Dr. David Palmiter's Blog for Hectic Parents

Bedwetting, or nocturnal enuresis, is very common in children. Indeed, it isn’t diagnosed by the International Classification of Diseases until age 5 and witnessed in about 12% of kids even by age six. Here are eight tips for when it has become a problem for you and/or your child:

• The most important thing is to stay calm. It’s almost for certain that the bedwetting is not under your child’s control (e.g., in my 20+ years of practice I’ve never seen a kid who was wetting the bed on purpose). The shame that children sometimes feel over bedwetting can be intense (e.g., Google the story of John Curtis, an Olympian who got his start in running because of shame over enuresis). If you remain proportionally calm and reassuring you reduce the odds that your child will feel shame. (Also remember that excessive reassurances can be problematic as they suggests that you are freaked out.)

• Let your kid know that this is very common and that he or she will grow out of it. Kids tend to think that they are freaks unless someone normalizes this for them.

• Have your pediatrician rule out medical causes. While medical problems are indicated in only about 3% of these cases, you’d hate to miss one if it’s there.

• Have your child either help you change the sheets or have him or her do so on his or her own (this depends upon your child’s age). This should be done as soon as you learn that the bed is wet, even if it’s in the middle of the night. This mild inconvenience, that doesn’t promote shame if done calmly, helps to program your child’s body to wake up before wetting the bed.

• Establish a star chart for having a dry bed. A dry bed earns a star and praise. A wet bed earns either no response, or a comment like “don’t worry about it,” or “lots of kids go through this” or “it’s okay, we’ll try again tonight” or “hey, no one gets a hit every trip to the plate.” Establish a reward after a certain number of stars have been earned (e.g., 7 might earn going to the movies, 14 might earn a video game). In no way shape or form should there be any punishment or restriction of privileges secondary to your child’s performance with the star chart.

• Restricting fluids before bedtime is sometimes recommended but I would only do this in the short-run as part of the goal here is to mature your child’s bladder capacity. I also wouldn’t deny a small dose of water to a child who is begging for a drink.

• A bell and pad alarm system can be very helpful (these are easily found online). The alarm sounds when a tiny bit of moisture is registered. The idea is to condition your child’s body to wake up. Make sure your child goes to the bathroom when the alarm sounds, as some sleep so deeply that the alarm will not wake them. If the problem persists create a word of the day and make your child wake up enough to state it. (Again, it’s important that you try to stay calm, which I know can be a challenge in the wee hours of the morning.)

• If these simple remedies do not work, consider taking your child to a child psychologist who can offer “Full Spectrum Treatment.” FST is a more elaborate, research supported, behavioral treatment for enuresis. For a referral click here.

Good luck!