Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful.
Reduce evening fluid intake. The child should try to not take excessive fluids, chocolate, caffeine, carbonated drinks, or citrus after 3 p.m. Routine fluids with dinner are appropriate.
The child should urinate in the toilet before bedtime.
Set a goal for the child of getting up at night to use the toilet. Instead of focusing on making it through the night dry, help the child understand that it is more important to wake up every night to use the toilet.
A system of sticker charts and rewards works for some children. The child gets a sticker on the chart for every night of remaining dry. Collecting a certain number of stickers earns a reward. For younger children, such a motivational approach has been shown to provide significant improvement (14 consecutive dry nights) in approximately 70% of children with a relapse rate (two wet nights out of 14) of only 5%.
Make sure the child has safe and easy access to the toilet. Clear the path from his or her bed to the toilet and install night-lights. Provide a portable toilet if necessary.
Some believe that you should avoid using diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet. Others argue that pull-ups help the child feel more independent and confident. Many parents limit their use to camping trips or sleepovers.
The parents' attitude toward the bedwetting is all-important in motivating the child.
Focus on the problem: bedwetting. Avoid blaming or punishing the child. The child cannot control the bedwetting, and blaming and punishing just make the problem worse.
Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the bedwetting each time it happens.
Enforce a "no teasing" rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the bedwetting in front of other family members.
Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help him or her overcome the problem. If applicable, remind him that a close relative successfully dealt with this same issue.
The child should be included in the clean-up process.
To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers.
Self-awakening programs are designed for children who are capable of getting up at night to use the toilet, but do not seem to understand its importance.
One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night.
Another strategy is daytime rehearsal. When the child feels the urge to urinate, he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet.
Parent-awakening programs can be used if self-awakening programs fail. These programs should only be used at the child's request.
The parent should awaken the child, typically at the parents' bedtime.
The child must then locate the bathroom on his or her own for this to be productive. The child needs to be gradually conditioned to awaken easily with sound only.
When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms.
Bedwetting alarms have become the mainstay of treatment.
Up to 70% of children stop bedwetting after using these alarms for
12-16 weeks.
About 20%-30% start wetting the bed again when the alarm is discontinued (relapse). However, the positive response to reinstating the alarm system is rapid due to the behavioral conditioning experienced during the first treatment cycle. With persistence, this method works for 50%-70% in the long run.
These alarms take time to work. The child should use the alarm for a few weeks or even months before considering it a failure.
There are two types of alarms: audio and tactile (buzzing) alarms.
The principle is that the wetness of the urine bridges a gap in the sensor, which in turn sets off the alarm. The sensor is placed either on the child's underwear or bed pad.
The child then awakens, shuts off the alarm, finishes urinating in the toilet, returns to the bedroom, changes clothes and the bedding, wipes down the sensor, resets the alarm, and returns to sleep.
Alarms are preferred over medications for children because they have no side effects.
It is generally believed that all children 7 years and older should be given a trial of an alarm.
For the alarm to be effective, the child must desire to use it. Both the child and parents need to be highly motivated.
Beware of devices or other treatments that promise a quick "cure" for bedwetting. There really is no such thing. Stopping bedwetting is, for most children, a matter of patience, motivation, and time.
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