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Five-Year-Old Still Wetting Bed
Q: My five-year-old is still wetting the bed. What can I do? I am a single parent and the doctor said there was nothing wrong with him. Please help me.
A: Wetting the bed at night (known as primary nocturnal enuresis when a child has never been totally dry at night) often becomes a concern to families when a child reaches age five or six. The child doesn't want to be embarrassed at sleepovers. Parents may feel that their child is the only one his age who wets the bed (actually about 20 percent of children at age five wet the bed at least monthly and 10 percent at age six). There is usually nothing "wrong" with their bodies. They are just taking longer than average to develop nighttime bladder control. Some children seem to be deep sleepers; other children's bladders may seem to hold smaller amounts than usual. It also runs in families. If one parent was a bed wetter, there is a 45 percent chance of bed-wetting in children. If both parents were bed wetters, the odds are 77 percent.
When discussing nocturnal enuresis, your child's doctor will want to take a detailed history and may want to perform a focused physical exam. Though rare, there are some symptoms and physical findings which suggest a medically treatable condition (these children usually aren't totally dry during the day or, if they are, now surprisingly begin wetting themselves). Social stresses do not routinely cause primary bed-wetting, so don't blame yourself because of that recent divorce, change of job, or move across the country. The fact that your child is dry during the day and even some nights, shows he can do it with time and patience.
Once your child is interested in overcoming nocturnal enuresis, apply two guiding principles: work with him and protect his self esteem. A child has to learn either to sense a full bladder during sleep and contract the muscles which hold in urine, or to wake from sleep, find the bathroom, and pee into the toilet. No small task for the average five-year-old!
Discuss specific training methods with your pediatrician. Initially, the goal is getting up at night and using the toilet. Discontinue diapers or pull-ups. Cover the mattress with a plastic sheet. Enlist your child's help in cleaning up (older children can change the bed by themselves). Avoid punishment or criticism. One successful method uses an alarm which is set off when a sensor, worn in the underwear, gets wet. Medicines are only used in special circumstances. Whatever your method, be patient and plan on keeping in close contact with he pediatrician for guidance and reassurance.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.