For Many Families, Dry Mornings Are Still a Dream

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It’s a typical morning for Lisa, mother of five-year old Jessica, a bright and happy little girl.

Jessica comes into her parents’ bedroom for a snuggle, and Lisa notices the distinct odour of urine emanating from her nighttime training pants. “Don’t forget to take those off,” she says lightly, not wanting to make a big deal. She hates having to use the disposable trainers, but without them, she and her husband are forever washing the bedding.  As frustrating as the bedwetting (known as enuresis) is, Jessica is far from unusual. According to paediatric nephrologist Dr. Norman Wolfish of the Children’s Hospital of Eastern Ontario in Ottawa, 15 percent of children over five still wet the bed, five percent of children over 10 and one percent of children over 15. “When you add that all up, it’s about 450,000 to 500,000 Canadian children.”

Why the problem?

Dr. Wolfish emphasizes that children aren’t wetting the bed on purpose. There are two main factors: number one, they are heavy sleepers. His original research showed that the depth of sleep among bedwetters is dramatically different from non-bedwetters. When their bladders begin to squeeze down, they don’t feel it. Number two, their bodies are producing too much urine overnight. This is because they are not producing enough antidiuretic hormone (ADH) or the ADH they are producing isn’t working very well. About 10 to 15 percent of bedwetters are cases of secondary enuresis, where the behaviour starts seemingly out of the blue. Dr. Wolfish dispels the myth that this is stress-induced. “Yes, stress can worsen any condition, but research has yet to prove that stress causes bedwetting.” Instead, he attributes it to a change in sleep pattern.

How to handle it

Dr. Wolfish has been working with families for almost 40 years to help their children make it through the night dry. Some children start seeing him at age 10, others at five, generally depending on how patient the parents are. “Some are very understanding and get lots of information from the Internet. Others think their child is being lazy and acting out.” Ideally, Dr. Wolfish likes to wait until age seven before seeing a child. “Before that, they are less likely to improve quickly.” School-age children who wet the bed may need psychological nurturing. “Some of these kids are ashamed,” says Dr. Wolfish. “They have very poor self esteem. They can’t go to camp or for sleepovers. Family trips are difficult. It’s a very real problem.” Dr. Wolfish says his main goal is to try to make them feel good about themselves. “We do a lot of talking, explaining and reassuring. I make them laugh. I tell them ‘One day this problem is going to disappear, and you know how I know? How many mothers and fathers do you know who wet the bed?’ When they say none, then I say ‘we just have to get you married,’ and that makes them laugh.”

Treatment options

Dr. Wolfish always makes a big deal about any “teeny improvement”. That’s why he supports parents resorting to disposable training pants. “In my view, there are no negative impacts of using them. They reduce parents’ laundry problems and the kids see their bed is dry and their pyjamas are dry. To them, that’s an improvement.” To address the antidiuretic hormone deficiency, Dr. Wolfish also prescribes an oral medication called DDAVP (also known as Desmopressin). “This is a very safe and effective drug that’s been used for close to 30 years.” Children can be on the medication for long periods until their body begins to produce the hormone itself. A nasal spray version of the drug is no longer recommended and should not be prescribed or taken. Some children have success with a Wet Alarm, a device that is slipped inside the underwear and connected to a buzzer. When it gets wet, the buzzer goes off and wakes up the child. “But this is a very slow process with only 40 percent of children responding,” says Dr. Wolfish. Not surprisingly, the alarm often isn’t enough to wake the heavy sleeper.

Published March 2010

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