Health Library Should I Treat My Child's Bed-Wetting?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your health professional's recommendation.

Key points in making your decision

Your decision on whether to treat your child's bed-wetting will depend on several issues, including your child's age, his or her history of bladder control, and the impact that bed-wetting is having on your lives. Consider the following when making your decision:

Treatment for bed-wetting may also be helpful if bed-wetting is affecting a child's self-esteem, performance in school, or relationships with peers.

• Your child will probably stop wetting the bed on his or her own. Gaining bladder control is a normal developmental process that takes longer in some children.
• In children younger than 5 or 6 who have never gained consistent nighttime bladder control, medical treatment for bed-wetting is generally not needed. Home treatment may help you manage the wetting until the child stops on his or her own.
• If your child has begun wetting again after having been dry for at least 3 months, the wetting may be related to a treatable medical condition, such as a urinary tract infection.
• If your child has never gained bladder control and is older than 5 or 6, the decision to begin treatment is based on the effects the wetting has on you and your child.

When should a child stop wetting the bed?

Bed-wetting is common in young children. It occurs in about 15% to 20% of 5-year-olds and gradually decreases to about 7% of 7-year-olds, 5% of 10-year-olds, and 2% to 3% of 12- to 14-year-olds.¹ Because children grow and develop at different rates, bed-wetting will usually stop over time without treatment. Bed-wetting is rarely related to a medical problem.

Treatment for bed-wetting is not a cure. The goal is to reduce the number of times the child wets the bed and to manage the wetting until it goes away on its own.

If bed-wetting is related to emotional stress, the child will usually regain bladder control when the stress is relieved or dealt with. Older children who wet the bed, especially girls, are more likely to show signs of emotional stress and to be more difficult to treat.

How effective is treatment for bed-wetting?

Devices and treatments that can be used at home vary in their effectiveness. Many treatments help the child learn how to notice the signals sent by the bladder when it is full. Treatments can be used alone or in combination and may include:

• A moisture alarm. This device is worn on the body and makes a sound when urine first touches the child's underclothing. The child is encouraged to try to "beat the buzzer." Moisture alarms are the most successful treatment for bed-wetting, especially in children age 10 and older.
• Motivational therapy. This method involves parents encouraging and reinforcing a child's sense of control over bed-wetting. Parents repeatedly tell their child that he or she can master bed-wetting, and they also work with the child to design a reward system that will encourage and motivate the child to stay dry. Counseling sessions with a trained professional may also be involved. This treatment works best for children who are eager to participate, have responsible parents, and have a good relationship with their health professional.²
• Self-awakening training. This is a method of helping a child awake from sleep. It involves having the child practice getting out of bed to go to the bathroom. This type of training works well when both parents and the child are motivated, and usually this is more likely with children older than 6.
• Dry-bed training. This method consists of following a strict schedule for waking the child up at night until he or she learns to wake up alone when needed. The dry-bed training program is implemented over 7 nights. After training is complete, the steps are repeated if the child wets the bed 3 nights in a row. Dry-bed training may take less time and have greater long-term success when it is combined with other treatments, such as a moisture alarm or self-awakening training.
• Imipramine and desmopressin medicines. Although medicines help some children with bed-wetting, the wetting usually returns after the medicine is stopped. Medicines are usually used with children age 8 and older after other treatments have failed. They may be used in combination with other treatments or when needed on a temporary basis, such as for an overnight event. Sometimes, medicine may be given for a few nights as a way to encourage or motivate a child by helping him or her experience nighttime dryness.

What new problems could develop if I treat my child's bed-wetting?

Depending on how you manage it, your child might feel punished or feel as though attention is being drawn to the wetting.

If you choose to use medicines to treat your child's wetting, he or she may have side effects from the medicines, such as an irregular heartbeat. Some of the medicines must be kept out of the reach of children because they can be very dangerous if taken in large doses.

What are the risks of not treating my child's bed-wetting?

As long as your child's bed-wetting does not have a specific medical cause, deciding against treatment does not increase his or her risk for physical problems.

Bed-wetting may affect the child's self-esteem and relationships with other same-age children and with family members. However, you may be able to help prevent these problems. Reassure your child that it is normal for some children to take a little longer than others to gain bladder control. Ask what the child would like to do to manage the problem until it goes away, and expect him or her to take responsibility for it (with your support).

If you need more information, see the topic Bed-Wetting.

In general, if your child doesn't have a specific medical cause for bed-wetting, your choices are:

• Wait for the bed-wetting to stop without treatment.
• Use home treatment, possibly including devices like alarm clocks, moisture alarms, and disposable underpants or techniques such as self-awakening training or motivational therapy, which may involve counseling by a health professional.
• Use medicine.

The decision about whether to treat your child's bed-wetting takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about treating your child's bed-wetting. Discuss the worksheet with your health professional.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to treat or not treat your child's bed-wetting.

Check the box below that represents your overall impression about your decision.

Return to the topic Bed-Wetting.

Citations

1. Makari J, Rushton HG (2005). Nocturnal enuresis, search date March 2005. Online version of Clinical Evidence (14): 1–10.

2. Koff SA, Jayanthi VR (2002). Nocturnal enuresis. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 3, pp. 2273–2283. Philadelphia: W.B. Saunders.

Author:	Amy Fackler, MA Debby Golonka, MPH	Last Updated: November 14, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Peter Anderson, MD, FRCS(C) - Pediatric Urology
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