Kids Health Info

Bedwetting

  • Bedwetting is sometimes called "nocturnal enuresis".

    Bedwetting is a problem for many school age children and their families. The good news is that for many, the problem can be fixed through fairly simple treatment.

    Bedwetting is very common. In Victoria alone, there are at least 37,000 children between the ages of five and 15 who regularly wet the bed. At four years of age nearly one in three children wets the bed, but this falls to about one in 10 by age six, and one in 20 by age ten. This is shown in the following graph:

    Percentage of children who wet the bed at different ages

    bed wetting graph

    You can see that your child is not the only one with this problem, and it is important that he or she does not feel alone with it. There will be many other bedwetters in the same school, even though they do not usually tell their classmates! It is very common for children to become dry at night for a while and then to start wetting again.

    Causes of bedwetting

    Not all of the causes of bedwetting are known. 

    Some of the possible factors are: 

    • Genetic tendency.  Bedwetting does tend to run in families.  If one or both parents wet the bed when they were children, then it is quite likely to occur in their children.
    • Smallish bladder capacity.
    • Deep sleeper.
    • Kidneys continue to produce a lot of urine at night (most people make less urine when they are asleep).

    In some rare cases, there may be a physical problem that is the cause of the child's bedwetting. For this reason, it is very important that a doctor examines your child. The doctor will consider all the details and recommend the best treatment.

    You may wish to see a doctor about your child's bedwetting if:

    • Your child is at least six years old (we do not recommend treatment before this age as many children get better spontaneously and treatment is less effective).
    • You or your child are troubled or frustrated by the bedwetting.
    • You punish, or are concerned that you might punish, your child for wetting the bed.
    • Your child wets or has bowel movements in his or her pants during the daytime.

    If bedwetting is worrying you or your child then you should seek some treatment. It is very important to be patient and to encourage your child. Most importantly, you must understand that punishing or making fun of your child for wetting the bed will only make the situation worse. Brothers and sisters need to understand this as well.

    Treatment

    Motivation

    Your child needs to be very involved in the treatment plan if it is to work. As the treatment progresses, your child will probably have some good nights and some bad nights. Be very positive on the good nights, and try not to be negative on the bad ones.

    Most children don't need rewards to encourage them to take part in treatment - the prospect of a regular dry bed is usually enough. Some small treats along the way may be a good idea, but don't promise them in advance. Rather, give them as a little surprise if your child is making some progress. Certainly don't offer big rewards (e.g. a new bike) because this can add to the stress associated with treatment, and can be very disappointing if your child doesn't become dry.

    It can be helpful to keep a record chart of wet and dry nights. Your child should make the chart themselves and choose how to complete it. Some children like to put stars or stickers on for dry nights or to colour it in or draw pictures. Choose something that fits in with your child's interests (e.g. football stickers). Charts used on their own have little success, but in combination with a bedwetting alarm they can be very useful.

    Changing habits and exercises

    It is important for your child to drink plenty of fluid spread evenly throughout the day. Don't try to restrict the amount of fluid your child drinks in the evening as this will not help and can even delay the process of being dry at night. However, don't give drinks containing caffeine (e.g. coffee, tea, hot chocolate, caffeinated soft-drinks like Coca-Cola etc) late at night.

    If you are putting your child in a nappy or pull-up at night to save on laundry it is unlikely that he or she will become dry while this continues. It is better to do away with the nappy or pull-up altogether.  If you must use one, at least try without a nappy or pull-up for a week every couple of months. Nappies or pull-ups cannot be worn while using a bedwetting alarm.

    Mattress protection etc

    You might like to use some form of protection for the bed while waiting for your child to stop wetting.  A variety of pads and covers are available to protect the bed and pillow, and there are underwear pads that can be used for special occasions (e.g. school camps, holidays, sleepovers). They are available from:

    • The Royal Children's Hospital's Equipment Distribution Centre (T 03 9345 5325).
    • Tyco Health care (NSW T 1800 112 242).
    • The Continence Foundation of Australia (T 03 9417 3584).

    Bedwetting alarms

    Bedwetting alarms are considered the most useful and successful initial way to treat bedwetting. Research has shown these alarms will help more than 80% of children to become dry, and most children will then stay dry. This treatment requires a supportive and helpful family and may take six to eight weeks to work. Alarms have good long-term success and fewer relapses than medication.

    Using a mattress bedwetting alarm

    These alarms are available for hire from The Royal Children's Hospital (RCH). You will need a referral from your GP to see one of our paediatricians before you can hire a bedwetting alarm.

    The alarm consists of a rubber mat that is placed in the bed under where the child's bottom will be, and it is connected by a wire to a box with a battery powered alarm bell. The system operates at low voltage and there is no risk to your child.

    • The mat should be placed on the bed on top of the bottom sheet and should be covered with a piece of thin material, e.g. an old sheet that has been cut up into strips just big enough to cover the mat and long enough to tuck in on either side of the bed.
    • The wires should be plugged into the box, which should then be placed as far away from the bed as the wire will allow.
    • When going to bed, your child should switch on the alarm and get into bed. It is best if he or she only wears a pyjama jacket and underpants rather than pyjama trousers or a long nightdress.
    • When your child wets the bed, a loud alarm will sound. He or she should get out of bed as quickly as possible, turn off the alarm and go to the toilet to finish emptying his or her bladder. Then your child should dry the mat using the piece of material, put a new piece of material over the mat, turn the alarm back on and get back into bed. You may have to help your child with some of this, at least for the first few nights and especially if he or she is a very deep sleeper. 

    Within a week or two your child should start to have some dry nights. This may happen because he or she wakes up and goes to the toilet before wetting the bed, or because he or she learns to hold on all night.

    If your child has seven dry nights in a row, try giving some extra fluid to drink in the evening. This is called "overlearning".

    If your child has 14 dry nights in a row, try leaving the mat on the bed but without the alarm switched on and see what happens. If dry nights continue, try leaving the mat off the bed all together.

    A few extra tips

    When you first get the alarm home, practise the whole routine a few times. You can use a glass of salty water, instead of urine, to set the alarm off. Talk over the routine together each night as he or she gets ready for bed.

    If your child is a deep sleeper, you may have to wake him or her up for the first few nights when the alarm sounds. Most deep sleepers will get used to waking to the sound of the alarm. Your job is only to wake your child - they must do the rest themselves.

    If the alarm fails to go off when the bed is wet, or goes off when the bed is dry, you should contact the hospital for advice.

    Medications

    Most children with bedwetting do not need to take medication, but there are some occasions when it can be useful.

    DDAVP (e.g. Minirin). This is a man-made form of antidiuretic hormone (ADH) that works as a substitute for the natural hormone. It helps a child's body make less urine at night, therefore reducing the risk of the child's bladder overfilling during sleep. DDAVP is best used in the tablet form.

    DDAVP is usually reserved for children who have not become dry when using a bedwetting alarm, and sometimes the two treatments are then given together. Some children use the medication for sleepovers or school camps.

    DDAVP is safe provided you never exceed the recommended dose and avoid excessive fluid intake in the evening after dinner.

    DDAVP can work quickly. Some children will be dry after the first night. Many doctors recommend using DDAVP for three months, followed by a tapering off period to determine if the child can stay dry without medication. Some children will resume bedwetting when the drug is withdrawn. If the child becomes wet again your doctor may ask you to restart DDAVP and try to stop it again every few months to see whether your child still needs it to stay dry.

    Key points to remember

    • Bedwetting is not a behavioral problem.
    • Most children have no lasting problems from bedwetting.  However, many will feel embarrassed or ashamed.
    • Family members of children who wet the bed need to be supportive and not critical.
    • Bedwetting alarms are considered the most successful first way to treat bedwetting. Talk to your GP about a referral to an RCH paediatrician if you think this could help your child.

    More information

    • The bedwetting clinics at the RCH see several hundred children each year who have been referred by their GP for treatment of bedwetting. They also run special clinics for children with more complicated bladder and bowel problems.

    Referrals should be addressed to:

     

    General Paediatric Enuresis Clinic
    The Royal Children's Hospital
    Parkville 3052

    F 03 9345 5034
    T 03 9345 6180

     

    • DAVID'S SECRET SOCCER GOALS - is a book for kids who wet the bed and would like to know more about their problem, and maybe do something about it. The book is designed to be easily read alone by children age seven and above.  Ask at your local bookstore.

    Developed by the RCH General Medicine department. Updated October 2010

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.