BEDWETTING
Bedwetting occurs when a child urinates during his sleep without knowing it, at an age when this would not usually happen. Bedwetting is common for children, affecting more boys than girls. Although children develop bladder control at different rates, most boys can control their bladder during the day and night by the age of 6, and most girls by the age of 5.

What causes bedwetting?
Bedwetting is most often simply related to deep sleep. Your child doesn’t wake up when his bladder is full because he is such a deep sleeper. Less often children have smaller bladders, or produce more urine during the night. 

Some say bedwetting can be caused by improper toilet training, either by starting the training when the child is too young or by being too forceful.

Stress - Dramatic changes in home and family life also appear to lead some children to wet the bed. Moving to a new town, parent conflict or divorce, arrival of a new baby, or loss of a loved one or pet can cause insecurity that contributes to bedwetting. For some patients, food allergies may be part of the cause. This link is not well established, requiring further research. 

Some children who suffer from constipation may also experience bedwetting because of the bowel pressing on the bladder. 

Children with ADHD are 2.7 time more likely to have bedwetting issues. 

Dandelions - Anecdotal reports and folk wisdom says children who handle dandelions can end up wetting the bed. Dandelions are reputed to be a potent diuretic. 

If the child is beyond the age of wetting the bed (age 6), it may also be Nocturnal Enuresis.
 

Nocturnal Enuresis
There are two main types of nocturnal enuresis: primary and secondary. 

The primary type is a condition where a child still wets the bed after age 5 or 6. It's often hereditary. In fact, scientists have discovered a gene for bedwetting. If one parent wet the bed as a child, their child has a 25% risk of bedwetting. If both parents wet the bed as children, their child’s risk increases to about 65%.

• delay in maturation of bladder control 
• genetics - children with parents who also wet the bed beyond age five are at an increased risk for bedwetting 
• sleeping soundly - this may make children less aware of cues for the need to urinate. 

Rare possible causes include the following: 
• problems with antidiuretic hormone (ADH), a hormone that causes the body to retain water - Normally, ADH levels increase at night to decrease the amount of urine produced. However, children with enuresis do not have increased ADH levels at night, causing greater urine production, which can lead to wetting. 
• minor nerve damage - this may decrease a child's ability to sense a full bladder .

Although it is often said that emotional stress causes primary nocturnal enuresis, there is little scientific evidence to support this claim. However, bedwetting itself may lead to feelings of shame and lowered self-esteem.

Causes of secondary nocturnal enuresis include the following: 
• emotional stress (e.g., birth of a sibling, significant loss, family discord) 
• urinary tract infection 
• diabetes mellitus

Symptoms and Complications of Bedwetting
For sleeping children who are old enough to control their bladders, the symptoms of bedwetting are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them. 

The most common complication of bedwetting is the impact on self-esteem and the emotional distress it causes children. Assuring children that the occurrences are accidental, and not blaming the condition on them, is key to managing the psychological effects. Many children who wet the bed may fear staying overnight at a friend's house in case they wet the bed there.

Diagnosing Bedwetting
Since many children under the age of six still wet the bed, any one of the following signs should signal the need to consult a doctor: 

• a child over the age of 5 or 6 who still wets the bed 
• a child who is wetting during the day after the age of 4 or 5 
• a child who starts bedwetting at night after having stopped for six months or more 
• urinary symptoms such as urinating frequently or having pain with urination 
• Laboratory tests can be done to make sure the bedwetting isn't caused by a urinary tract infection or by other medical conditions such as diabetes.

Do children outgrow bedwetting?
Yes. At 5 years of age, 15% of all children wet the bed. By 8 years, 6 to 8% wet the bed. Even without treatment, this number goes down to 2% by 15 years of age.

Does bedwetting need to be treated?
Usually not. The most important question is whether the bedwetting is a problem for your child. If bedwetting isn’t upsetting her, then treatment probably isn’t necessary. Children will outgrow it. Children under the age of five or six aren't treated for bedwetting because they generally outgrow the problem. By 8 to 10 years of age, however, bedwetting may affect your child’s self-esteem and can interfere with social activities like sleepovers. 

Whether you and your doctor decide to treat the bedwetting or simply wait for your child to outgrow it, be sure that your child knows bedwetting is not a bad behaviour. 

Treatment may involve bedwetting alarms or medications.
A bedwetting alarm is triggered when the child passes the first few drops of urine and wakes him or her up. Alarms become effective for most children after they have been used for 12 weeks.

Medications are another option for bedwetting. Children five years old and older may take desmopressin*, a medication available as a nasal spray or tablets, that decreases the amount of urine the body makes. Desmopressin works well for bedwetting and doesn't have many side effects. For parents without drug plans, cost can be a factor. It does not permanently stop bedwetting, but it does help while it is being used. This medication is particularly useful to help children during sleepovers and overnight trips.

Strategies for parents to help children who are wetting the bed.
• Realize that bedwetting is fairly common up to age 5 to 6. 
• Keep a matter-of-fact attitude and convey that this is nothing out of the ordinary. 
• Don't blame the child; offer support and encouragement instead. 
• Don’t demoralize the child by telling other people of their condition.
• Point out that bedwetting is common, that it can be corrected, and that there's nothing to feel guilty about. 

** Don't get angry when your child wets the bed, because this can cause the child to give up trying to stop bedwetting, or can lead to emotional problems. 

• Make sure your child doesn’t drink too much fluid before bedtime. 
• Avoid drinks with caffeine (such as colas). 
• Encourage your child to go to the bathroom before bedtime. 
• Use training pants instead of diapers. 
• Make sure your child can easily reach the bathroom at night. For example, use a night light in the hall or in the bathroom. 
• Use a hospital-strength plastic mattress cover to avoid damage to the mattress. 
• Place a large towel underneath the sheet for extra absorption. 

Don’t bother to change a sleeping child who is wet. It’s more important for everyone to get a good night’s sleep. Leave a towel and change of clothes in case your child does wake up. 

When your child does wet the bed, help him wash well in the morning so that there is no smell. 

If there are family problems (psychiatric or emotional) affecting either the child or another member of the family, these may also be root causes of bedwetting and need attention. Otherwise, the bedwetting can lead to life-long emotional and psychological distress.

Talk to your doctor about your child’s bedwetting if your child: 
Wants to be dry at night and is concerned by the bedwetting. 
Is having daytime accidents. 
Is dry for many months and then suddenly starts bedwetting. 
Has other symptoms such as a frequent need to pee or a burning sensation when he pees. 
Is still wetting at 5 to 6 years of age (or older). 

Source/Reference: 
CPS Community Paediatrics Committee. 
http://en.wikipedia.org/wiki/Bedwetting
Nocturnal Enuresis by American Family Physician 
National Inst. Of Health 
PediatricEducation.org 
HealthForums.com 
DrGreene.org 
eMedicine Health: Bedwetting 
Nocturnal Enuresis article at Urology Nurses Online 
 

This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.