READER'S QUESTION
My 6-year-old son keeps wetting the bed. I’ve tried cutting down on his liquid intake before bedtime and am sure he uses the bathroom before bed. What else can I do and could it be a medical issue?
DR. BLUM'S ANSWER
Bedwetting is a very common problem. At age 7, about 15 percent of children still wet the bed sometimes. Each year after age 7 about 15 percent of those children will become dry. Bedwetting tends to run in families so if you have a child who wets the bed it is likely that one of the parents had a similar problem. If 15 percent of second graders wet the bed that would suggest that every classroom in school has 3 or 4 children who still are not dry every night.
Bedwetting is rarely a medical problem. It is important to check the child’s urine at least once to make sure that there is not a problem with the kidneys. This is a simple test that can be done in any pediatrician’s office. If the child has some dry nights it makes a medical problem less likely. If the child also has trouble holding their urine during the day it is more likely that there is an underlying medical issue and further testing is likely.
To help a person stop bedwetting the first step is what you have already done: hold fluids after dinner. It is also helpful to have the child drink extra fluids during the early part of the day and try to hold their urine for as long as possible before using the bathroom. A child will have about one ounce of bladder capacity for each year of life and pushing extra fluids and having the child postpone urinating can help stretch the bladder a little bit.
Assuming that restricting fluids in the evening and bladder stretching during the day do not stop the bedwetting there are two approaches to helping the child become dry at night. The first is what are called bedwetting alarms. Many children who wet the bed are very deep sleepers and because of this they do not wake to the feeling of a full bladder. Bedwetting alarms are attached to the underwear and will wake the child with the first drops of moisture. The alarm can be a bell, buzzer or a vibration. The child will then wake up, stop urinating, and go to the bathroom to finish emptying the bladder. Within a few weeks they will learn to sleep differently and will wake to use the bathroom without any moisture being released in bed. Alarms have about a 65 percent success rate and usually work within 4 to 6 weeks. I have had many children in my practice become dry in the first few nights and never wet the bed again. These can be ordered online or purchased at stores. Usually they cost about $75.
The other approach to stopping bedwetting is medication. There is a medication called DDAVP, which reduces the amount of urine a person produces while sleeping. This reduction in urine volume allows many people to stay dry at night. This has about a 65 percent success rate, the same as the alarms. The main difference is that this requires at least 6 months of medicine and there is a very high relapse rate when the medication is stopped. About 65 percent of those helped by the medicine will begin wetting the bed again when the medicine is discontinued. As you can probably guess from the way I wrote this, I greatly prefer alarms to medication. I will sometimes use medicine for short periods of time for special things such as weekend camps or school overnights. If a child is going to camp during the summer for many weeks it would be better to use the alarm a few months before camp to make the child comfortable before going to camp.
Bedwetting can be a difficult psychological problem for children but there is help available. This is something that you should discuss with your pediatrician. Talk about it in front of the child. If you keep the discussion a secret the child will guess that there is really something wrong and worry about what it could be. Having an open discussion with the doctor and the child can go a long way to solving this problem
Dr. Robert M. Blum is a pediatrician at Southfield Pediatrics in Bingham Farms and West Bloomfield. Email him questions at askdrblum@www.metroparent.com.
