Many kids have early childhood experience with bed-wetting; for some, the problem extends beyond the average toilet training learning period. Potty training is much easier for kids when they are awake than when they sleep--they must learn to recognize and respond to cues that their bodies provide while asleep. A number of factors influence how quickly children are able to make it through the night without an accident.
Identification
Bed-wetting results from the passage of urine produced by the kidneys as a child sleeps. Urine is held in the bladder by its sphincter muscle, which relaxes to allow elimination. A second muscle, the detrusor, contracts around the bladder to push urine out. Some bed-wetting is normal as children learn to wake in response to signals sent to their brains by these muscles.
Features
The American Psychiatric Association (APA) calls bed-wetting beyond the age of 5 primary nocturnal enuresis. The American Academy of Pediatrics suggests that 20 percent of children may have some bed-wetting problem at age 5 and that the percentage decreases with each year of age; about 1 percent of 16-year-olds still have the problem. The American Academy of Family Physicians (AAFP) estimated that as of 1999, 5 to 7 million American children had the condition.
Causes
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) lists immature bladder, over-production of urine, deep sleeping and heredity as common causes for bed-wetting. Children whose bed-wetting stems from these factors often grow out of it between ages 5 and 7. Other causes may require treatment; infection or nerve disease may also cause daytime wetting, and bed-wetting may reappear due to stress factors in the family or at school.
The National Association for Continence (NAFC) adds two more causes. Arousal dysfunction is the inability to respond to cues from the bladder muscles during any level of sleep, and constipation may crowd or reduce the capacity of the bladder.
Considerations
Although some bed-wetting is normal in very young children, when it persists several times a week past age 7, the NKUDIC recommends consulting a health care professional who can rule out infections and offer advice. According to the NAFC, most pediatricians begin to show concern about bed-wetting only after age 6; parents should be proactive and bring up wetness concerns during any of their child's regular visits. In addition to working with pediatric specialists, parents should be careful to emphasize that bed-wetting is a treatable problem and support their children's efforts.
Options
Seeing specialists in pediatric urology and psychiatry may help if bed-wetting persists or returns as secondary enuresis after six or more dry months. For older children, medications including desmopressin acetate and the antidepressant impiramine may successfully regulate urine production or improve wake-up cues. Some practitioners employ complementary, holistic and integrative solutions successfully.
References
- American Academy of Family Physicians: Primary Nocturnal Enuresis - Current Concepts
- National Kidney and Urologic Information Clearinghouse:What I Need to Know About My Child's Bedwetting
- National Association for Continence: Pediatric Nocturnal Enuresis
- National Kidney Foundation: Medications to Treat Bed Wetting
- American Academy of Pediatrics: Complementary, Holistic and Integrative Medicine - Nocturnal Enuresis
