BED-WETTING — AND THE TENDER-LOVING RESPONSE REQUIRED

There is nothing more embarrassing for a youngster than having an "accident" at a sleepover. I recall such a moment in my own childhood - and then my attempt to cover the evidence by spilling a coke as a "cover." To this day I don't know if I got by with it, but I could have died of mortification!

Nighttime bed-wetting, also known as nocturnal enuresis, requires tender-loving care from the adults on clean-up duty. Lack of parent understanding and failure to try and find a solution can emotionally scar a child. Bed-wetting is NOT a voluntary activity and should never be punished. It is a common childhood issue — one that affects 40 percent of children age 3, and over 5 million children age 6 and older. It is also a problem that almost always disappears on its own.

We do not know exactly why bed-wetting happens — but we do know that it tends to run in families. In fact, research shows that a child has an 80 percent chance of being a bed-wetter if both parents were bed-wetters. My own children were not happy that I passed this trait down!

There are several additional factors that can contribute to the problem; often, children who wet the bed sleep deeply; they may have a small bladder or a large production of urine at night (due to a lower ADH level, a hormone that tells the body to produce less urine during sleep). The body's complicated "alarm" system, which involves the bladder sending signals to the brain for the body to wake up, may not yet be fully developed. Rest assured that bed-wetting is rarely a sign of physical or emotional problems.

Although rare, underlying illnesses, such as diabetes and urinary tract infections, can be a cause of bed-wetting. At most, only 1 percent of bed-wetting is due to an underlying medical condition.

Make sure to alert your child's doctor if:

· Your child is experiencing painful urination or strains while trying to urinate

· Your child is experiencing unusual thirst

· Urine is pink

· Bed-wetting and snoring developed at the same time

Can Bed-Wetting Be Treated?

Statistically, bed-wetting starts to slow down at age 5. Before this age, the best treatment is time, sweet time, and patience. If your child is still bed-wetting after the age of 5 or 6, a visit to the doctor to rule out any medical causes and to talk about helpful strategies is a good idea.

Simple changes that can help your child include:

· Holding off on fluids one to two hours before bedtime. Be sure to use this strategy within reason. Your child shouldn't go to bed thirsty or dehydrated.

· Be aware that caffeine can make the problem worse, and many sodas contain caffeine.

· Increase fiber in your child's diet, since constipation can contribute to the problem.

· Have your child go to the bathroom right before laying down in bed.

· Consider a regular nighttime "bathroom" break. Set an alarm in your child's room.

· Consider disposable underpants or sleeping bag liners for slumber parties or summer camp.

· Your child's doctor also may suggest bladder-stretching exercises, which can help to allow the bladder to expand.

· Remember to never criticize your child for wetting the bed.

Chat It Up

Children are often very embarrassed about bed-wetting. They may feel they are the only ones in the world with the problem. It is important to open up lines of communication. Let your child know the problem is not his or her fault. If you were a bed-wetter, tell your child; this information can be very comforting. Make sure your child knows that this is a normal part of growing up that will pass with time. Some experts believe that positive visualization of a dry night before bed can be helpful. Since it is a strategy with no negative side effects, it's worth a try.

In certain circumstances, anxiety can be a factor, especially if your child has kept dry sheets for some time and then suddenly begins wetting again. If you know that your child is experiencing an anxiety-provoking experience, such as separation of parents, the arrival of a new sibling, or a move to a new school — talk to your child's family physician or pediatrician about ways to ease the emotional toll.

Let the Bell Ring

For children over 7 years old, the use of a special bed-wetting alarm pad can help. The alarm is activated by moisture. It can take several weeks before things improve — but this method can be effective. According to the National Kidney Foundation, 50 to 70 percent of people respond to this kind of treatment.

Other experts express concern that this method can be anxiety provoking and cause sleep disturbance. Before using an alarm pad, discuss this method with your child's physician, and talk with your child and find out if he or she has a desire to use it. Some children will try anything to eliminate bed-wetting.

If your child is old enough, leave clean sheets and pajamas near your child's bed every night, so she or he can take care of the problem if an accident does occur. Many experts agree that having your child take on this responsibility can help ease your child's stress over creating a "mess."

Medications

In certain chronic bed-wetting situations, after other treatment methods have failed, medications may be prescribed. This is usually a last resort for older children and is never a first line of treatment.

If the doctor has determined that your child has a small bladder, a medication to enlarge the bladder may be used; if your child has an overactive bladder, a medication to relax the muscles is an option. A synthetic version of ADH (Desmopressin) can be used to decrease urine production at night. And certain medications may be used for specific occasions — such as slumber parties or summer camp.

Medications usually provide short-term, rather than long-term success. When a medication is stopped, the bed-wetting usually returns. Keep in mind that all medications have both benefits and risks. Make sure you discuss both with your child's doctor before starting any medication.

Final words

For almost all children, bed-wetting goes away on its own as the bladder gets larger; the "alarm" telling the brain the bladder is at capacity turns on; production of ADH increases; or situations that were anxiety-provoking pass.

Bed-wetting is not a symptom of toilet training gone bad. It is a situation in which there is no one to blame. My best advice is tender loving care and patience, as well as open communication with both your child and your child's doctor.