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My son still wets the bed. How can I help him cope?

The question: My seven-year-old wets the bed. How can I help him cope and stop?

The answer: Wetting the bed at this age is extremely common. Although many children achieve night-time dryness by the time they start kindergarten, about 10 per cent of seven-year-olds will still wet the bed regularly.

Bedwetting, also known as nocturnal enuresis, is much more common in boys and often runs in families. I think of these children as those who have both a small bladder and who are also deep sleepers. It is important to remember that bedwetting is not your child's fault, so punishment and discipline will not be effective and in fact may make the problem worse. Fortunately, bedwetting naturally gets better over time so patience is critical.

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There are some things that parents can do to help support their child:

  • Keep in mind that the goal is not for your child to sleep through the night without peeing, but rather for your child to awaken to urinate in the middle of night.
  • Keep a lid on your child’s fluid intake, especially two hours preceding bedtime. A small drink at bedtime is acceptable.
  • It is critical that your son urinate at bedtime so that he is starting the night with an empty bladder.
  • Consider waking your child to urinate around midnight. This may be more difficult than it sounds, especially if your child is a deep sleeper.
  • Treatment should only be considered if the wetting is truly bothering your child, particularly if it is affecting his self-esteem or ability to participate in normal activities such as camping trips and sleepovers. If your child is not troubled by the wetting, it is usually best to leave well enough alone.
  • The most popular enuresis treatment in my clinic is desmopressin acetate, also known as DDAVP. DDAVP tablets are taken at bedtime and essentially put the kidneys to sleep for the night, resulting in very little urine overnight. This medication lasts about 12 hours so normal urine production starts again in the morning. DDAVP is usually well tolerated with few, if any, side effects.
  • Another treatment option involves purchasing a small alarm system with an underwear sensor that triggers an alarm to ring when it becomes wet. Systems can be purchased at pharmacies, medical supply stores, or online. Expect to pay $100 to $500, although the cost may be covered by some insurance plans. These devices are very effective in training children to awaken to urinate but definitely require a motivated child and family who are ready and willing to respond to alarms in the middle of the night. Although they can be used in younger children, I find them most appropriate for children 10 and older.

Seek medical advice if your child develops bedwetting after being dry at night for more than a year, if your child also has wetting during the daytime, if your child is losing weight, or if he is showing signs of stress, anxiety, or significant behaviour changes.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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