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Communication is Key with Bedwetting


Every day, 5 million American children wake up not knowing if their bed
will be wet or dry. Many of these children feel embarrassed and ashamed—and some are punished.
Bedwetting is almost as common as asthma, but it is often not discussed, even with doctors,
because of its embarrassing nature.

A recent study showed a significant communication
breakdown between parents and doctors on this issue. While 82% of parents want healthcare
providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves.
Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at
routine visits.

Bedwetting is rarely caused by a serious medical disorder. In most cases, it
is due to a maturational delay in the way the brain and bladder communicate with each other at
night. There are three main factors that contribute to the problem:

A fourth factor, which is often overlooked by doctors
and parents alike, is constipation. Because the rectum is right behind the bladder, constipation
can interfere with bladder emptying or the way the bladder signals the brain that a child needs to
go. This can lead to both daytime and nighttime wetting episodes.

There is no magic age when
children are ready to work on becoming dry, however, most children show some concern about the
problem by the time they are 6- to 7-years-old. (Bedwetting is so common that most doctors do
not consider it to be a “problem” until children are at least 6 years of age.)

There are five
signs parents can look for to see if their child is ready to work on becoming dry:

Whether or not a child is ready to work on becoming dry,
there are a number of steps parents can take to help children feel better about

The most effective treatment for bedwetting is a product called the
bedwetting alarm. Most bedwetting alarms are small, battery-operated devices that children wear
to bed at night. One part of the alarm attaches to their undershirt or pajama top and the other
part attaches to their underpants. When the child urinates, the alarm goes off, creating a loud
buzzing sound. The sound is designed to wake the child up and teach him what his bladder feels
like when it fills up with urine. As the alarm begins to work, it teaches children to wake up
before they wet the bed. Over time, most kids stop waking up at night to urinate. This happens
because the bladder learns to hold all of its urine until morning.

There are a few medications
available to treat bedwetting. The one that’s prescribed most often is called desmopressin (brand
name: DDAVP). This drug works by reducing the amount of urine a child makes during the night.
The effects are not long lasting, however, and most children relapse when the medication is
stopped. Consequently, doctors generally recommend it for short-term use such as sleepovers,
vacations or as an adjunct to other behavioral measures.

So why is it that parents and
doctors are not talking to each other about bedwetting? Parents aren’t asking about bedwetting
because they’re either embarrassed about the problem or they aren’t sure the doctor can help.
Doctors aren’t asking about bedwetting because they assume parents would bring it up if it were a
concern. For every child who gives the doctor an indication that something is bothering him, there
are many more who would never say a word. The prescription for this situation is simple: Doctors
need to ask about bedwetting at routine checkups, and parents need to be more proactive by asking
for help if they have a child who is wet at night.



Dr. Bennett is pediatrician in Washington, DC. He is the author of a self-help guide
written for children and parents entitled, Waking Up Dry: A Guide to Help Children Overcome
Bedwetting. On his website, www.wakingupdry.com, he posts bedwetting-related information.




 – Dr. Howard Bennett