Some healthy 5-year-old children still wet the bed at night; in such cases, wearing a diaper at bedtime may be a reasonable precaution. Note, however, that incontinence sometimes occurs as a symptom of a serious underlying medical condition requiring treatment. Consult a doctor to rule out these conditions and learn about treatments appropriate for your child's situation.
Nocturnal Enuresis
Children who accidentally urinate beyond the age most doctors consider them capable of full bladder control may be diagnosed with enuresis. Nocturnal enuresis specifically refers to nighttime bed-wetting. According to Children's Hospital Boston, about 15 percent of 5-year-olds still experience at least occasional bed-wetting. The University of Rochester Medical Center says that percentage may be higher: up to 20 percent. Most children are expected to achieve full daytime bladder control by age 4 and nighttime control by age 6. However, girls typically master continence earlier than boys do.
Underlying Medical Conditions
First, consult a doctor to ensure no medical ailment is causing the nighttime incontinence. Some problems often linked with bed-wetting include constipation, fecal incontinence, bladder infections and psychosocial problems. More serious -- but less common -- problems associated with nighttime incontinence include kidney infections, reflux of urine into the kidneys, kidney scarring, diabetes and high blood pressure. To rule these out, the doctor will compile your child's medical history and perform a physical examination. He will test your child's urine for other problems and measure his blood pressure. Resolving the instigating condition may also resolve the enuresis. If all other conditions are ruled out, your doctor may treat the enuresis as an isolated condition.
Enuresis Causes
Although your doctor may deem a 5-year-old too young for an official diagnosis of enuresis, it may be useful to consider common sources of the problem and adjust family habits as a preventative measure. Enuresis may be caused by poor toilet training, a small bladder, poor sleep habits, a sleeping disorder, a hormonal problem or simply a delay in the ability to hold urine. According to the University of Rochester Medical Center, delayed ability to hold urine may still be a factor in children up to the age of 5.
Treatment
Do not punish your child for bed-wetting; he is sleeping and cannot help it. Remember, too, that nocturnal enuresis nearly always resolves on its own, usually by puberty. For current or alternative information on toilet training methods, ask your doctor for book and class recommendations. Some parents also find a bed-wetting alarm, which goes off whenever the child wets the bed, to be effective if used consistently. Although treatment should not involve punishment, rewards for dry nights may encourage your child to make progress. For a small bladder, your doctor may suggest bladder training to increase its size. This involves having your child hold his urine as long as possible during the day before relieving himself. This strategy may also help your child better recognize when he needs to urinate.
Medication
For severe or complicated cases, a doctor may prescribe medication such as desmopressin or imipramine, but these suppress the symptom rather than cure the problem. Most children relapse when they stop taking the medicine. The drugs also pose a risk of severe side effects, including water intoxication, seizures, heart rhythm disturbances, headaches and abdominal pain.
References
- Children's Hospital Boston; Enuresis (Urinary Incontinence): Overview; Leonard Rappaport, MD, MS, et al.; 2010
- University of Missouri School of Medicine; Heterogeneity of Diaper Dependency in Three to Six Year Old Children: Implications for Management; David R. Fleisher, MD
- University of California San Francisco Medical Center, Pediatric Urology, Child and Family Information material: Pediatric Urinary Incontinence
- Cedars-Sinai; Pediatric Incontinence
- University of Rochester Medical Center; Urinary Incontinence (Enuresis)
- Children's Hospital Boston; Enuresis (Urinary Incontinence): Treatment and Care; Leonard Rappaport, MD, MS, et al.; 2010
