Help for nighttime bedwetting

It’s 10:30 pm, and you hear your little one calling you from the room. When you get there and reach out to your child, you feel it…wet bedding. It’s happened a few times before and you’re frustrated and exhausted by the thought of having to change bedding in the middle of the night. You’re also not sure if this is a serious problem now. Once is an accident, right? But several times - what does this mean?

Nocturnal Enuresis

Nighttime bedwetting, also known as nocturnal enuresis, can be a normal part of a child’s development. Even up to the age of 7, it is generally not a concern as the child may still be developing nighttime bladder control (around 10% of 7-year-olds wet at night).

It is twice as common in boys as in girls, and there are two types of nocturnal enuresis:

1. Primary - the child has always wet the bed. This is the most common form.
2. Secondary - the child has had a period of 6 or more months of night dryness and has now started wetting the bed.

Reflect on your own expectations

When determining what course of action, if any, to take, it’s essential to reflect on your own expectations for your child. Are other children your child’s age night dry, so you expect the same for yours? Are you just tired of the nappies? Was your child potty trained very early? Has your child ever been fully night dry? Or, has your child previously had a period of night dryness and is now suddenly wetting the bed at night?

Be patient

If your child is displaying primary nocturnal enuresis, has never been night dry and was potty trained very early (before showing any signs of being ready to use the toilet), the night wetting could be a sign that mentally and physically she was not prepared for dryness. Take a few steps back and be patient with your little one. Just as we can’t rush crawling or walking or talking, we can’t rush bladder control. We can provide a supportive environment for our children, though.

Control fluids

Traditional solutions to enuresis tend to skew towards policing fluid intake. This entails decreasing fluid intake as it gets closer to bedtime and then also setting the alarm and waking the child to take them to the toilet in the middle of the night.

Controlling fluids in this way can have varying success, but very often has no impact on the problem. The use of medication can be useful in some cases but must be used with caution and only after considering the underlying causes of the wetting.

Other factors to consider

If your child has had a period of dryness and the wetting is recent (secondary nocturnal enuresis), or if you believe that your child should be night dry by now, here are some factors to consider:

• Chronic constipation. Constipation is one of the most common causes of accidental wetting, even in a child who seems to void, as they may not be voiding completely.
• A medical condition. Common medical conditions that may be involved include urinary tract infections. A healthcare provider could assist you with a diagnosis and appropriate treatment.
• Very deep sleep/sleep apnoea. Enuresis tends to be more prevalent in those that have been diagnosed with sleep apnoea and sleep so deeply that their bladder signals don’t rouse them.
• Attention Deficit (Hyperactivity) Disorder. Some studies have shown that there is a higher risk for nocturnal enuresis in children who have been diagnosed with AD(H)D.
• Medication. Certain medications can irritate the bladder leading to an increase in bedwetting.
• Premature toilet training. Toilet training that was started when the child was not developmentally ready may be a factor.
• Family history. There is some evidence of a familial link in bed wetting with the risk increasing further if both biological parents experienced bedwetting at some stage.
• A sudden change in routine. This may be due to the addition of another child or a change in family structure or family routine (e.g. illness, death, unemployment).
• A change in the child’s bedtime routine.
• A trauma.
• Stress or anxiety.

Things to avoid

While it’s understandable that bedwetting can leave you feeling disappointed, frustrated and even angry; your reaction in the moment can have an impact on your little one’s view of themself.

Slow down your response. Take a breath and mentally calm yourself before doing or saying anything. Taking that moment can help you to avoid shaming or embarrassing your child.

It’s important to note that while shaming can take obvious forms of shouting at; criticising; using harsh words to describe your child, or forcing the child to wash the bedding/clothing as a punishment; sometimes our judgements can be as subtle as a sigh.

Things to do

If the wetting is not confined to nights only and is present during the day and your little one attends school, have an open discussion with teachers/principals on how best to support your child.

If it is causing significant distress for your child and is impacting negatively on your child’s daily functioning such as his social functioning, seek support from your health care provider.

If the latter point does not apply, try to have patience with your child and remember that this is just a phase that will be outgrown soon.