Bed wetting in children

It is common for children younger than six to kiss at night. It is only when the child has turned five that it is called bedwetting, or enuresis. It is one of the most common health problems for children who are six to seven years old. There are treatments that help the vast majority. As a parent, there are also things you can do.

Bed wetting is often due to the fact that the nervous system that controls the bladder and awakening is not fully developed. Bed wetting is not dangerous for the baby.

Children up to the age of four who pee at night do not feel worse than other children. But later, they may find it both embarrassing and troublesome.

The older the child, the greater the risk of being ashamed and of poor self-confidence. The child may also worry about teasing his friends. Bed wetting often means that it becomes more difficult to sleep away, for example.

What can I do for myself?

Most children who suffer from bedwetting are helped by regular dietary and toilet habits. Therefore, it is good to teach the child to:

  • Pee regularly and at least four times during the waking part of the day.
  • Spread the drink throughout the day and drink less in the evening.
  • Avoid beverages in the evening that increase urine production, such as soft drinks or tea.
  • Unwind an hour before bedtime, for example by reading, watching children’s programs, or listening to music.
  • Pee before bedtime.

Extra bedding and sheets

It is good to have a clean pajamas and dry sheets made if the child is peeing. This makes it easier to change in the middle of the night. Most five-year-olds don’t want diapers. For some children, night diapers or night pants can be a temporary solution on special occasions, such as whether they are going to camp or school travel. Of course, it assumes that your child wants it himself. It is good to prepare the staff who are involved so that it works well for both children and staff. You can also send with extra sheets or an extra sleeping bag. If the child wants to, you as a parent can also follow, for example, school trips.

A district nurse or urotherapist can prescribe so-called continence aids if the child is over five years old and has been diagnosed with bedwetting. It is possible to distinguish between the county councils which rules apply to which continental aids can be printed. Sheets are usually printed from the age of five. 

It is important not to punish a child for bedwetting. Instead, encourage your child when they can sleep one night without peeing in bed. The most likely cause of bedwetting is that the nervous system that controls the bladder and awakening is not fully developed. It is also important that both you and the parent understand that it has no connection to the child’s other development, which is usually quite normal.

What can I say if I want to talk to the child about bedwetting?

For example, if you want to talk to your child about bedwetting, say:

  • There’s nothing wrong with you.
  • You do not stir because you pee in bed.
  • You don’t have to be ashamed for kissing in bed.
  • You are not alone, there are at least one or two children in your class who have the same problem, even if you do not know who they are.
  • There is good help to get rid of the problem.
  • The problem will disappear over time. Sometimes it may take some time but you will stop peeing in bed.

When and where should I seek care?

Seek care if your child asks for help, or if you as a parent worry about the child peeing at night. The care center gives advice on bedwetting regardless of the child’s age.

It is also possible to seek help from the school nurse or school doctor. Children up to the age of six can get help at the child care center .

It is important that the child himself wants help

It is important that your child is motivated to get help with his / her bedwetting. Otherwise, as a parent, you must ask if your child is mature enough for treatment.

Children younger than five to six years may not see bedwetting as a problem. Then talking about care and examinations can make it a problem and cause unnecessary shame. You should not “nag” to get the child motivated even if the child is older than five years and does not want help. It often makes the problem more shameful and more difficult to get rid of. But you can talk to your child to understand why they do not want to participate in treatment.

You should seek care regardless of the child’s age if your child begins to pee at night after failing to do so for months.

Surveys

You as a parent and your child must first answer some questions, so that the doctor can understand what causes bedwetting. The doctor usually wants to know how developed your child is for his age and whether the child has had any illnesses.

 Frequently asked questions are:

  • How much the child drinks and kisses during the day.
  • If the child has trouble keeping close during waking time.
  • If the child has trouble with  constipation .
  • If the child has ever had a  urinary tract infection .
  • If the child has sleep problems.
  • If someone else in the family has had bedwetting problems.
  • How the  child sleeps at night .
  • If the child snores.

Thereafter, the child may undergo a physical examination where the doctor often feels on his stomach and looks at his back. The doctor examines the nerves by testing how the reflexes work in the arms and legs. The doctor also looks for external signs of congenital malformations of the urinary tract.

The child is allowed to submit a  urine test  which can show if, for example, they have urinary tract infection or diabetes. It  does happen that  diabetes causes bedwetting, although it is very uncommon.

Sometimes more investigations are needed

Children who snore a lot and have disturbed sleep  may sometimes undergo more examinations, for example by an ear doctor. Bed wetting decreases in some children if sleep improves, by  removing the tonsils  or  gland behind the nose , so-called adenoid.

Since bed wetting rarely results from a serious bodily error, it is rare that further investigations need to be done. But if the doctor suspects that the child has a congenital malformation or kidney injury, they are examined with, for example,  ultrasound  or x-rays of the urinary tract .

If the child also pauses during the day  or has  constipation  , this should first be investigated and treated.

It is also important to try to assess how motivated the child and the family are to get rid of bedwetting, which is important in the discussion about the choice of treatment.

Treatment

It is common for the child to receive bedwetting treatment when they are six years old. But a younger child may also receive treatment if they feel ill due to bedwetting and are motivated to seek care. Your child’s experience of his situation and his desire to be treated is most important.

Treatments available in healthcare include:

  • Bed wetting alarm, so-called enure alarm.
  • Drugs for the night to reduce urine output.

The methods are usually used individually, but sometimes in combination.

Usually, the child may try the enuresis alarm first, because this treatment more often causes the bedwetting to stop completely. Sometimes the baby gets drugs first. This is especially true if the doctor concludes that the main reason for bedwetting is that too much urine is produced at night. 

Alarm treatment can help in the long term

Alarm treatment is about trying to wake your child with an alarm when they start peeing. There are two methods. One is that the child receives an alarm mat in his bed which is connected to an alarm clock. The second is that the child may wear an alarm sensor. It is as big as a regular patch, about six cm but a little thicker. The alarm sensor is inserted into a panty protection that is attached to the underwear. It is connected wirelessly to an alarm clock.    

If the child is peeing at night, the alarm mat, or sensor, senses it and sends a signal to the alarm clock. The child hears the sound, stops peeing, and goes up to pee. The idea is that the child will eventually learn to feel when the bladder is full and awake by itself. Sometimes the child does not wake up despite the alarm signal and then you have to wake the child. Therefore, a parent needs to sleep in the child’s presence for the first time.

Alarm treatment is the method that best helps the child get rid of the hassles. About seven out of ten children will be helped within three months. The treatment has no side effects.

It can be good if the child first gets used to the alarm during play, by testing the alarm with water. Ideally, the child should then actively help with the treatment of the treatment. For example, it may be that the child helps to put the sensor on, to start and eventually also learn to turn off the alarm, and to go up and pee. If the child is frightened by the alarm, you can interrupt treatment and try again in about six months.

Alarm processing can be demanding and the alarm can sometimes wake the whole family. Therefore, it is good if you start the treatment during a quieter period for the family.

Medicines can often help temporarily

Vasopressin is a hormone that reduces the production of urine. Many children who pee at night do not have enough vasopressin. Then the child may receive a prescription drug containing desmopressin. It is an artificial hormone similar to vasopressin. The child takes the drug in the form of tablets that are placed under the tongue to melt in the mouth.

The drug is taken one hour before the baby goes to bed. Then the child should not drink anything and they should pee just before bedtime. The drug causes less urine to form during the night and the child then becomes easier not to urinate in bed during the night.

Medicines can be used on occasional occasions, for example when the child is going to sleep away or have a friend sleeping over.

The child may also receive the hormone regularly for an extended period of time. Then a break is usually done about every three months to see if the child by itself has stopped peeing in bed.

Drug treatment should be discontinued if the child does not stop peeing after a few weeks of treatment. Then try again after about six months.

About half of all children who use drugs stop peeing during the time they use the medication. But the trouble often comes back when the child has stopped taking the drug.

Risk of side effects with drugs

There is a small risk that your child will have side effects as a headache when taking desmopressin.

There is also a small risk that the child will have a serious side effect in the form of so-called water poisoning if they drink very much the hours before bedtime. It can cause the child to have cramps. Children receiving treatment with desmopressin should therefore only drink small amounts of fluid one to two hours before bedtime. Ideally, the child should not drink anything at all for the first eight hours after taking the medication.

If the treatments do not help

Children who feel ill because of bedwetting and are not helped by alarm treatment or medication should be referred to special clinics. There the child can receive other medicines and treatments. This is especially true if they have a so-called overactive bladder that wants to drain quickly even with small amounts of urine in the bladder.

More about bedwetting

The most common reason for children peeing at night is that the part of the nervous system that controls the child’s urinary tract is not fully developed. Another common reason is that the baby does not produce enough of the hormone vasopressin which causes the kidneys to reduce urine output at night.

Many children also have difficulty waking up and are not awakened by the body’s signals that the bladder is full. Others have a so-called overactive bladder. This means that the bladder is more sensitive to being full and wants to contract even with small amounts of urine. Sometimes it is a combination of these causes.

Many parents wake up their baby after a few hours of sleep to let the baby pee. It can cause the child not to pee in bed, but rarely affects how quickly the child stops peeing on himself.

If the child manages not to pee during the day, many parents choose not to use diapers at night either. There is no scientific support for the continued use of night diaper to prolong bed wetting, but it has been described that children become dry after the night diaper has been removed.

Common in children six to seven years

In children six to seven years old, bedwetting is the most common problem after allergy and asthma. Roughly every tenth of seven-year-olds pee regularly at night. At the age of 15, one in a hundred children cannot fully control urine at night. 

Bed wetting in children aged six to seven years is more common among boys than among girls. In teens, it is just as common in both boys and girls.

Bed wetting can also be due to anxiety or illness

Bed wetting may be because something is worrying the child. This may be the reason if the child has not kissed at night for a six-month period or longer and then suffers.

Urinary tract infection ,  constipation  and  diabetes  can also be causes of bedwetting. This is especially true if the child starts to pee at night after not doing so for a long time.

 It is very uncommon but sometimes bed wetting may be due to a congenital malformation or kidney disease.

Common hereditary problem

Bed wetting is often hereditary. If one of the biological parents has had bedwetting problems as a child, there is about a 40 percent probability that the child will also have the same problem. If both biological parents have had bedwetting problems, the probability increases to about 70 percent.

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