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At age 7, Billy was getting invitations for sleepovers from friends. He wanted to go, but there was a problem: how to stop bedwetting.
Bedwetting had been an ongoing issue for Billy, says his mother, Jane, (not their real names) of Bethesda, Md. Her two older children hadn't had the problem, but Billy couldn't seem to stay dry. "He wanted to start being dry so he could go to sleepovers," she says.
Billy has lots of company -- 20% of 5-year-olds and 10% of 6-year-olds are bedwetters, says the American Academy of Pediatrics. Most grow out of it and usually there's nothing serious going on. But statistics and research weren't making the sleepovers easier for Billy.
So Jane broached the topic with Billy's pediatrician and heard some good news. Bedwetting solutions abound, from simple "reward" systems to using urinary bed alarms -- the strategy that ended up working for Billy.
Here, what parents hoping to help their child stop bedwetting need to know about solutions.
Before pediatricians suggest a specific bedwetting solution or treatment, most seek to educate parents.
Bedwetting "often runs in families," says Howard J. Bennett, MD, a pediatrician in Washington, D.C., author of WakingUp Dry, and Billy's pediatrician. Usually, the child becomes dry at about the same age as the parent did. And no matter what you may think, bedwetting is not due to laziness or spite, two common misconceptions, pediatricians say.
Getting your pediatrician's input, instead of trying remedies on your own, may speed things along, according to a study published in the Journal of Urology. Researchers found that when children followed their pediatrician's advice about bedwetting solutions they were dry earlier than a group of children whose parents picked the treatment to stop bedwetting on their own.
Next, physicians are careful to take a medical history and rule out medical causes, such as constipation or infection. Most bedwetting is what doctors call primary enuresis, meaning the child has always wet the bed. Doctors think it’s usually caused by a delay in the maturation of the mechanisms controlling the bladder.
But if bedwetting occurs after the child has been dry for a year or so, it’s termed secondary enuresis, and physicians must look more closely at the cause. Secondary enuresis could occur with psychological stress or trauma, and the child may need counseling or other treatment.
If no medical or psychological causes for bedwetting can be found, the family can move on to ways to help the child stop bedwetting.
Urinary bed alarms are generally regarded as the most effective bedwetting treatment for the long term.
Alarms are available in several different styles, but all include a moisture sensor and an alarm. One model, for instance, involves a moisture sensor worn on the underwear or pajamas, attached to an alarm box worn on the shirt. The sensor detects moisture almost immediately and sounds the alarm, alerting the child to get up and go to the bathroom.
In a report summarizing the medical evidence on bedwetting treatments such as alarms, behavioral interventions such as giving rewards, and medications, alarms were found to be the most effective. The study was published in the Journal of Wound Ostomy Continence Nursing.
In another study, published in the Journal of Paediatric Child Health, researchers found that 79% of 505 children who wore bed alarms achieved dryness within about 10 weeks (half took longer, half took less time). Six months later, 73% of those children were still dry.
While many parents try the other strategies first even before discussing bedwetting with their pediatrician, some go straight to the bed alarm.
Eleanor and her husband, Ray, moved to another common strategy -- the reward system. This can involve giving the child a small toy after a dry night or rewarding him with a trip to the park or someplace else he wants to go. Eleanor and Ray bought little prizes, such as coloring books and rubber balls, and pasted them on the wall so Michael could look at them.
"When he had a successful night, he would pick a prize," Eleanor says. "That worked for a while."
Anything special to the child can be used as a reward, says Robert Mendelson, MD, a Portland, Ore., pediatrician who often counsels parents about bedwetting issues. Load on the praise, too, he says. "Any time the child is dry in the morning, tell them how great they are," he says. "Congratulate them, tell them, 'You are getting to be a big boy or girl.'"
Eleanor and Ray also tried a technique called "lifting." This strategy involves making sure your child goes to the bathroom right before his bedtime, and then waking him up after he has been asleep two or three hours and taking him to the toilet.
"We went to two times a night," Eleanor says. "One at 11 and the other at 2:30 a.m. My husband got the 2:30."
Patience won out. "It didn't work immediately," she says. "We did this for over six weeks." Suddenly, one day he didn't wet. And the next, and the next. She doesn't know if it was the lifting or just time. "I think he just grew out it," say Eleanor, who is relieved.
"Lifting can be a helpful temporary measure while you are waiting for kids to get dry on their own," agrees Bennett.
Helping your child delay urination during the day is another strategy. Using an egg timer, you ask your child to tell you when he has to go, then ask him to hold it for another few minutes. You start with about five minutes and add a couple minutes each time, he says. The goal is to get to 45 minutes.
But this process takes time and you should do it every day, he says. If old enough, a motivated child can do it on his own.
Limiting fluids at night is widely suggested but can be difficult to do. Eleanor, 40, of West Covina, Calif., tried taking away liquids every night at 7 p.m. when she was attempting to help her son Michael, now 4 1/2, stay dry all night.
Then she moved it up to 6 p.m. "He started begging me for a tiny drink, and I felt so bad," she says. Looking into his eyes as he begged for just a sip was too much for her, she says. "So I couldn't do that anymore."
"I don't recommend restricting fluids unless it is the kid's idea," says Bennett. "Otherwise the kids see it as a punishment."
Plastic sheets and disposable underwear can save sanity and mattresses. You can also use the "double bubble" method of making a bed. Layer a plastic sheet, regular sheet and a blanket; then repeat the process.
Teach the child how to strip off the top layer and make a fresh bed. Keep some fresh pajamas or disposable underwear bedside, too, so he or she can easily change into dry ones.
Super absorbent training pants designed for use at night can help, as well. Bennett tells parents they are fine to use when the child is 4, 5, or 6
By age 7, he usually suggests trying something else.
Medications usually work while the child is taking them, but once they’re stopped the bedwetting typically starts again. And the medicines can have side effects.
Among the bedwetting treatment options are desmopressin (DDAVP), a synthetic copy of a body chemical that controls urine production, given at bedtime. It's available in tablets and nasal spray forms, but the nasal spray is no longer indicated for primary bedwetting treatment, according to an alert issued by the FDA in late 2007. The agency cites risks of the nasal spray causing low blood sodium levels, in turn possibly leading to seizures and death.
Bennett sometimes prescribes DDAVP in tablet form temporarily, perhaps to help a child stay dry on a sleepover or at camp. "It works immediately if you have the right dose," he says. He will try out a dose before it's needed to be sure he has picked an effective one.
Another medication option is imipramine (Tofranil), an antidepressant that may work by reducing urine production, affecting the amount of time a child can hold urine in the bladder, or other ways.
Bedwetting medications may help in a social situation such as sleepovers but are usually a last resort, according to the American Academy of Pediatrics. They are not recommended for children younger than 5 years old.
Jane's family had tried most of the do-it-yourself strategies with Billy before turning to the bed alarm because nothing else had worked.
Using the bed alarm takes commitment from parents and children, according to Bennett, who says he has worked as an unpaid consultant helping bed alarm companies with product design. And it takes different amounts of time to work, he says.
"Early on, even the alarm didn't wake him," Jane recalls. "We would have to go wake him up." Things got better. "It wakes them up quicker and quicker. It took us a couple months of the alarm going off, and then it worked well."
"It took probably six months until he was totally dry. And then he had a recurrence about a year later. We put on the alarm again and in a week he was OK."
But Susan, her husband Mark, and their son Mike (not their real names), who was then 6, had a much more dramatic experience using the bed alarm. Within a week of using the alarm, he was dry. "He had a problem at least three or four times a week," Susan says. After the alarm worked, she says happily: "He went from a guy who wet the bed a few times a week to a guy who never had a problem."
Encouragement is crucial as you work to help your child stay dry, Mendelson says. He encourages parents who wet the bed as children to tell their kids -- and to tell them at what age they became dry. It ''points out the hereditary nature of the problem" and helps children understand that eventually they will have control over the problem, he says.
Whatever method helps a child stay dry, most parents -- and kids -- are relieved when dry nights prevail. Eleanor, who used the reward system, considers dry nights a milestone that may even surpass other important ones such as learning to walk or starting preschool.
"This one wins," she says happily. "It is the biggest milestone we have hit so far."