No definitive cause of bedwetting
Bedwetting is a common problem in young children but, in time, most become dry at night without any treatment. However, treatment is considered for children aged five and over.
Although many children are dry at night by the age of three, it is common for children to require nappies at night until school age. However, bedwetting may occur beyond this age and about one in seven children aged five and one in 20 children aged 10 are bed-wetters.
There is usually no specific cause for bedwetting; it occurs simply because the volume of urine produced at night is more than the child's bladder can hold. The sensation of a full bladder does not seem strong enough to wake the child at night.
Factors that can contribute to bedwetting include stress (arising from school pressure, bullying etc), drinks and foods containing caffeine which increase the amount of urine made by the kidneys, and constipation in which large stools in the rectum may press on and irritate the bladder.
Further causes include a urinary infection, sleep apnoea (pauses in breathing whilst asleep), diabetes and rare disorders of the bladder. A specific medical cause is more likely if daytime wetting occurs in addition to night time bedwetting.
* It is best to stop using nappies when you decide that the time has come. Some older children are still put in nappies at night when trying to be dry but this gives them little motivation. However, in young children, if a trial without nappies does not work out you can go back to nappies and try again at a later date.
* There is a great variation in the age at which children become naturally dry at night. Do not punish children for bedwetting - it is not their fault. If an improvement is noticed, praise and make a fuss of your child.
* Your child's co-operation is important. As soon as your child is old enough to understand, a simple explanation can be helpful.
* Encourage your child to help change wet sheets when old enough. Children respond to being given responsibility.
* Make sure there are no hidden fears about getting up at night e.g. fear of the dark or of spiders.
* Restricting drinks can help but does not cure bedwetting. The bladder has to get used to filling up and holding urine. Daytime restriction prevents this - children should drink at least 6-8 cups of fluid per day. A sensible plan is to only give drinks if your child is thirsty 2-3 hours before bedtime.
* Parents may wake children to take them to the toilet several hours after bedtime. However, this can prolong the problem; children have to get used to waking up when their bladder is full.
Bedwetting alarms are a common form of treatment. An alarm is usually needed for 3-5 months to condition the child to wake and empty their bladder when it is full. The alarm goes off as soon as wetting starts, waking the child to prompt him or her to go to the toilet.
Medicines containing desmopressin work by reducing the amount of urine made by the kidneys. However, when discontinued, the bedwetting often returns.
Reward systems such as star charts, can prove effective in motivating children to become dry.