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Bed wetting is an issue that we see frequently in primary care and causes a lot of distress, not only for the parents but also for the children. It creates a fear of overnight stays with friends and a lot of anxiety for those who are affected. But what is considered normal, and what is not?
For starters, in the US, 5-7 million children suffer from bed wetting, and it is 3 times more common in boys than girls. As with everything in medicine, there is a definition of abnormal bed wetting – the child must be at least 5 years old for it to be considered “abnormal”, and they must have bed wetting episodes at least 2 times per month (if they are only 5) or at least once per month if they are 6 or older.
We also consider if they have ever had periods of being dry at night, as there are different things we look at when a child is having a sudden onset of bed wetting after being dry for a period of time versus never being consistently dry at night.
Even with decades of research, a definitive cause hasn’t been nailed down and there seem to be many factors that can lead to this. Interestingly, there is a genetic link- if both parents struggled with bed wetting, a child has up to a 77% chance of being affected! If just one parent had problems with bed wetting, the child’s risk is 43% and in general for children without a family history, the risk is 15%. That’s about 1 in 6-7 kids! There’s been no link made between it being a “mental problem” or rebellion, however it does cause a lot of stress and anxiety for affected children. Studies have also been unable to find a definitive link to differences in sleep patterns or depth of sleep of children who wet the bed at night.
Some things your child’s doctor may do when evaluating him/her can include a full physical exam to make sure there aren’t any neurological or physical reasons your child has difficulty with staying dry at night. They will also likely check your child’s urine to rule out an infection as a cause. They may also have you keep a “voiding diary” to keep track of your child’s urination habits during the day.
But how do we go about treating it? The great news here is the most helpful things we can do to help your child don’t have to be medications. Bed wetting alarms have shown to be the most effective tools at helping kids stay dry at night. They include a pad that goes under the child’s sheet on the bed and detects moisture. There are a variety of “alarms” you can get, but the goal of this is to wake the child the moment any wetness is detected so that they can get up and go to the bathroom.
Restricting fluids in the evening and making sure to go to the bathroom right before bed time is very helpful too, and creating a reward system and positive feedback for dry nights can help your child with success as well.
There are medications that can help your child with staying dry that work like naturally occurring hormones in our body to restrict the amount of urine we produce at night, and these can be very successful for some kids but tend to have a higher relapse rate.
Only 1 in 3 parents of children with bed wetting talks to their provider about this, so make sure you have the conversation with your provider to decide which options are best for you and your family! It can save you and your child a lot of stress.
