Bedwetting (Enuresis)

When Should You Seek Help?

You take your child to the doctor or nurse practitioner if:

• Your child is bothered by the bedwetting.
• Your child had been dry at night for longer than three months and starts to wet the bed again.
• You'd like reassurance.

What Kinds of Treatment Are Available?

There are two common approaches to treating bedwetting: behavior training and medication.

Behavior training usually involves a bedwetting alarm. A sensor is placed in the underwear and attaches to an alarm that sounds when the underwear is wet. Over the course of months, the child learns to wake himself before he wets. About 70 percent of children are cured with this approach, but relapse occurs in about 25 percent. Dry Nite Training® by Fisher Price and WetStop® by Palco are two such alarms. They cost $60 to $80. These alarms have been proven safe over many years and do not have a risk of shocking the child.

Medication can be used to treat bedwetting yet rarely cures the problem. Desmopressin (DDAVP) is an antidiuretic hormone that helps the body to conserve urine so the child produces less urine than normal overnight and is less likely to wet the bed. DDAVP is available in a nose spray or tablet form and is taken just before bed. DDAVP works in one to three days and is ideal for camps and overnights at friends' homes. It is recommended that the child restrict fluid two hours before bedtime and drink extra fluid the next day.

Imipramine, an antidepressant medication, also reduces bedwetting. It probably works by altering the depth of sleep and is taken at bedtime. About half of treated children will show improvement. Some children become drowsy from the medication or have difficulty sleeping or concentrating. In rare cases, Imipramine can cause heart rhythm disturbances. Although once widely used, it has fallen into disfavor.

Both medications result in temporary improvement in many cases, but rarely cure the problem. As soon as the medicine is stopped, the bedwetting often recurs.

What Can Parents Do?

• Reassure your child that bedwetting does not make them abnormal. It represents a slow maturation of a normal process. Punitive measures damage the child's self esteem without reducing the problem.
• Never allow teasing about bedwetting.
• Establish a chart tracking the child's success and a program of positive reinforcement.
• Protect the bed by using disposable underwear on your child and/or a plastic cover on the mattress, depending on your child's age.
• Allow older children to take responsibility for changing the linen each morning.
• Remember the majority of children outgrow this by the age of five or six.
• If your child doesn't outgrow bedwetting by at least five to six years of age, your child's pediatrician or nurse practitioner can help you by evaluating the situation and providing information about potential treatment.

Plainly Speaking

Bedwetting is a common problem that rarely has a medical cause. As the child gets older, almost all children outgrow the problem. If you or your child are concerned about bedwetting, you should contact your physician or nurse practitioner.