Often, when parents come seeking help for their child’s bed wetting problem, they are as distressed by it as the child himself, which not only distresses the child further; but it also usually makes the stressed parents unable to manage the problem calmly. The first step towards success in managing bed wetting is to for caregivers to realize that accidents are bound to happen, and that there will be many bumps in the road to nighttime dryness despite their best efforts. Parental frustration translates into anxiety by the child and makes the treatment process more difficult and laborious.
Nocturnal enuresis, or bed wetting, is by no means a rare problem. There are almost half a million children at any given time in the UK that regularly wet their beds at night. Afflicted children are as young as five and as old as sixteen. Bed wetting is generally more common in boys and sometimes there is a familial tendency for nocturnal enuresis.
Bed wetting is classified among the developmental sleep problems in children and may accompany other disease entities from this class such as sleep walking and night terrors. If these co-morbid conditions are present, achieving night time dryness usually takes longer than if nocturnal enuresis is isolated. Other potential co-morbid conditions, which physicians usually investigate if there are suggestive symptoms, are urinary tract infections and diabetes.
Management of bed wetting depends on the child’s age. In children younger than four years of age bed wetting does not necessitate any investigations, except upon association with other symptoms or developmental delays. Children between the ages of 4 and 6 usually respond to simple measures that involve limiting fluid intake 2 hours before bedtime, eliminating caffeinated and fizzy drinks, and by making urinating immediately before bed part of the regular nighttime ritual. Parents should also use positive reinforcement techniques, which involve rewarding the child for every dry night, and they should avoid punishing or reprimanding the child for accidents and mishaps. These bed wetting incidences are best ignored. Parents should regard this as part of the normal development of a child. A “late bloomer” develops the necessary nervous system maturation needed to awaken him when the bladder is full and needs emptying a few years later than his peers.
If bed wetting persists after the age of six or seven, most children will need further interventions. A popular gadget used, with absolutely no side effects, is the bed wetting alarm. The bed wetting alarm is designed to detect the first drops of urine leaked and wakes up the child to go to the toilet. While it may not seem like a practical idea at first, bed wetting alarms have been very helpful in training a child to recognize the need to urinate. Eventually, usually in 4 to 5 weeks, the child starts to awaken before the bed gets wet.
Finally, when all else fails, or in if the child is significantly older, the treating physician may suggest the use of drugs, like desmopressin or imipramine, for the treatment of bed wetting.