Bedwetting1 Heidi Liss Radunovich and Garret D
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FCS2112 Bedwetting1 Heidi Liss Radunovich and Garret D. Evans2 Bedwetting, referred to as enuresis by the medical commu- 1. Primary type: The child is age 5 or older and has never nity, is a common problem in children ages 5–10. At age 4.5 gained full bladder control. In other words, they have not around 30% of children experience some degree of bedwet- gone more than three months without wetting the bed at ting, but by around age 9.5 only 9.5% of children experience least twice a week. any amount of bedwetting. By age 9.5 only 1.5% of children wet the bed frequently (more than twice per week). 2. Secondary type: Loss of bladder control after the child (or adult) has previously demonstrated bladder control Fortunately, most children grow out of bedwetting. In fact, (usually defined as going three months without wetting only about 1% of adults have problems with bedwetting. the bed). However, some children develop psychological and behav- ioral problems related to embarrassment, low self-esteem, Around twice as many boys as girls wet the bed at night and anger stemming from this condition. Parents and after age 5. However, more girls wet their pants during siblings often feel frustration, anger, and embarrassment the day than boys. This publication primarily focuses on over their attempts to help stop the child’s bedwetting. bedwetting because it is the most common wetting prob- Children may be afraid to sleep over at a friend’s home for lem. However, keep in mind that daytime wetting is often fear of having an “accident.” Thus, while problems with treated with many of the same strategies discussed here. bladder control and bedwetting are relatively common among children and eventually tend to go away, the prob- “Problem” Bedwetting lem can lead to longer lasting effects on the ways children Many parents are not sure how old their child needs to be view themselves and their relationships with others. before their wetting is considered a problem. Most children begin to stay dry at night at around the age of 3. However, Types of Enuresis a number of children continue to wet the bed after this age. • Diurnal enuresis: Wetting that occurs during waking Parents often become concerned around this age, especially hours. if they begin to notice other children of the same age or siblings who stopped wetting by age 3. Yet most of these • Nocturnal enuresis: Wetting that occurs during sleep. children require little more than some extra attention and This is the most common type of wetting. There are two a few changes in their bedtime routine to stay dry through types of nocturnal enuresis: the night. 1. This document is FCS2112, one of a series of the Department of Family, Youth and Community Sciences, UF/IFAS Extension. Original publication date May 1996. Revised August 2006 and September 2013. Reviewed September 2019. Visit the EDIS website at https://edis.ifas.ufl.edu for the currently supported version of this publication. 2. Heidi Liss Radunovich, associate professor, Human Development, Department of Family, Youth and Community Sciences; and Garret D. Evans, former associate professor, Clinical Psychology; UF/IFAS Extension, Gainesville, FL 32611. The use of trade names in this publication is solely for the purpose of providing specific information. UF/IFAS does not guarantee or warranty the products named, and references to them in this publication do not signify our approval to the exclusion of other products of suitable composition. The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county’s UF/IFAS Extension office. U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension. Most physicians and psychologists agree that bedwetting For example, some parents may adopt an overly punitive can be classified as a clinical problem if the child is unable strategy for toilet training. Such approaches can make to keep the bed dry by age 7. However, many professionals kids nervous about using the toilet, which may then cause admit that bedwetting becomes a serious problem for the wetting to actually increase. younger child when it begins to impact self-esteem, behav- ior, and relationships with others. It is often the child’s and Hormones. Recent research suggests that some children family member’s reaction to bedwetting that determines who wet the bed may lack sufficient levels of an important whether it is a problem or not. hormone, nocturnal arginine vasopressin (AVP). AVP helps decrease the amount of urine produced at night. This pro- What Causes Bedwetting? cess helps prevent the bladder from overfilling. However, some children who wet the bed do not show this increase of All of the causes of bedwetting are not known. Physicians AVP during sleep, and end up producing more urine than emphasize that bedwetting is a symptom, not a disease. their bladders can hold. If the cause of the bedwetting is a Bedwetting is not a mental problem, learning problem, lack of AVP, then it is possible to use a medication that can or behavioral problem. Even children with no history of increase the amount of AVP in the body. bedwetting may lose bladder control from time to time. Bedwetting may appear or increase when a child is ill. For Psychological causes. Sometimes bedwetting can be a example, urinary tract infections or certain medications response to stress, such as an emotional conflict or anxiety can cause bedwetting in children and adults. In addition, a child is experiencing. Psychologists and other mental children with diabetes commonly wet the bed when their health professionals regularly report that children begin blood sugar (glucose) levels become erratic. Bedwetting by wetting the bed during times of conflict at home or school. itself does not mean that a child has diabetes. Dramatic changes in home and family life also appear to lead some children to wet the bed. Moving to a new town, Although the reason(s) for bedwetting may vary from child parent conflict or divorce, arrival of a new baby, or loss of to child, there are some common reasons why a child might a loved one or pet can cause insecurity that contributes wet the bed: to bedwetting. Often children are not even aware of their emotions and can’t believe that there is a link between their Bladder size. Kidney or bladder problems are rarely the feelings and bedwetting. cause of bedwetting in older children (after age 3–4). However, it appears that some children who wet the bed Many parents mistakenly believe that wetting the bed have relatively small bladders that cannot hold much urine. is their child’s way of “getting back at them.” Children At times the body’s ability to produce urine might outpace very rarely wet the bed on purpose, and are usually the growth of the bladder. If this is the reason for a child’s ashamed of it. In the vast majority of cases, bedwetting is bedwetting, the bedwetting should reduce or go away as the unintentional and children would gladly stop it on their bladder increases in size. own if they could. After all, few children like to wake up in a wet bed. Parents should be careful never to make a child Neurological issues. Some children may have nervous feel ashamed or naughty for wetting the bed. Rather, they systems that are not sufficiently developed to get the right need to encourage the child and praise attempts to remain signal between the bladder and the brain. For these children dry (e.g., praise them when they use the toilet successfully). it is just a matter of time until their brain develops enough Parents should NEVER punish a child for bedwetting. to solve the problem. In the past it was thought that some Punishment almost never works and may actually increase children may be such deep sleepers that they do not wake bedwetting as the child becomes more upset, nervous, up when they have the urge to urinate. Recent research ashamed, and/or resentful toward parents. does not seem to support this idea, because children who wet the bed seem to have similar sleep cycles to those who do not wet the bed. What Should You Do? See a doctor. If your child is age 6 or over and continues to Genetics and family factors. Bedwetting appears to run in wet the bed frequently, it is probably time to talk to his/her families. Approximately 75 percent of children with a wet- pediatrician. If your child has never been able to establish ting problem have a parent and/or sibling who has or had bladder control for 3–6 months, there may be medical a similar problem. In addition, the approach parents take causes to his/her problem (e.g., tumors, undiagnosed infec- toward toilet training their children can cause bedwetting. tions, etc.). If your child is age 3–5 and has recently started Bedwetting 2 to wet the bed after several months of dryness, you may also Moisture Alarms wish to consult your pediatrician (see the following list). Long considered one of the most successful strategies to The rule of thumb is: Don’t make bedwetting a problem, eliminate bedwetting, moisture alarms are a common but if it becomes a problem, don’t hesitate to take action.