You wake up in the morning to find a wad of soaked bedsheets stashed in your child’s bedroom closet. Childhood logic is at work: “If only I hide the evidence, I won’t have to talk about wetting my bed again.”

For most adults, that kind of thinking – and the feeling of waking up in a cold, wet bed – are distant memories. Yet children age 6 and older may wet their beds, and some may do it often.

Persistent bedwetting, called nocturnal enuresis (en-yoo-REE-sis), is a trial for both parents and children. Children feel a sense of shame, while many parents assume that they’ve somehow failed.

Put the problem in perspective

To move past the inevitable frustration, start with some facts:

- If bedwetting is a recurring problem in your household, you’re not alone. Each year, 5 million to 7 million families in the United States face the same situation.

- Nocturnal enuresis occurs in people of many ages. About one in ten 6-year-old children may wet the bed 3 to 4 nights a week. For some children, the problem continues into puberty. Less than 1 percent of adults wet their beds.

Bedwetting varies widely

A formal diagnosis of nocturnal enuresis usually means that a child:

- Urinates at night without waking up.
- Wets the bed relatively frequently (at least once per month).
- Is past the age when it’s usually expected that children routinely stay dry.

Many factors involved

Even though nocturnal enuresis is common, its causes still aren’t fully understood. However, research has found some related factors.

Age – Staying dry at night requires a certain level of physical development. This means adequate bladder capacity, brain function and muscle control. Because children grow and develop at different rates and many children still wet the bed until 6 years of age, physicians don’t usually recommend treating nocturnal enuresis until a child is 6 years old.

Heredity – If both parents had nocturnal enuresis, there’s a 70 percent chance that one of their children will experience the condition, (If only one parent had nocturnal enuresis, it drops to 40 percent.)

Other factors that may be related to nocturnal enuresis:

- Delays in development of the nervous system.
- Sleep apnoea, a condition where a child temporarily stops breathing during the night.

Common beliefs about bedwetting include that it happens in children who sleep deeply, who have small bladders, or who feel emotional stress. While these factors may be linked at times to nocturnal enuresis, they’re usually not the keys to overcoming the problem.

However, research has developed an approach for treating nocturnal enuresis. This plan may include three main strategies.

Strategy 1 – Take simple steps at home
Your child’s physician will probably suggest that you begin treatment at home with simple1 practical steps:

- Protect your child’s bed with a zippered vinyl cover, available at mattress or hospital supply stores.
- Keep a diary. Note each night that your child stays dry.
- Make sure that your child stops drinking liquids 1 hour before bedtime.
- Ask your child to urinate every night just before going to bed.
- Offer support, not punishment. Remember that enuresis is involuntary – children don’t wet their bed on purpose. Scolding and sarcasm are useless and can only be harmful.

Strategy 2- Change behaviour

For long-term success, many physicians recommend a program to help your child learn new habits. Conditioning treatment programs for nocturnal enuresis have achieved success rates of more than 70 percent. This technique is called behaviour modification.

Special alarm systems are a cornerstone of behaviour modification. These systems include sensors that attach to your child’s underwear, or to a pad that your child sleeps on. In either case, the sensors sound an alarm when they detect urine. With time, the alarm teaches the child to recognize the sensation of a full bladder before wetting occurs and then appropriately respond by squeezing muscles to prevent the wetting or by getting up to use the bathroom.

You can use stickers or a “star chart” to reinforce your child’s success in staying dry – or, more importantly, in responding to the alarm.

To make behavior modification more effective1 give your child a larger reward for gaining a certain number of stars. Examples are a toy or a trip to your child’s favorite restaurant.

Behavior modification calls for patience. Often 3 weeks pass before any positive results occur. Eventually. though, behavior modification offers high rates of success.

Strategy 3 – Medication

After examining your child, your physician may recommend medication. Some physicians favor desmopressin, which has fewer side effects than other medications used to treat nocturnal enuresis Desmopressin (DDAVP), available by prescription, comes in several forms – nasal spray, liquid and tablets. Desmopressin is not a cure. It simply causes the kidneys to temporarily decrease urine output. Enuresis often comes back after desmopressin treatment is stopped.

Many children are given desmopressin to stay dry during sleepovers and overnight trips. If desmopressin is prescribed for your child, plan a trial run at home before the first sleepover or trip.

Time is an ally

For most children, the passage of time provides the ultimate treatment for nocturnal enuresis. By age 5, about 85 percent of all children will stop wetting the bed. During each year after that, 15 percent of children with nocturnal enuresis will see their symptoms disappear spontaneously. Medical treatment assists this process. Because effective treatments are available, it’s unnecessary to delay seeking treatment.

Your support and understanding are extremely important in helping your child cope with this problem.