A child wakes in the middle of the night, removes her sheets
from the bed and places them in the laundry, then returns to sleep on
the floor to avoid embarrassment, ridicule or humiliation. This child
also avoids attending sleepovers with her friends and does not invite
others to spend the night at her home. Although for most children it is
not an every night problem, the unpredictability of bedwetting can be
enough to affect self-image and esteem, confidence and social
interaction. But what can be done?
What is Bedwetting?
Nocturnal enuresis – the medical term for bedwetting – is the
“involuntary discharge of urine after an age by which bladder control
should have been established, which in children is normally presented by
the age of 5,” according to Taber’s Medical Dictionary. Most commonly,
the involuntary discharge of urine occurs at night, while the child is
sleeping, causing them to wake.
According to the National Kidney Foundation, bedwetting affects
approximately seven million children in the United States alone. The
condition is more common in boys than in girls and tends to occur more
frequently in first-born children than in younger siblings. A distinct
family connection or inheritance tendency is also present.
Causes of Bedwetting
Bedwetting may be caused by one or more factors. These factors
include poor bladder control, spastic bladder conditions, stress,
trauma, urinary infection, increased fluid intake, diabetes mellitus or,
in a small percentage of cases, a serious disease or illness involving
the spinal cord or muscles of the pelvis. The most common cause of
bedwetting, however, may typically be due to a child’s bladder not
growing as fast as the rest of his body.
“The most common causes of bedwetting continue to be issues involving
bladder control, infection, fluid intake, stress and trauma,” says Dr.
Stephen Sheldon, director of the Sleep Medicine Center at Children’s
Memorial Hospital in Chicago, Ill., noting that more serious causes
In addition to these factors, the role of family inheritance also can
play a part in the presence of bedwetting. According to Dr. Sheldon,
the reason for the family trait of bedwetting is not clear, although the
passing of the condition from parent to child is. “If one or both
parents wet the bed when they were younger, than it is more then likely
that their child will wet the bed as well,” he says. There are lots of
conditions or diseases that also run in families that could be a
contributing factor of bedwetting, which is one of the reasons why it is
so difficult to say why it runs in families but we know that it does.”
“My son is 10 and he has always wet the bed,” says Denise, a mom from
Mays Landing, N.J. “His father and several of his aunts wet the bed
until they were in their teens. We feel it’s hereditary. We’ve always
treated it as no big deal and we’ve let him know that it’s quite common.
If he starts to become really bothered by it and asks for help, we’ll
tell him about alternatives … and see if he wants to try any of it.
It’ll be his choice.”
Effects of Bedwetting on Children
Children who wet the bed are often overcome by feelings of
embarrassment and humiliation. These children know that they are old
enough that they should be able to sleep through the night without
wetting the bed and may feel out of control when an “accident” occurs.
In addition, a child may feel ashamed as a result of the bedwetting
episode. Any or all of the feelings related to bedwetting can cause a
child to see himself as a failure, affecting his self-esteem and
According to Dr. Sheldon, the feelings that stem from episodes of
bedwetting can carry over into other parts of a child’s life. “A child
that wets the bed may feel all kinds of emotion,” he says. “Whether
embarrassment, fear of someone finding out or failure, these feelings do
not stay confined to the bedroom. A child who wets the bed may feel
they are a failure or that they cannot control their own body and this
can inhibit participation in other areas such as sports, friends or
outings. Bedwetting – and especially the feelings a child may have
accompanying an episode – can affect more than a child’s sleep.”
“My daughter is 5 years old now and will often have bedwetting
incidents when upset or stressed,” says Crystel, a mom from Clemson,
S.C. “The stress and feelings she feels when she wets the bed are
obvious in other areas of her life as well. We are just patient. She is a
sensitive child and we have to keep that in mind when dealing with her
in any aspect of her life. All we do is dry the bed and put on clean
sheets. It’ll all come out in the wash and a hug and kiss will help with
Reacting to the Bedwetting Episodes
One of the most important aspects of dealing with bedwetting episodes
is the way a parent or caretaker reacts. According to Paul Coleman,
author of How to Say It to Your Kids,
reacting harshly can often cause the problem to worsen. “It is
important to teach a child about the problem without causing any more
humiliation than is already there,” says Coleman. “As a child may be
feeling stress already – and the stress may be the cause for the
bedwetting incident – adding more stress will only make it worse,
getting both the parent and the child into a vicious cycle with no end
So how should a parent react to their child’s bedwetting? Coleman
suggests reacting with reassurance. “Empathy is crucial,” says Coleman.
“Let the child know that you understand that he/she is upset and help
them to understand that they are not alone in having this problem.
Reassure him or her that they are just as normal as other kids and that
with help, they will overcome this problem, too. Offer to help. After
the bed is wet say, ‘OK, you pull off the sheets and I’ll get a fresh
set.’ It is fine if the child prefers to make the bed alone – they may
be embarrassed. It is also fine if the parent tells the child that
he/she is to make it by him/herself if they are tired or very busy.
However, making the bed should not be viewed as a punishment. The tone
should not be scolding. Having to make a bed will not motivate a child
to overcome enuresis.”
Bedwetting is a different problem for different kids. For some, it is
simply a phase they will outgrow. For others, professional help may be
needed to overcome it. There are several things a parent can do at home
in an attempt to work through bedwetting.
Dr. Sheldon says that one of the first steps in helping a child
combat bedwetting is the limiting of fluids two hours before bedtime. As
fluids build up as urine during the night, limiting the amount of
fluids a child consumes before going to bed can often limit the number
of “accidents” that occur. “Children who do not suffer from any
conditions such as diabetes, a blood disorder or are prone to
dehydration, limiting the amount of fluids consumed before bed will
often decrease the occurrence of bedwetting,” he says.
Making it routine that a child use the bathroom immediately before
going to bed is another intervention parents can do at home. According
to Dr. Sheldon, by emptying the bladder before going to bed, children
may reduce the incidence of bedwetting by one night a week. In addition,
parents can awaken their child once each night – approximately four
hours after bedtime – to take their child to the bathroom. This
technique often may result in a habit the child continues on his own,
lessening the occurrence of bedwetting.
Using disposable absorbent underpants is another strategy. Waking up
dry may have positive effects on the child’s self-esteem, ease stress
and allow parents and children to cope during the bedwetting period.
Additionally, using disposable underpants may allow the child to attend
sleepovers or host them at his own house, without fear of embarrassment.
“Parents should attempt to do what they can for their child at home
with simple interventions,” says Dr. Sheldon. “Oftentimes little things
work wonders in decreasing the frequency of bedwetting. But, if the
parental intervention doesn’t work, don’t be afraid to ask for help.”
Should your child need more assistance to overcome bedwetting,
consult your doctor. Treatment can range from bladder training to
administering medication before bed. Depending upon the frequency and
consistency of the bedwetting, a treatment plan is individualized for
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