Bed wetting does not result from bad parenting or naughty children. Bed wetting is often seen as a private problem which occurs in the home at night and is seldom discussed outwith the family. This problem affects one in ten children at seven years of age. Some children may experience urgency, frequency or wetting during the day. Others who have managed to toilet well in day time, and progress from nappies to underwear, may still have difficulty in remaining dry overnight. This is something which can be overcome by bladder training.
If bed wetting occurs after 5 years of age, and there has been a period of 6 months of more being dry at night, then there may be a specific trigger factor which must be investigated. Children with ADHD are 2.7 times more likely than the rest of the children in the population to have problems staying dry at night. If one or both parents have been bed wetters then the risk of their children also having this problem is increased. Children with normal bladder function at 7 years of age should pass urine 5-7 times a day when their fluid intake, spread over 24 hours, is about 1.2 liters.
Some children sleep very deeply and are not aware of a feeling of bladder fullness. Others may not reduce urinary production at night. This is something our brain has overall control of. It is difficult to teach bladder control in sleep. Although the World Health Organisation defines nocturnal enuresis as bed wetting at 5 years of age or older, there is new evidence that this problem should be tackled before the age of 4 years. Statistically the odds against becoming dry at night after the age of 4 decreases slowly as the child gets older.
Children who bed wet are much more likely to experience urinary tract infections and this should be one of the first things that requires to be checked out. Untreated and unrecognised urine infections can result in kidney dammage and high blood pressure. Restricting fluids before bed time has no effect on reducing or eliminating bed wetting. Toileting the child before bed, and again before parents retire can be helpful. If the child has a bladder disfunction then the irritablity of the bladder can make it difficult to cope with a "normal" volume of urine.
Children who bed wet should be seen by their doctor and have a urine specimen checked for infection before any treatment plan is instigated. There are a variety of medications which can be used to help resolve nocturnal enureisis but these should be used along with behaviour modification or enuretic alarms. Enuretic alarms may be bed or body worn and have a lasting success rate of about 40%. They must be used every night for 6-8 weeks and at first may wake the whole family. The use of an alarm together with medication or behavioural management is more effective than the alarm on it's own.
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