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Welcome, medical contents search April 25, 2013
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My five year old son still wets his bed at night. Will this ever improve and how?

Hundreds of thousands of American children experience the same symptom, which may include a medical or psychological problem.

My youngest son is 5 years old and still wets his bed almost every night, drenching his nightgown and the bed sheets. He was late at toilet training to begin with, and didn't start to go to the toilet by himself even in the daytime until he was 4. He refuses to wear protective underwear or diapers. Both my husband and I are exhausted getting up in the middle of the night to change him. Lately, after wetting his own bed, he's begun going to his brother's bed and disturbing him by wetting his bed, too. We hoped it would improve with age. We are at our wit's end. What should we do?

It is generally agreed among pediatricians that any girl over four years of age, and any boy over five who still wets the bed are considered to be bedwetters. Be comforted by the fact that bedwetting usually declines with age. For example, approximately 10% of all six years olds wet their bed, while only about 3% of all 14 year olds wet the bed. Bedwetting is considered to be primary if the child always, or nearly always, wets the bed. It is deemed secondary if the child's bed is generally dry, with occasional episodes of wetting.

Primary bedwetting may continue into school years and can be helped by intervention and treatment. In the case of secondary bedwetting, the episodes are usually prompted by various childhood events and crises, and the condition tends to clear up on its own. If not, there may be a physical or emotional problem requiring treatment. Regardless of the classification, help is available and effective.

But first, let us address the main misconceptions about bedwetting, harmful not only to the child's self-esteem, but very likely responsible for prolonging the condition, and his torment, unnecessarily.

Many parents mistakenly believe that bedwetting can be stopped by punishing the child, or making him or her feel ashamed. Often they believe that children wet the bed because they are lazy and can't be bothered to get out of bed and relieve themselves in the bathroom.

Firstly, some children may have a physical/medical problem, interfering with their ability to control urine properly. Consult a pediatrician or pediatric urinologist first, for a medical work up of your child.

Secondly, be advised that when children are stressed by sudden change that alters their secure routine, they may become incontinent. For example, going to overnight summer camp or sleeping at a friend's may be enough to disturb them.

Another source of anxiety often associated with the onset of bedwetting involves parental disputes and even separation. For example, one of my patients, seven-year-old Jessica, suddenly started wetting her bed about the time her parents began having financial difficulties. Though they claimed not to have argued in front of her, it turns out that she overhead them arguing on a number of occasions when they thought she was asleep, but was eavesdropping. No doubt, the child thought she was to blame for their problems.

In this case, treatment included helping the parents cope with their anger and find ways to express their frustration without letting it affect their daughter. As for Jessica, she was helped with play therapy that allowed her to vent her feelings and let go of her guilt. The bedwetting stopped.

Chronic enuresis or bedwetting may be the result of a physically or neurologically immature bladder, and/or a deep sleeping pattern. It may also be an inherited condition, further alleviating a child's isolation, shame, and hopelessness, if told about a relation who suffered from it and got over it. Not surprisingly, children with learning disabilities, attention deficit disorder, and allergies also tend to be more susceptible to bedwetting. Often when these complications are treated or identified as the cause, the condition improves.

However, if bedwetting continues as the child gets older, it may seriously damage his self-esteem and lead to isolation and alienation. It becomes a vicious circle, with parents growing more and more angry and frustrated, amplified by the child's mounting anxiety and shame, causing more bedwetting.

In the case of some bedwetters, they are simply immature, and will improve as time goes on. Children with developmental defects or learning disabilities may also improve over time, if given patient training, specifically in retention control, night-lifting (awaking the child at night and walking him to the bathroom to get him in the habit of controlling and relieving himself), and by using moisture alarms. Biofeedback may be of some assistance in cases such as these.

If your child fails to respond to training, it may be advisable to seek medical intervention, especially in the case of immature bladder development. In this case, Imipramine (Tofranil) or Desmopressin acetate (nasal spray that reduces urine) may be effective in getting relief from the symptom, and the stigma, at the same time.

Your son must be having a hard time. Regardless of how he overcomes the problem, he will need your continued support, encouragement, and acceptance.

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