 6 p.m. although this alone will not solve the problem. Severely restricting fluids is harsh and of no value," he added.
Another approach is bladder training that can be accomplished in the following ways:
Do not restrict your child's fluid intake during the day (such restrictions have never proven helpful) although it is reasonable to avoid large amounts of liquid near bedtime.
On the first two days, collect the urine each time your child urinates at home and measure the volume. Note the amount of time between urinations.
Record the largest volume of urine over the two-day period and use that as the "record to beat."
If your child urinates more often than every three to four hours, have her try to increase the intervals a half hour each day until she achieves a three-to-four-hour minimum.
Once a day, at the same time each day, have her hold her urine as long as possible, at least to the point of some discomfort. Then when she urinates measure the volume. This will help to gradually increase bladder capacity during the day as she tries to beat her previous "record."
There is no specific volume that will guarantee nighttime continence, but ten to 12 ounces are reasonable goals. Or try for a 50 percent improvement over the initial record.
At least once each day have your child practice starting and stopping the stream of urine several times.
When your child has been dry at night for two consecutive weeks, reinforce the success with a program of "over-learning", encourage her to drink more and more fluids during the day and up to two to four glasses at bedtime so that she will get better and better at controlling her bladder.
Some parents rouse their kids in the middle of the night and ask them to urinate before they do so in bed. While this may save you the trouble of changing wet pajamas and bed sheets it won't help your child learn how to recognize the need to urinate nor teach him or her how to wake in the process. "Lifting" - as this practice is called - may work only if the child urinates in bed once each night at a regular schedule. Otherwise, it may hamper your child's progress.
Don't forget these tips for drier nights.
Also see Teen Bed Wetting
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