How to stop Bed wetting in children : Behavioural therapy

How to Stop Bed-Wetting

Bed wetting is a common problem in children that needs to be understood and dealt with appropriately by the parents and the child. The difficult aspect in bed wetting (nocturnal enuresis) treatment is that it needs commitment from both parents and children. This article is for educational purposes only and not a substitute to medical consultation and therapy.

If you have a child with nocturnal enuresis you should go to a doctor to evaluate the condition and search for possible causes (urinary tract infection, diabetes and other problems have to be excluded). The doctor will be able to address the problem, suggest medication if needed, follow up the case regularly. In this article I will focus on understanding the problem and helping parents cope with enuresis and practicing the right behavioral therapy techniques.

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Understand the problem: Avoid blaming the child

Bed wetting is not uncommon in children over 5 years even if they are toilet trained and dry by day. Urinary continence is a developmental process, being dry at night is the last step of this process. This is important to know, because this tells us that the problem can be solved with time and some good practices.

Parents and children should understand that bed wetting is not the child's fault, under no circumstances you should make your kid feel shameful or "dirty". Avoid blaming the child.

Factors that affect bed wetting

  • A normal delay in the continence mechanism (as mentioned above).
  • Deep sleep! children who sleep deeper than others can be more likely to wet their beds.
  • Bladder irritability. A doctor may order a test to evaluate the bladder capacity and irritability to give treatment accordingly.
  • Genetic susceptibility.

You will find that treatment options will target these factors e.g. to overcome deep sleep you should wake the child, the doctor may give treatment for bladder irritability, etc.

Treatment options for bed wetting in children

When organic causes are excluded/treated (e.g infections), most doctors will start with behavioral therapy and reward systems to stop bed wetting before trying medications and will advice continuing it with medications. Treatment strategies should be modified depending on the severity of the symptoms, age, response to therapy and other associated symptoms (that's why your doctor will ask you about many details!).

The basics
These are the basic tips your doctor will tell you, don't underestimate them:

  • There shouldn't be diet restrictions for children with nocturnal enuresis.
  • During the day, the child can drink as he wishes, avoid anything with caffeine (cola, tea, Nescafe, coffee, etc).
  • Encourage regular emptying of the bladder during the day.
  • Limit drinking at night to water only when the child is thirsty, no extra drinking at least 2 hours before sleep.
  • The last thing your child should do before sleep is going to the toilet.
  • Wake the child at night and help him go to the toilet about midnight or 2-3 hours after sleep, if you know the exact time the child wets his/her bed eery night, wake her up before this time. This is why I mentioned it will need commitment from the parents, try to take turns or use your phone's alarm.

Reward Systems

  • Using reward systems have shown great results in treating nocturnal enuresis. Remember to avoid blaming the child or showing anger. Reward the child not only for dry nights but for good behavior, for example: for going to the bathroom before sleep, for not drinking cola, etc.
  • Never punish the child or remove a reward he previously earned.
  • Record the child's progress e.g. put a star next to every night he has behaved well.

Using alarm treatment

Special alarms ar available at the market that can sense moisture and wake up the child. Alarms can be effective, reward systems should be combined with alarms, they have good long term effects. Discuss your roles with your partner about rewarding and waking the child.

The alarm will wake the child (and the parents) when the child wets his underwear, this way, the child will get used to waking up at certain time, that is why alarms may take weeks before achieving dry nights (yes, it is that biological watch, it will need about 2-3 weeks to readjust itself!).
So basically, alarm treatment is the substitute to waking the child yourself. Alarms are not suitable for all families, if the alarm is not acceptable by the child or by you, tell the doctor.

If there is poor response to the initial trials of therapy or when rapid improvement is needed, the doctor might start adding drugs such as Desmopressin or anticholinergics (oxybutynin).

Things to Remember

  1. No diet restrictions to treat bed wetting, just encourage a healthy diet.
  2. Encourage using the toilet regularly during the day and before going to bed. Reward your child.
  3. Avoid caffeine based drinks.
  4. Never blame the child or punish him. It is important to understand and to help the child understand that this is a common problem and that it is curable and improves with age.
  5. If you are having problems coping with enuresis, if you are too angry about it or you think you need support, ask the doctor for help and look for support groups. Also, consult with your doctor if this problem causes psychological or emotional impact on your child. This is stressing enough for the kid and he/she needs understanding and helpful atmosphere to help him stop bed wetting.

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