Dr. MJ Bazos MD,
Enuresis: Why Does My
Child Wet the Bed?
Enuresis (say "en-yur-ee-sis") is the loss of
bladder control that leads to the release of urine. There are several kinds of
enuresis. Nocturnal enuresis is also called "bed-wetting," because it happens
during the night while a child is sleeping. Bed-wetting is fairly common. About
5 million to 7 million children wet the bed. It's more common among boys than
Bed-wetting isn't caused by drinking too much
before bedtime. It's not a mental or behavior problem. It's not because the
child is too lazy to get out of bed to go to the bathroom. And children do not
wet the bed on purpose or to irritate their parents.
Some of the causes of bed-wetting include the
- Genetic factors (it tends to run in families)
- Difficulties waking up from sleep
- Slower than normal development of the central
nervous system--this reduces the child's ability to stop the bladder from
emptying at night
- Hormonal factors (not enough antidiuretic
hormone--this hormone reduces the amount of urine made by the kidneys)
- Urinary tract infections
- Abnormalities in the urethral valves in boys or
in the ureter in girls or boys
- Abnormalities in the spinal cord
How can my family
First, your doctor will ask questions about your
child's daytime and nighttime bathroom habits. Then your doctor will do a
physical exam and probably a urine test (called a urinalysis). Although most
children who wet the bed are healthy, your doctor will also check for problems
in the urinary tract and the bladder.
The doctor may also ask about how things are
going at home and at school for your child. Although you may be worried about
your child's bed-wetting, studies have shown that children who wet the bed are
not more likely to be emotionally upset than other children. Your doctor will
ask about your family life, because treatment may depend on changes at
How will my
child's bed-wetting be treated?
Most children outgrow bed-wetting without
treatment. However, you and your doctor may decide your child needs treatment.
There are 2 kinds of treatment for bed-wetting: behavior therapy and medicine.
Whichever treatment is chosen, it's most successful when the parents, the child
and the doctor work together. A diary that keeps track of wet and dry nights is
helpful during treatment. It will help you and your doctor see your child's
What is behavior
Behavior therapy is a treatment that doesn't use
medicine. It's often tried before a child is given medicine. Some kinds of
behavior therapy are motivational therapy, behavior conditioning,
bladder-training exercises, and diet changes (limiting caffeine, dairy products,
and citrus fruits or juices). Because bed-wetting is a very emotionally
stressful problem for older children, your doctor might also suggest counseling.
Motivational therapy tries to take away the
guilt your child feels about bed-wetting. It tries to give emotional support to
your child (and to you). This treatment may work better if your family uses
positive reinforcement (such as verbal praise) and reward systems to help your
child keep track of his or her progress.
Behavior conditioning uses an alarm. There are
two kinds of alarms: one kind makes a sound and the other kind vibrates. The
alarm goes off when your child first begins to wet the bed. When the alarm goes
off, it wakes your child. This gets him or her into the habit of waking up in
the night to go to the bathroom.
You should keep track (in a diary) of your
child's response to the alarm and his or her progress.
Bladder-training exercises help your child wait
longer between trips to the bathroom. Although you may feel that your child has
a "small bladder," this usually isn't a cause of bed-wetting. However, trying to
hold the urine longer during the day may help your child increase the amount of
urine his or her bladder can hold at night.
What kind of
medicines are used to treat bed-wetting?
Your doctor may give your child medicine if your
child is 7 years of age or older and if behavior therapy hasn't worked. But
medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder
hold more urine, and the other kind helps the kidneys make less urine. The
medicines may have side effects.
How can I make my
child not feel so bad about wetting the bed?
Bed-wetting can lead to behavior problems
because of the guilt and embarrassment a child feels. It's true that your child
should take responsibility for bed-wetting (this could mean having your child
help with the laundry). But your child shouldn't be made to feel guilty about
something he or she can't control. It's important for your child to know that
bed-wetting isn't his or her "fault."
It may help your child to know that no one knows
the exact cause of bed-wetting. Explain that it tends to run in families (for
example, if you wet the bed as a child, you should share that information with