Resources for Parents
- Dry at Night - Bedwetting Information: http://dryatnight.com/
- KidsHealth - Bedwetting: http://kidshealth.org/parent/general/sleep/enuresis.html (also links to information sites directed at children and teens)
- Raising Children Network - Bedwetting: http://raisingchildren.net.au/articles/bedwetting_%28cyh%29.html/context/618
Counselling points for parents and caregivers
As a pharmacist, the most accessible health professional to patients, you will have a large responsibility in counselling the parents of children affected by nocturnal enuresis.
This page goes over some main points that should be told to parents, as well as children, if they are old enough.
About the condition
- Bedwetting is also called nocturnal enuresis
- It is common; 15-16% of children still wet the bed at age five
- Most cases of bedwetting will disappear with age, however, treatments can help
- It can take longer for children to learn how to control their bladders at nighttime, compared to daytime
- Boys are twice as likely to struggle with the condition
Causes
- Causes may include delayed maturation, genetics, lower levels of a hormone that reduces urine production, or if the child is a heavy sleeper
- Some medical problems may contribute to wetting the bed, and when treated, the bedwetting may stop: diabetes, urinary tract infections, pin worms, kidney failure, constipation, and sleep conditions
When to see the doctor
- Clinicians typically do not think bedwetting is a cause for concern until the child is six-years-old or older
- Visit the doctor if your child experiences burning or pain when urinating, if the child experiences daytime symptoms, experiences excess thirst, is urinating very frequently, or if the condition has only started recently; these may be symptoms of another disorder
- If the condition is having a significant impact on the child or family
Treatments
- Education, advice, behavioural and motivational therapies are the first choice for treatment; bedwetting alarms may be added if these are not sufficient
- Typically, bedwetting alarms or medications are not used until the child is at least seven-years-old
- Consult the child's physician regularly, around every four months
Education and advice
- Remember that your child is not trying to wet the bed; never use punishment or shaming
- Discourage any teasing by family members
- Use a journal to record bedwetting frequency, the amount of liquids consumed in a day (and when), and the number of times the child urinated during the day
- Encourage regular voiding during the day, ex. every two hours
- Avoid drinks containing caffeine, especially at night
- Create a schedule to distribute the amount of fluids that the child drinks. One proposed schedule could be 40% in the morning, 40% in the afternoon, and 20% in the evening.
- Ask the child to urinate before going to bed
- Avoid the use of training pants; the child may grow accustomed to having that protection
- Make the bed using alternating waterproof pads and sheets, so that when a wetting episode occurs, you save time only removing one sheet and pad
- Always use a waterproof sheet to avoid urine seeping into and causing an odor in the mattress
Behavioural therapy
- Self-awakening is to teach the child to learn how a full bladder feels during the day so that he or she can recognize this feeling when asleep
- Over-learning: if the child is using an alarm, after being dry for a month, the child drinks a certain amount of water before bed, and continues using the alarm, while trying to stay dry
- Alarm clocks: used to wake the child periodically through the night so that he or she may visit the bathroom and urinate. It is more effective when it can be estimated when the child will have to use the bathroom.
Motivational therapy
- Sticker charts- create a calendar or journal with your child and place stickers on days that the child has a dry night
- Give rewards for consecutive dry nights (ex. a fun activity)
Bedwetting alarms
- Wakes up the child when he or she begins to urinate, so the child will visit the bathroom and finish urinating there
- To train the child to wake up when his or her bladder is full
- Very loud and will wake the whole family
- Response is seen within one to two months; 2/3 of children are cured by four months
- A small percentage of children will start bedwetting again after they stop using the alarm
Drug treatments
- Desmopressin is the most common medication used for bedwetting; up to 75% of children will respond, and response is usually seen within two weeks. Do not give your child any fluids one hour before until eight hours after taking desmopressin; drinking too many fluids during this time can cause life-threatening mineral imbalances in the blood. It is available as a rapid-melt tablet that dissolves under the tongue.
- Tricyclic antidepressants like imipramine may cause dry mouth, trouble sleeping, or stomach aches. They can take a week to show effect.
- After stopping using medication, many children start wetting the bed again
References:
Drutz JE, Tu ND. Patient information: Bedwetting in children (Beyond the Basics). In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Nov 9, 2011. Accessed Mar 24, 2013.
Dry at Night. Bedwetting. http://dryatnight.com. Accessed Mar 24, 2013.
Ramakrishnan K. Evaluation and treatment of enuresis. Am Fam Physician. 2008;78(4):489-96.
Tu ND, Baskin LS. Management of nocturnal enuresis in children. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.
Drutz JE, Tu ND. Patient information: Bedwetting in children (Beyond the Basics). In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Nov 9, 2011. Accessed Mar 24, 2013.
Dry at Night. Bedwetting. http://dryatnight.com. Accessed Mar 24, 2013.
Ramakrishnan K. Evaluation and treatment of enuresis. Am Fam Physician. 2008;78(4):489-96.
Tu ND, Baskin LS. Management of nocturnal enuresis in children. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.