An experienced Child Development expert, Dr Cathrine is available to answer your questions about bedwetting and your child.
Unfortunately there are no simple answers when it comes to understanding children’s bedwetting. The most common causes of bedwetting include a larger than normal production of urine overnight, difficulty in responding to a full bladder as well as a family history of bedwetting. Children usually become dry when their ADH hormones stabilize and they produce less urine overnight or they learn to wake in response to the signals sent from their bladder to their brain telling them to wake-up and go to the toilet. You can help your son by making sure he drinks plenty of water throughout the day. Good drinking patterns will help his bladder to learn to store more urine and reduce the risk of bedwetting. Given both his age and the frequency of his nighttime wetting I would recommend that you make an appointment with your GP to discuss treatment options. While many children are able to outgrow bedwetting on their own without the need for treatment, the likelihood of this happening does decrease with increasing age and frequent bedwetting (that is wetting that occurs 4 or more nights a week). The fact that it doesn't bother him is a true testament to how well you have managed the situation - we find the most significant impact of bedwetting is psychological rather than physical - so continue to be supportive and he will outgrow this stage feeling positive and confident.
All the best,
It is not unusual for children to waiver between periods of dryness and return to wetting as they move toward achieving permanent nighttime continence. Given she was dry for up to 6 months it would be worth having her checked by your doctor just to make sure there is no underlying medical cause. Bedwetting can occasionally be an indicator of health-related issues such as tapeworms (a simple worm treatment can rectify this) or a urinary tract infection. Young children may wet the bed if they become particularly over-tired, shifting her bedtime forward even ½ hour may make a big difference. It is perfectly fine to her back into DryNites to help manage her nighttime wetting - these are a form of management and are unlikely to prolong the nighttime wetting.
Your son is experiencing a condition known as secondary nocturnal enuresis (SNE) – this is the term used to describe a situation where children who have been previously dry for six or more months then begin wetting the bed again. When it comes to SNE the first thing you need to think about is what has caused this change – up until now your son had good nighttime bladder control, so something must be different. There are a number of possible medical causes - this can be as simple as a urinary tract infection or something more challenging like juvenile diabetes - so it is very important that you make an appointment for him to see your GP for a full medical assessment. A return to bedwetting may also result from emotional stress, which may be due to things like bullying or difficulties with friends. Talk to your son to see if there is anything bothering him. If stress is the cause, once the stressful situation has been resolved, children’s bedwetting usually stops. In the meantime reassure your son that none of this is his fault, promoting self-confidence and positive self-esteem is particularly important at this time.
All the best,
It is perfectly normal for your 2-year-old daughter to still be wetting the bed at night with many children continuing to do so right up to school age. While some children become dry at night a few weeks or months after achieving daytime control for others it can take a little longer. It is important that her nappy fits snuggly around her leg as improper fit (nappies that are too small or too large) can contribute to leakage. Children’s overnight urine output can be quite variable. You can try and reduce her urine output by making sure she fully empties her bladder just before she goes to sleep and by limiting drinks high in sugar as well as the amount of dairy and citrus she drinks in the evening (i.e., after 6 pm) as these are known to stimulate the kidneys. Calcium intake is very important for growth and development so only limit intake in the evening. If you were at all concerned about the amount of urine she is producing, I would certainly recommend you consult with your GP. Sometimes an increase in urine output can be the result of a urinary tract infection - this is often accompanied by a strong odour so it would be worth considering this.
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.
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!
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