Bed-wetting is a common problem. About 16 percent of children age 5 years old and 2 percent of children age 15 years old continue to wet the bed. In most cases, bed-wetting is not caused by an underlying medical problem. However, it can become a problem if it interferes with the child’s self confidence or ability to socialize with friends. Parents should remember that bed-wetting is completely involuntary, and the child should not be spanked, teased, scolded, or punished for wetting the bed. Seeking medical advice is warranted when the child has symptoms that go beyond bed-wetting (see below). The initial treatment of bed-wetting can be done by the parents. This treatment includes education and motivational therapy that requires that the child be mature enough to cooperate with the treatment. The child should not be forced to assume any responsibility that he/she is not ready to handle.

Strategies for Addressing Bed-Wetting

• Let your child know it is not his/her fault and that a lot of kids have this problem.
• Create a plan with your child that includes daily routines, reminders, and rewards for staying dry.
• Spread out your child’s drinks throughout the day and avoid drinking a lot just before bedtime. Avoid drinks in the evening that contain sugars or caffeine.
• Remind your child to use the bathroom right before going to bed.
• Encourage your child to get out of bed and use the bathroom if he/she wakes up at night. Keep a night light in the bathroom and hallway so that he/she can easily find the toilet. Do not using diapers, training pants, or pull-up pants at home since this will make the child less motivated to get out of bed. These items may be used for overnight visits with family or friends.
• Have a plan in case an accident does happen. Have an extra set of pajamas and a towel ready so that your child can find them easily. Cover the child’s mattress with several alternating layers of plastic covers and bed sheets so that the mattress is protected and can be remade quickly after an accident.

When to seek expert advice
Even though at home treatment can be started without medical advice, parent should feel free to seek professional advice at any time. Additionally, parents should seek medical attention if the child experiences a sudden change in his/her urination frequency or urgency, has difficulty initiating urination, has burning with urination, or if the urine has a strange odor. Other symptoms include swelling of the ankles and feet or an increase thirst. These symptoms may indicate a more serious condition that may need medical treatment before any bed-wetting treatment is attempted. Finally, parents should be aware that treatment can often be prolonged and may involve cycles of success and failure. A healthcare provider will have additional information and treatment options to help the child. These may include recommendation for bed-wetting alarms and medications.

Contributed by Thuc Duy Phan, MD