(© Bonnie Schiedel. Originally published in Canadian Family, March 2009). 

It’s a rare parent who hasn’t awakened to a soggy little person in the early morning hours. While you may associate bedwetting with very young children, about 10 per cent of kids in elementary school are wet at night, says Dr Howard Bennett, a Washington, DC pediatrician and author of Waking Up Dry. “However, it’s the kind of thing that isn’t talked about outside the family, so your child may think he or she is the only one this happens to,” he adds. “It helps them to know it’s a very common situation.” Here’s how to help your family avoid the wet-bed blues. 

Causes of bedwetting 
Bedwetting, also known as enuresis, is divided into two categories. Primary enuresis, the most typical form, is defined as a child over age five who has never consistently had bladder control at night. There are a number of contributing factors. “The brain may not be communicating with the bladder—we’re not sure why not—so the child is not getting the signal to wake up and pee,” says Katharine Saje, an advance practice nurse at the urology clinic at Sick Kids’ Hospital in Toronto. Heavy sleeping, snoring, small bladders and genetics may also be factors. “Upwards of three-quarters of children I see at my practice will have a parent or another close relative was wet as a child too,” notes Dr Bennett. “We always encourage parents to talk about that to make the kids feel better.” Constipation can lead to bedwetting too, since a full rectum pushes against the bladder. 

About ten per cent of the time, bedwetting falls into the secondary enuresis category, where a child has been dry for about six months to a year or more, and then starts wetting the bed. Underlying medical conditions, like a urinary tract infection or diabetes, may be the cause of secondary wetting. But most often, the condition arises due to anxiety, resulting from a move, new baby, divorce, or trouble at school. That’s the case for the Vogel* family in Brandon, Man. “Jacob is eight and wets the bed about four nights a week. He was dry from about age four to age six, but then started wetting the bed after some bullying in grade one,” says his mom Sandy, who is working with their pediatrician to help Jacob stay dry at night. “We give him lots of drinks during the day and we ask him to wait as long as possible before going to the washroom. Our pediatrician suggested these two things in tandem would help increase his bladder capacity,” says Vogel. Jacob also goes to the bathroom before and after reading a book at bedtime, plus his parents get him out of bed for another pee before they do to sleep. Very occasionally, bedwetting may be due to an underlying medical condition like a urinary tract infection or diabetes.


Stay-dry tips
The most important thing to remember is that kids who wet the bed are not doing it on purpose, and they shouldn’t be punished or made to feel ashamed, says Saje. There are a number of ways you can help your child stop wetting the bed, but only when he is ready. Signs of a motivated child include his communicating that he does not want to wet the bed and a willingness to make changes in the bathroom routine, such as limiting liquid at night. Saje also recommends following a consistent routine. “When your child wakes up wet, she should go into the bathroom to pee, because that completes the action. With the help of a parent, put the wet sheets in the tub until morning, when she can help wash them, and remake the bed. It’s not punishment at all, but it’s a way of training the brain.” Saje says that over time, the child learns that it’s easier to use the bathroom rather than wet the bed. 
Studies show that bedwetting alarms (where a buzzer sounds when an underwear or mattress sensor detects the release of urine) are successful tools for teaching the brain and the bladder to communicate with each other at night, says Dr Bennett. For short-term situations like overnight camp, your doctor may prescribe a medication called desmopressin which decreases the amount of urine the body produces. Or for sleepovers, you might ask your child to wear age-appropriate disposable night-time training pants. 
But the best way to help a bed-wetter is a positive attitude, says Vogel. “We keep reassuring Jacob not to worry and that he will be able to stay dry long before he goes off to university!”