From Penn State Health, welcome to Ask Us Anything About... Bedwetting in Children
I'm Scott Gilbert it's a scenario familiar to many parents, they may walk
into their child's room in the morning and find wet pajamas, sheets and a
mattress. And they may find themselves wondering, why did it happen? Especially
when the child's been toilet trained for a couple years. We'll answer that
question and talk about how parents can support their children in that situation.
As we talk here with Dr. Amy Burns, she's a pediatric urologist. Dr. Burns, thanks
for being here today. Thank you for having me. Also with us Karen Thompson,
she's a nurse practitioner in pediatric urology here at Penn State Children's
Hospital. Karen thanks for your time. You're welcome. Let's start with, normals,
is a subjective word but what is normal with regard to bedwetting? Given that it
seems like, pretty much every child deals with us for at least some period of time.
Yeah, so bedwetting or nocturnal enuresis is very common in children. A lot of
children will outgrow it by the age of five but even around five years of age
for girls and up to seven years of age for boys, about 20% of children will
still have episodes of bedwetting. And then over time, about that number
will decrease each year so that by age fifteen only about 1% of children wet
the bed. 1% okay and this is not a conscious decision by the child right
what we want to emphasize. That is true that is completely out of their
control. And that's important to emphasize
because it should not be a reason for punishment for example. Right, nor
should they be rewarded for a dry night because that too is out of their control.
So when it comes to the risk factors and causes of this, I mean I can think of one
of drinking too much liquid before bed but it really goes beyond that doesn't it?
There are a lot of risk factors. There are quite a few risk factors including
parents that wet the bed as well will have an increased incidence in their
children. So like when the genetic factor when when parents were young, if they
tended to struggle with this as their children may? Correct.
What about some of the other causes? Well, along with the genetics, which does play
a strong role in many kids, if one parent what the bed there's a 40% chance that
their child will wet the bed and if both parents were bed wetters then there's a
75% chance that the children will have bed wetting. Other things that can
contribute to bedwetting though include certain behaviors like you mentioned
drinking too much water prior to bedtime. Many children who wet the bed don't go
to the bathroom before they go to sleep or won't empty their bladder
completely prior to going to sleep so that's another contributing factor.
Some kids will not drink much water throughout the day at school and so
they'll come home from school very dehydrated and thirsty, get the vast
majority of their fluid and taken the late afternoon and early evening and
then at night they wet. Sometimes, it's related to children just having a
smaller bladder capacity than their peers. That can contribute to it as well.
In some instances there can be an abnormality in a hormone called ADH
that regulates the production of urine overnight. In other instances, children
who have significant bladder and bowel dysfunction during the day can have
problems with bedwetting at night. Symptoms associated that with that would
be constipation, urinary urgency frequency, wetting accidents during the
day, prolonged holding of urine during the day, recurrent urinary tract
infections. Sometimes the if the child has sleep
apnea or snoring, that is also a known risk factor for urinary tract infection.
And then finally, there are various other medical conditions that can that can
contribute to bedwetting but for most of these children, they have primary
enuresis of the kind of the traditional bedwetting that we think of where the
kid has just never become dry at night. You're watching, Ask Us Anything About
Bedwetting in Children. For Penn State health I'm Scott Gilbert,
alongside Dr. Amy Burns, she's a pediatric urologist at Penn State
Children's Hospital. We also have Karen Thompson, she's a nurse practitioner in
pediatric urology. We welcome your questions in your comments and the
comment field below this Facebook post. Whether you're watching this video live
or if you're watching on playback. Feel free to ask some of those questions and
we'll get the answers here from the experts. You know, I think one question
that a lot of parents watching probably have, Karen, is when is it time to
possibly have your child evaluated? When is it time to talk to the pediatrician
about this versus just writing it off as something that he or she will grow out of?
I think the biggest consideration there is whether or not it bothers the child.
If they're not bothered by it, medically, this problem does not hurt them.
It certainly can be a psychological problem and if they're waking up feeling
bad about themselves. I think it's time to consider referral to a urologist
When that referral takes place Dr. Burns, tell me about the steps that you take to
evaluate the child as to whether or not treatment may be necessary. For the
initial evaluation for these children, it involves a good history and physical
exam along with a collection of data about their daytime voiding habits and
their your urologic history and then really just checking a urinalysis so
dipping their urine and checking for protein or signs of infection any other
abnormalities I really reserve any sort of imaging like ultrasounds to look at
the kidneys and bladder or any neurologic imaging like MRI if
there's the significant problems with daytime voiding dysfunction or a
neurologic abnormalities seeing on physical exam then that would prompt
other studies but for the most part the initial evaluation is just history
physical exam in your analysis. You're watching Ask Us
Anything About... Bedwetting in Children from Penn State Health. If you find this
information valuable, we encourage you to share this post on your Facebook feed.
Think of all the parents out there pretty much every parent encounters this
issue at some point so, we're trying to give you some
good information on that and we welcome your questions as we do so here for
Dr. Amy Burns and for Karen Thompson. Karen, can we talk a little bit about some of
the treatments? There's a range of different treatments and I imagine it
could depend on kind of what the cause is but you talked about some of the most
common treatments that are utilized in the clinic setting? In, general we have
three treatments. One, do nothing because again this does not harm the child.
Number two, there are bed alarms. This is a device that is clipped to the
child's underwear and it's senses when there's wetness and sets an alarm off.
The child then wakes up and goes to the bathroom and finishes peeing. There will
be a little bit in the bed and over time, less in the bed more in the toilet.
And this has a very good success rate. It is a lot of work though. A lot of these kids
are very very sound sleepers so that alarm is waking up other kids. Loud alarm?
Yes. And the child with the problem may sleep right through the alarm. So,
I've seen behavior modification as a form of treatment. That sounds like it
fits into that category. Right and with any of these
treatments, we recommend kids have nothing to drink two-hours before
bed and make sure they empty their bladder well before bed. There's also a
medication DDAVP. Dr. Burns, tell us a bit about what that medication can do and
when it might be time to go that route. Yeah, DDAVP is very effective. It
doesn't cure bedwetting per se. It basically treats the symptom which is
overproduction of urine in children. It's basically a mimic of the hormone
that your body naturally makes. It's very safe in children. It can be increased or
decreased to have a desired effect. About 30% of children will become completely
dry on DDAVP with another 40% that will have significant improvements. It's also
really nice for kids that are just interested in being dry when they
go to slumber parties or they're going on vacation where they might be in
social situations we're wetting the bed would be embarrassing for the child. But
it doesn't actually cure the bedwetting. And then periodically we'll try to wean
the child off of the medication and see if they've outgrown it. Whereas you know
the urine alarm actually can can cure the bedwetting. You're watching Ask Us
Anything About... Bedwetting in Children from Penn State Health and Penn State
Children's Hospital. We have a comment here from Marie. She says, thank you for
talking about this. I have a seven-year-old who pees the bed almost
every night. So, I imagine again, there are a lot of parents out there kind of
wondering at what point is that something I should be concerned about?
Is it age six? Is at age seven? Is it eight or does it just really depends on the Child
I suppose? Yeah, I think it really depends on the child. I think, you know, age
five for girls, age seven for boys, are kind of the rough cut offs that I use
because more boys tend to wet the bed a little bit later. You know, I tell
families when they asked me about this you know if the child's not bothered,
then neither am I. And I won't intervene and treat but occasionally
sometimes it children are bothered by it and so we try we do our best to reassure
them that this is a normal behavior. We think that there's just an immaturity
between the bladder and brain communication. The child has no control
over it. I think it's always reasonable to you know offer reassurance since the
spontaneous resolution rate is so high, oftentimes people feel better just
knowing that. And then, doing the simple behavioral changes like the fluid
restriction but just making sure that they're drinking enough throughout the day.
Making sure they don't have any daytime issues particularly with
constipatio. A lot of people don't think their children are constipated and yet
when you start asking questions about the children having hard stools,
straining, I'm having a belly pain, having very large stools, you start to see the
the kid actually does have significant problems with constipation even if
they're they're pooping every day . So your talking about fecal issues but those do
have a connection to urinary issues as well? Yeah, absolutely, and I
describe it to people as being a real-estate issue the rectum sits right
behind the bladder and if it's filled with stool then at nighttime, the bladder
just can't expand to fill with urine instead and oftentimes kids that are
have constipation also have urinary problems during the day. And I really
think for any parent that's going to commit to the urine our alarm
or use DDAVP, it's very very important to make sure that any daytime voiding
issues like constipation or lower urinary bladder symptoms are treated
because any intervention for nighttime weighing is bound to be much more
successful after constipation and daytime voiding dysfunction are remedied.
We see that probably in twenty to thirty percent of our children. And Karen, on
rare occasion bedwetting may be a sign, not in all cases, but in some it may be a
sign of more serious underlying medical issue. Can you talk about what some of
those issues might be? I can throw that to Dr. Burns? Yeah, I mean, it's such a wide range of it.
If it's a spinal anomaly, you know, we would send them off to neurosurgery
and be a big workup. I would say the vast majority of these kids do not have an
underlying issue. It can be associated with, you know, most of the kids they
don't, so just to reassure the parents and our audience but if we do detect
something abnormal and physical exam or they have significant daytime voiding
issues or they have secondary enuresis where they might have been dry
for a period of six months and then started to wet the bed again that's also
a little bit more concerning for the child may be developing something like
diabetes or have some sort of chronic kidney disease and so, for the
most part, these kids are healthy children and it's a very common
behavior and children. Good to know and for that reason I know we talked a bit
of earlier about praising and things you should and even should not praise a
child for. So, if a child who typically wets the bed has a dry night, that's
actually not a good reason to praise them. Right Karen? Correct. Because you know
then they're going to feel even bad. May feel even worse when they have a wet night.
The dry night is out of their control as well. They do have control
about limiting fluids in the evening and always emptying their bladder well.
So those are things you can praise the child for. Yeah, absolutely. So if the
child has a daytime peeing and pooping problems, if they're peeing on a schedule,
relaxing when they pee, taking their time, drinking fluid throughout the day,
eating their fiber gummy bears or whatever treatment is being used for constipation,
then you can praise the child for that. And that and of itself is
effective for treating a good number of kids with a bedwetting. But you got to
be careful about praising the child when they just wake up dry because just like
waking up wet and they don't have control over either situation and like
Karen said, you do run into a trouble if you know you're praising the child and
cheering them for a dry night and then the next morning they're wet again,
they're going to feel bad. And really, like I know we've said
this already, but they really have no control over whether or not they
wet the bed and it's a normal thing for kids to do so we really wanted to emphasize that today.
It's an important takeaway here as we wrap up.
So, thank you both for your time and thanks for all the great information today.
We did get a comment from Megan she commented to thank Dr. Burns for caring
for her son. I'm sure that's always great to hear. Thank you, that
makes me happy! Thank you for your comment Megan.
Thanks to the others who commented and we appreciate you watching this edition of
Ask Us Anything About... Bedwetting in Children. If you want more information
about pediatric urology at Penn State Children's Hospital, you can go online to
Childrens.PennStateHealth.org that's Childrens.PennStateHealth.org
Children's, plural Penn State Health dot org. Just a reminder,
If you find this information helpful make sure you subscribe to this Facebook page so that
we can provide you with more updates and you can follow everything going on here
and the good information from Penn State Health Milton S. Hershey Medical Center
One other question that just popped in... What if your child is aged 12 and still wets the bed?
[Sorry - Lost connection - See Facebook comments for answer]