Bed-Wetting
About 30% of children still wet the bed at age 4, 10% at age 6, 3% at age 12, and 1% at age 18. Bed-wetting is more common in boys than in girls and seems to run in families.
Bed-wetting is usually caused by slow maturation of the nerves that supply the bladder, so that the child fails to awaken appropriately when the bladder fills and needs emptying. Bed-wetting can accompany such sleep disorders as sleepwalking and night terrors (see Section 23, Chapter 269). A physical disorder--usually a urinary tract infection--is found in only 1 to 2% of children who wet the bed. Other disorders, such as diabetes, rarely cause bed-wetting. Bed-wetting occasionally is caused by psychologic problems, either in the child or in another family member, and is occasionally part of a constellation of symptoms that suggests the possibility of sexual abuse.
Sometimes bed-wetting stops and then begins again. The relapse usually follows a psychologically stressful event or condition, but a physical cause, especially a urinary tract infection, may be responsible.
Treatment
Parents and the child need to know that bed-wetting is quite common, that it can be corrected, and that nobody should feel guilty about it. An older child who has bed-wetting can take responsibility by limiting fluids after dinner (especially caffeinated beverages), urinating before going to bed, recording wet and dry nights, and changing clothing and bedding when wet. Parents may choose to give the child age-appropriate rewards (positive reinforcement) for dry nights.
For children younger than 6, parents can avoid giving the child fluids 2 to 3 hours before bedtime and encourage the child to urinate just before going to bed. In most children of this age, time and physical maturation solve the problem.
For children older than 6 to 7 years, some form of treatment is often indicated. Bed-wetting alarms, which awaken a child when a few drops of urine are detected, are the most effective treatment available. They cure bed-wetting in about 70% of the children, and only about 10 to 15% of children start wetting the bed again after the alarms are discontinued. Alarms are relatively inexpensive and are easy to set up. In the first few weeks of use, the child awakens only after fully urinating. In the next few weeks, the child awakens after urinating a small amount and may wet the bed less often. Eventually, the need to urinate wakes the child before the bed is wet. Most parents find that the alarm can be removed after a 3-week dry period.
If bed-wetting persists in an older child after alarms and age-appropriate rewards have been tried, the doctor may prescribe imipramine. Imipramine is an antidepressant drug but is used to treat bed-wetting because it relaxes the bladder and tightens the sphincter that blocks urine flow. If imipramine is going to work, it usually does so in the first week of treatment. This rapid response is the only real advantage of the drug, particularly if the parents and child feel they need to cure the problem quickly. After 1 month without bed-wetting, the drug dose is decreased over 2 to 4 weeks, then discontinued. However, about 75% of children eventually start wetting the bed again. If this happens, a 3-month course of the drug may be tried.
An increasingly popular drug for bed-wetting is desmopressin tablets or nasal spray. This drug reduces the output of urine, which reduces bed-wetting. This drug is used for a 1- to 3-month period and then discontinued as soon as possible. It can be used intermittently, such as when the child goes to camp.
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