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Bed-wetting Form
 Printable version
Tips for Drier Nights
Most children who are bedwetting overcome the problem between the ages of 6 to10. Therefore, treatments that might have harmful complications should not be used. On the other hand, treatments without side effects that help overcome this problem at a faster rate can begin as soon as the child has had complete bladder control during the daytime for 6 to 12 months. The following tips may be used preventively, or may used to complement other treatments such as Traditional Chinese Medicine.
Tips for Children of Any Age
- Encourage your child to get up to urinate during the night
At bedtime, tell your child at to try to get up in the night if they have to urinate. Open and consistent communication is imperative.
- Improve the child’s access to the toilet
Put a night light in the bathroom. If the bathroom is at a distant location, put a portable toilet in your child's bedroom.
- Encourage daytime fluids
Encourage your child to drink more fluids during the morning and early afternoon, and restrict fluids after dinner. Many children drink very little during the day and this causes their bladder capacity to be smaller than it should be. Lack of fluids during the day may also cause the child to be thirsty at night.
- Discourage evening fluids
Discourage your child from drinking too many fluids during the 2 hours before bedtime. Avoid the three C’s - caffeine, carbonated drinks (like colas) and chocolate because they increase urine production and therefore increase the likelihood of wetting the bed during sleep. In general, dietary therapy may be a good option to treating enuresis. A study on dietary therapy found that foods suspected of contributing to enuresis included some of the above mentioned foods as well as dairy products, citrus fruits and juices.
- Empty the bladder at bedtime
Even if your child says they do not have to urinate, encourage them try every night before they go to bed. Sometimes parents need to remind the child. Older children may respond better to a visual reminder at their bedside or on a bathroom mirror.
- Take your child out of diapers or Pull-ups
Although this protective layer makes morning clean-ups easier and protects the bed, it can interfere with the motivation for the child to get up at night to use the bathroom. A few experts believe the use of diapers or pull-ups may even prolong bedwetting but no studies have been done to prove this to be true. Use Pull-ups or absorbent underpants selectively for camping or overnights at other people's homes. Moreover, use them only if your child wants to use them. Use of these garments should rarely be permitted beyond the age of 8. Consider discontinuing use of these absorbent products for a few months while the child is on a program.
- Protect the bed from urine
Odor becomes a problem if urine soaks into the mattress or blankets. Protect the mattress with a plastic mattress cover.
- Include your child in morning clean-ups
Including your child as a helper in stripping the bedclothes and putting them into the washing machine provides a natural disincentive for wetting the bed. Older children can perform this task independently. Also, make sure that your child takes a shower every morning so that he or she does not smell of urine at school.
- Respond positively to dry nights
Praise your child on mornings when he/she wakes up dry. A calendar with gold stars or happy faces for dry nights may also help.
- Respond gently to wet nights
Never punish your child, because they are not wetting the bed on purpose. Children who suffer from enuresis feel guilty and embarrassed about this problem. Moreover, blame and punishment by the parent only increases these feelings. Children need patience, support and encouragement. Siblings should not be allowed to tease bed-wetters. Your child needs to feel safe and supported in their home. Punishment or pressure will only delay a cure and cause secondary emotional problems.
Tips for Children 6 Years and Older
Follow the previous recommendations in addition to the guidelines given below:
- Help your child understand his/her goal
Explain that the key to becoming dry is to learn how to self-awaken when they need to urinate at night and find the toilet. Getting up and urinating during the night can keep your child dry regardless of how small their bladder is or how much fluid they drink. Help your child take responsibility for doing this. Some children think that enuresis is the parent's problem to solve; they need to be reminded that this is not the case.
- Have a bedtime pep talk about self-awakening
To help your child learn to awaken himself/herself at night, encourage him/her to practice the following routine at bedtime:
- Lie on your bed with your eyes closed.
- Pretend it's the middle of the night.
- Pretend your bladder is full.
- Pretend you feel the pressure.
- Pretend your bladder is trying to wake you up.
- Pretend your bladder is saying, "Get up before it's too late."
- Then run to the bathroom and empty your bladder.
- Remind yourself to get up like this during the night.
- Daytime practice of self-awakening
Whenever the child has an urge to urinate and they're at home, have them go to their bedroom rather than the bathroom. Tell the child to lie down and pretend they're sleeping. Remind them that this is how their bladder feels during the night when it is trying to wake them. After a few minutes, have the child go to the bathroom and urinate (just as they should at night).
- Parent-awakening
If self-awakening fails, use parent-awakening to teach your child the goal of urinating into the toilet during the night. It makes more sense than putting a child back into pull-ups and having them urinate in their bed every night (the wrong goal). The parent’s job is to wake the child up at set times during the night (1-2 times); the child’s job is to locate the bathroom and use the toilet. The parents may wake the child before they go to bed (if this is a few hours after the child has went to bed). Try a hierarchy of prompts (the minimal one being the best), ranging from turning on a light, saying his/her name, touching him/her, shaking him/her or turning on an alarm clock. If your child is confused and very hard to awaken, try again in 20 minutes. Once they are awake, they should be encouraged to find the bathroom without any directions or guidance.
- Encourage changing out of wet clothes during the night
If the child wets at night, they should try to get up and change their clothes. First, if the child feels any urine leaking out, they should try to stop the flow of urine. Second, they should hurry to the toilet to see if they have any urine left in their bladder. Third, they should change themselves and put a dry towel over the wet part of the bed. (This step can be made easier if you always keep dry pajamas and towels on a chair near the bed.) Do not allow your child to climb into your bed or a brother or sister’s bed after wetting. Basically, make clean-up quick and matter of fact - no big fuss and encourage your child to help. This way, the two of you can work together to help each other get back to sleep. The child who shows the motivation to carry out these steps is close to being able to awaken from the sensation of a full bladder.
- Praise your child for positive behaviour that will eventually lead to a dry bed
Examples of positive behaviour include an earlier bedtime to avoid overtiredness, getting up to go to the toilet at night, calling the parent if they have a wet patch, washing themselves after wetting and helping to change the bedding and their clothes.
- Parents need to talk to the child about bed wetting
The parents need to talk to their child about bed-wetting and let them know that lots of other children wet their bed and that they are not alone. The parents need to let their child know they love him/her, and that they understand how he/she feels. The child should be reminded that wetting the bed is not his or her fault. The child should be given an explanation of what is happening. If the parent (or another family member) wet the bed as a child, they should share this experience. Make the child understand that enuresis sometimes runs in the family because this can help reduce the child's anxiety or feeling that there is something "wrong" with him or her. If the child has Secondary Nocturnal Enuresis, the parent should ask the child to discuss what is bothering him or her if stress is the cause.
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