This week saw some of the older children at my son's school go off on a two-day trip. The playground was buzzing with excitement. I watched as rucksacks were piled high and parents bade fond farewells to their kids. For many of the children this was their first night away from family and you could sense the mix of excitement and slight apprehension on some of their faces. I couldn't help wondering if some of the youngsters (and parents) had any extra worries? Bedwetting is not an uncommon problem, but only really becomes an issue once children start attending sleepovers, camps and so on. I crossed my fingers that none of the kids would have any nocturnal accidents and the only reasons they wouldn't sleep would be due to too much chatting and midnight-feasting.
Approximately 30% of children aged 41/2 wet the bed, and developmentally it isn't expected for children to become dry overnight until they are at least five years of age. Even at the age of seven years around 3% of children wet the bed on a regular basis, and approximately one in 65 children are still having accidents aged nine.
There are many reasons as to why children suffer with bedwetting - or nocturnal enuresis - to give it its proper name. The first is simply that children develop at different rates. Just as some children walk earlier or later, so some become dry overnight earlier or later. Deep sleepers often struggle to become dry overnight, and drinking too much before bed is certainly not going to help the situation. As children get older it is worth making sure that there are no other factors preventing them becoming dry. Constipation is a common reason kids have night-time accidents, and anxiety symptoms can also exacerbate the problem. Occasionally other complaints such as a urine infection or overactive bladder can be to blame. Vasopressin is a hormone that reduces the amount of urine the body produces overnight. Sometimes there isn't enough of this hormone in children, which leads to regular bedwetting.
The most important pieces of advice I have about bedwetting are those of reassurance. Firstly: for most children it will sort itself out with time and patience. Secondly: it is not their fault. It is also not your fault. In fact it isn't anybody's fault.
Simple tricks can often help considerably in the first instance. Making sure your child drinks most of their fluids during the daytime, and limiting drinks before bed to a minimum, are sensible steps. Children between the ages of 4 and 8 should drink in the region of 1000-1400 mls of water per day (around four to six cups) and caffeinated and fizzy drinks are best avoided.
Current evidence shows that lifting your child in the night will not help them to get dry quicker, and nowadays is not recommended.
Many children love a good old-fashioned reward chart. Rewarding your child for responsible behaviour, not for having a dry night, is the aim of the game. Ideas for the chart include: drinking the correct amount of water each day, not drinking an hour before bed, having a wee before going to bed or helping to change the sheets if they have had an 'accident'. This approach should help encourage good habits, whilst also empowering and engaging your child.
Should rewards not do the trick, you may want to consider alarms. Alarms can be immensely helpful at training children to hold on to their wee during the night, and often results can be seen within just a few weeks. There are many different alarms on the market and your school nurse or local nocturnal enuresis clinic may be able to help advise you on the different products available.
Occasionally medication can be useful for children. Usually it is reserved for kids over the age of seven, especially if a quick response is required (eg for a sleepover etc). Desmopressin is the initial medication used and must be prescribed by a doctor or specialist nurse It is a synthetic version of the vasopressin hormone I mentioned earlier, so helps reduce the amount of urine the body produces overnight.
As the statistics bear out, the vast majority of children grow out of bedwetting with time. Holding your nerve and keeping positive can go a long way in helping both you and your child. For more information the website ERIC has a wealth of additional information and tips on it, so may be worth checking out.
Dr Jessica Garner is a GP and health blogger. Visit her blog here.