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Bed wetting

Like a rock: Children who wet the bed later than normal are often described as heavy sleepers.

Dear Dr. Lanny:
Our daughter is 8 years old and still sometimes wets the bed at night. I was a late bed wetter, and I’ve heard this can run in families. We’re going to bring this up with our pediatrician, since the problem is starting to interfere with her being able to go on sleepovers. What kind of options do we have to deal with this? How common is the problem?

A: Your daughter has my sympathy. The anxiety associated with sleepovers is certainly real. It is easy to see your daughter asking, “How can I stay up all night and not embarrass myself?” Or in many cases choosing not to take the chance and staying home instead. This is quite a common story, and as you noted, there is very often a close relative who was a late bed wetter as well.

Bedwetting is not considered abnormal until 5 to 6 years old in girls, and about a year later in boys. By 6 years of age, 85 percent to 90 percent of children are dry at night. Clearly those who are still wetting at night at 8 years of age are a small but still significant minority.

The typical history is one of a healthy child who is dry in the daytime but has never had an extended period of being dry at night. The child is growing well and is developmentally normal. The child is very often described as being able to sleep through a tornado.

Almost always the parents restrict fluids after dinner and make sure the child goes to the bathroom before bed. Parents often wake the child before they go to bed themselves. This often results in a semiconscious child who staggers to the bathroom, urinates on, or near, the toilet, and still wets the bed at night.

Perhaps the most important message, and one I believe most parents understand, is that their child is not lazy, undisciplined or obstinate. Psychological problems are almost always the result of bedwetting, rather than the cause. Your son or daughter doesn’t want to wet the bed and would stop immediately if he or she could. Consequently, punishment not only won’t help the situation but is unfair as well.

Before moving on to the natural history of the problem and possible treatments, it is important to make clear when bedwetting may represent a significant problem. The typical history, as described above, is that of primary enuresis (nighttime wetting). It needs to be differentiated from secondary enuresis, where the child starts to wet at night after having been dry for an extended period of time. This situation does require medical attention and could represent a problem such as a urinary tract infection (UTI) or diabetes.

I am presuming that your child has primary enuresis. The good news is that there is an approximately 15 percent spontaneous rate of resolution per year. By adulthood only 1 percent still have a problem. That’s all well and good, you say, but what can I do for my daughter now?

Fortunately there are treatments that can help. There is medication, and there is non-medication as well. The non-medicine treatment is an alarm system. A sensor is placed in the underpants or on the bed linen. When the child starts to urinate, the sensor is activated and an alarm wakes the child. She then stops urinating, gets up, goes to the bathroom and finishes urination.

Or so goes the theory. Harking back to an earlier paragraph, you will remember that this is often a child who can sleep through a tornado—or an alarm. Many parents tell me that the alarm wakes the parents but not the child. Nothing is perfect. However, studies show a 70 percent to 85 percent success rate with alarm systems after a three-month period. The alarms are quite reasonably priced (less than $100), are a one-time expense, and are free of side effects—except for waking parents in the middle of the night.

The principal medication used in enuresis is called DDAVP, or Desmopressin. It is administered as a pill or a nasal spray. Recent concerns have been raised about the spray and it is unlikely your doctor will recommend that form. The pill is taken before bedtime and is often helpful. There is, however, a substantial relapse rate once the child stops taking the medicine. Side effects are unlikely but could be serious. This medicine can be thought of as buying time until your child outgrows the problem. It may also be useful in short-term situations, such as spending a week at a friend’s summer home.

As with virtually any problem that is vague in its cause, or has imperfect treatments, honest and not-so-honest people will fill the void with cures that sound too good to be true, or too expensive to be reasonable. Take any print advertisements or Web sites that use testimonials or “guarantees” with a very large grain of salt.

With luck, your daughter will be one of the 15 percent who spontaneously resolves this year.

As always, I would be interested in your personal experiences.

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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