An experienced Child Development expert, Dr Cathrine is available to answer your questions about bedwetting and your child.
I am assuming you are currently under the care of a specialist so I am reluctant to give any specific advice around treatment as I do not want to counteract any advice or treatment plan you are currently following. It may, however, be worth exploring the use of conditioning alarm which can be used in conjunction with your medication. This is unlikely to help with your daytime continence but can train your body at night to respond to and wake up when your bladder is full and needs emptying. You can certainly continue to use DryNites as a form of management, both day and night. be sure to change these regularly throughout the day to avoid leakage or odour. I would recommend speaking with your doctor to see if you qualify for financial support to help cover the ongoing costs of your DryNites.
All the best,
The time between achieving daytime control and nighttime continence is quite variable with many children not achieving nighttime control until school age. Bedwetting is typically not seen as an issue or condition until children are at least 5 or 6 years of age - with the majority of children up to the age of 7 outgrowing this phase on their own. Unlike toilet training, which is conscious and deliberate, nighttime bladder control is more dependent on maturation of children’s nervous systems and bladder so it is much more challenging to train a child a night. Training at night usually involves the use of a conditioning alarm (also commonly referred to as a bedwetting alarm), this works by helping your son learn to recognise the need to pass urine and either wake-up and go to the toilet or learn to hold on until morning. The conditioning approach is based on the theory that by repetitively waking a child at the time of urination the child becomes conditioned into recognising that urination is about to occur. This method requires a great deal of commitment on behalf of the family, as parents need to take initial responsibility in ensuring their child wakes in response to the alarm. Treatment can take up to 6 months, with about a third of children experiencing relapse. Motivation is a big factor in determining success which is why we often do not recommend introducing the alarm before the age of 6. In the meantime you can encourage healthy bladder habits by getting your daughter to drink water regularly throughout the day - limit dairy intake after 6 pm and avoid foods and drinks high in sugar and caffeine (like hot chocolate) as these can stimulate the kidneys. If your daughter continues to refuse to wear nappies you could try her in DryNites these are made to look more like undies and can be more appealing to older children who have outgrown the nappy stage.
Given his age and the frequency of his wetting I would certainly recommend taking him to see a doctor. While many children his age do outgrow bedwetting on their own without the need for intervention - children who experience nightly bedwetting like your son are less likely to be able to achieve nighttime continence without some form of intervention or treatment. It is important that when you do go down the treatment path you do this with the support of a continence specialist - the more guidance and support you receive the more likely you will achieve dry nights! In the meantime it is fine to continue with the limited drinks after 6pm and toileting just before bedtime - it's also worth checking his diet as high levels of dairy in the evening (after 6pm) can place additional pressure on his bladder as does food and drink with high sugar and salt content. Do not cut out dairy completely as this is essential for healthy bone growth and development.
DryNites have been specifically designed to cater for older children so that they do not feel that they are wearing a nappy to bed, and therefore do not impact negatively on their self-esteem. You can certainly request a sample off the website to see which size provides the best fit for your son.
It is not unusual for children to return to wetting at night at times of high stress – and moving house can certainly be a causes of stress among young children. If her return to bedwetting is in direct response to getting used to her new surroundings then we typically find that children stop wetting once they feel better about the situation. In saying this it is always a good idea to have children checked by their GP when they experience a return to wetting. A return to wetting can also result from such things as urinary tract infection and constipation so it is worth ruling these out. When children experience significant changes in their life such as moving to a new house it is important to provide lots of emotional support and minimize any other changes in their life. Young children take great comfort from the familiar – check that she is happy with how her new room is set-up – even a shift in furniture can sometimes be disturbing. With respect to managing her bladder – make sure she drinks water regularly throughout the day, its fine to taper off in the evening or restrict fluids just before bedtime - and make sure she empties her bladder fully just before going to sleep. Avoid overtiredness as this can make it more difficult to wake in response to a full bladder. All the best!
Bedwetting can result from a number of factors with the three most common causes being (1) an overproduction of urine overnight – children who have low-levels of ADH (antidiuretic hormone) produce four times the amount of urine as those who have the hormone and are therefore at a greater likelihood of exceeding their bladder capacity overnight (and explains why her bladder seems to keep filling). If this is the cause children generally stop wetting their bed when their ADH levels return to normal; (2) Difficulty arousing from sleep in response to a full-bladder – these children are unable to detect the signals sent from their baldder to their brain telling it it is full and needs emptying. These children will stop wetting when their body matures to a point where they can wake-up in response to their full bladder; and (3) a genetic disposition – children who wet the bed are more likely to have a family member who also wet the bed as a child. Whatever the cause - support and understanding from parents is one of the most important factors in ensuring children survive the bedwetting phase relatively unscathed!
Not every child who wets the bed does so because of low levels of the hormone ADH. Given the potential complexity of the causes it would be certainly worthwhile having your child assessed by a medical practitioner. Typically the assessment will involve gathering information on nighttime and daytime forms of incontinence, history and type of toilet training, any previous attempts at intervention, frequency of the urination (day and night), the longest dry period, whether you child is suffering from constipation and any emotional, physical or psychological concerns.
It is perfectly fine to use DryNites even when girls start menstruating. If you are after additional protection, its fine to line the DryNite with a sanitary pad, in the same way you would place in in her underpants during the day. With respect to treatment - the best and most successful approach is the conditioning alarm. Bedwetting alarms work by setting off an alarm when the child starts to wet, waking them up so that they get up and go to the toilet. Over a period of time this conditions the body (and child) learns to wake without the need for the alarm. It is not unusual for the alarm not to work at first and may take up to 6 months of constant use. Children may experience one or two relapses, when this occurs you need to reintroduce and repeat the process. It may be helpful to get your daughter to practice setting the alarm off during the day (with a drop of water) so that ways she will become familiar to the sound of the alarm and it will be less frightening at night. In the meantime reassure her that this is in no way her fault and that with time (and perhaps a little bit of help) she will become dry!
It is always tricky when younger siblings achieve nighttime continence first – in these instances it is important to focus on all the things your eldest son does well, explaining that everyone is different and with time he too will become dry. You need to reassure him that you understand this is not his fault and that you are in no way disappointed or angry. In saying this, it is perfectly normal for him to be still wetting at night, with around 20% of 4-year-olds contusing to do so. Taking off his DryNites is unlikely to have much of an impact other than result in an increase in workload and potential distress. Children wet when asleep and therefore not in conscious control of their bladder, their body responds in much the same way regardless of whether they are wearing absorbent pants or underwear. If you are at all concerned about his wetting or if he continues to wet once he turns 6 than I would definitely follow this up with your GP.
It's fine to do this in emergencies but as a rule I would not recommend using the girls DryNites as the absorbency patterns differ and may result in leakage. The patterned outer layer is also uniquely designed to appeal to girls rather than boys and may cause your son additional embarrassment.
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