By Tom Jackson, M.D.
When it comes to the problem of children wetting the bed, the consolation for most parents is that most children usually outgrow bedwetting. Sadly, however, this is not always the case. And even when a child does eventually outgrow nocturnal enuresis, much of the psychological damage from the problem until that point has already occurred.
Fortunately, there is much you as a parent can do to help shepherd your child through and past these experiences with self-esteem intact.
- Do NOT get angry with the child.
More importantly than what you do here may be what you don’t do. That is, whatever actions you decide to take, never get angry with him, blame him, put him down, embarrass him, punish him, or spank him. - Reassure your child.
If your child wets the bed, first and foremost reassure him that the problem is common and not his fault. Assure him you know he’s not wetting the bed on purpose. And above all emphasize the behavior doesn’t make him a bad person. Encourage your child to communicate openly with you about his bedwetting, while at the same time supporting discretion and protecting his privacy regarding the matter. Remain watchful that siblings don’t tease, embarrass, or humiliate him for having the problem. A convenient side benefit of giving your child compassionate support is that doing so tends to decrease recurrences of bedwetting. - Encourage more fluids during the daytime.
Proper hydration, ironically, actually plays a major role in preventing bedwetting. Many children avoid drinking fluids all day, only to guzzle down large quantities at night. Additionally, many children wait to drink anything until they’re parched, at which point they drink sugary, caffeinated beverages to quench their thirst, only making the problem worse, for caffeine and sugar act as diuretics; rather than increase the body’s fluid levels, they actually inhibit fluid retention and promote increased urination rather than less.Aggravating the problem, when a body suffers from an imbalance of fluid intake, it demands replenishment of fluids at the most inconvenient time of day possible, namely in the early evenings. Proper hydration, supportive of the ability to sleep through the night without wetting the bed, is best achieved by consuming smaller quantities of water at a time, consistently and frequently throughout the day. Think ahead. Encourage proper hydration, for example, by including a bottle of water in your child’s backpack before he leaves for school each day.A common scenario is for children to drink insufficient amounts of fluids during the day and then feel thirsty at night, causing them to drink more before bedtime and possibly throughout the night. This creates an obvious risk for bedwetting that can easily be avoided by encouraging the child to drink more during the day. This will lead him to be less thirsty at night and therefore less likely to drink excess fluids before bedtime or during the night.
- Eliminate caffeine.
To be practical, most families would be hard pressed to eliminate all dehydrating foods and beverages from their child’s diet. But the more you can restrict caffeinated foods and drinks, at the very least, the more you eliminate a high risk factor for children prone to bedwetting. Caffeine, found in chocolate, sodas, and black and green teas, is a diuretic, meaning it promotes urination. - Incorporate bathroom time into the bedtime routine.
Bedtime routines are a crucial part of sleep hygiene, especially for children, because they work with the body’s own biorhythms to help facilitate smooth transitions between natural processes like eating, waking, and sleeping. If you incorporate urination time into the child’s bedtime routine, that too can become one of the positive patterns ingrained in the child’s biorhythms. That is to say, the child’s body may get used to urinating at the same times each night and therefore adjust accordingly so as to eliminate the bladder completely during these one or two pre-bedtime bathroom visits. I suggest you have the child urinate twice immediately prior to going to bed, the second time just five or ten minutes after the first. - Encourage calming, relaxing pre-bedtime activities.
Another way you can use your child’s bedtime routine to help avoid bedwetting is to encourage calming, relaxing activities before bedtime, and discouraging active, excitable play, be that rough-housing or stimulating video games. - Enforce bedtimes.
Perhaps the most important part of a child’s bedtime routine is his scheduled bedtime. Getting a child’s body accustomed to bedding down at the same time every night is a powerful way to help encourage healthy biorhythms. Sticking to a routine, and longer regular durations of sleep both have been reported to help control bedwetting. This means that beyond enforcing your child’s scheduled bedtime, consider setting up an earlier bedtime still. - Make nighttime bathroom visits easy.
Make it easy for your child to get up in the middle of the night to go to the bathroom, such as by putting a nightlight in your child’s bedroom or giving him a flashlight by his bed should he need it. Enuresis alarms are becoming an increasingly popular approach to bedwetting. These alarms awaken the child as soon as any urine is excreted, increasing the likelihood that the child can halt the flow of urine until he makes it to the bathroom. The intention with these alarms is that progressively, over time the child’s body is trained to alert itself to awaken when the sensation of needing to urinate arises. - Stopgaps
One practical stopgap is to try a waterproof sheet on the child’s bed to help alleviate some of the secondary stressors associated with bedwetting. Other similar strategies include PODS (Potty On Discreet Strips), absorbent underpants, protective diapers, and pull-ups. Just remember these stopgap measures are just that: they’ll relieve some of the stress you and the child feel over bedwetting while you and the child hone in on permanent solutions. - Have a doctor examine your child to rule out medical causes.
If bedwetting seems a chronic problem for your child, consult your child’s pediatrician in order to rule out any underlying medical causes that can be appropriately treated. If a child’s bedwetting is accompanied by poor daytime bladder control, more serious medical concerns are more likely involved. So, too, may be the case if your child’s bedwetting is accompanied by pain in the urinary tract while urinating, or by back pain, abdominal pain, or fever. If the urine has a strong, unpleasant odor or if the child awakens regularly in the middle of the night intensely thirsty, a pediatrician’s counsel is also wise.
Dr. Tom Jackson is a psychiatrist who has specialized in the treatment of sleep disorders and anxiety for the past thirty years. He is the creator of the DreamChild™ Adventures audio programs and author of the companion guide, DreamChild™ Adventures in Relaxation and Sleep (August 2012). He is currently medical director of a public mental health clinic and in private practice. For more information, please visit3DAudioMagic.com and ThomasJacksonMD.com.
