Children under age five may occasionally wet the bed because their bladder control is still maturing. However, only children over age five who experience involuntary urine loss on a regular basis are considered enuretic, according to the American Academy of Family Physicians (AAFP). Older children may need to receive treatment for nocturnal enuresis if they wet the bed at night, although the condition may also eventually subside on its own.
Definition
A diagnosis of nocturnal enuresis is established in a child between five and six who has two or more bedwetting episodes in a month, or a child over age six who has one or more bedwetting episodes in a month. However, this diagnosis is adapted for mentally disabled children. A mentally disabled child should reach a mental age of four before he is deemed enuretic.
Statistics
Between 15 and 25 percent of five-year-old children wet the bed, with boys being three times more likely to have nocturnal enuresis than girls, according to the AAFP. Since the percentage of bedwetters declines by 15 percent each year thereafter, only four percent of 12-year-old girls and eight percent of 12-year-old boys are enuretic. According to the Urology Channel online, about 25 percent of bedwetters have secondary nocturnal enuresis, wherein bedwetting suddenly begins after at least six months of dryness.
Causes
A variety of factors may cause bedwetting in older children. While some children are genetically predisposed to nocturnal enuresis, others may experience nocturnal enuresis due to hormonal conditions or a reduced functional bladder capacity, which is how full a bladder will get before it empties itself. Moreover, nocturnal enuresis has been linked to children who sleep deeply, are prone to sleepwalking or have night terrors.
Diagnosis
Before a doctor diagnoses nocturnal enuresis, he will perform a physical examination and inquire about a child's past health, family health and any current medications she is taking. He may also ask about bowel habits, sleep patterns and any urinary issues. If a child experiences pain upon urination or feels a consistent urge to urinate even if the outcome is small, she may have a health condition such as a urinary tract infection (UTI). A doctor will also likely order a urinalysis and urine culture of a child's urine in order to rule out potential disease.
Treatment
The treatment of bedwetting in older children will vary depending upon the underlying cause. For example, a bladder infection may require antibiotics but behavioral approaches will be necessary for most other causes of nocturnal enuresis. Behavioral approaches may include offering a child fewer beverages and no caffeine before bed, encouraging a child to use the toilet prior to sleep, investing in a bedwetting alarm that will ring when a child starts to wet the bed, and teaching a child positive imagery--e.g. before she goes to sleep, imagining herself dry when she wakes up.
