Module 2 • Behaviour Problems


• Delayed bladder maturation. “Simply put, the brain and bladder gradually learn to communicate with each other during sleep, and this takes longer to happen in some kids,” Bennett tells WebMD.


• Low anti-diuretic hormone (ADH). This hormone tells the kidneys to make less urine. Studies show that some kids who wet the bed release less of this hormone while asleep. More urine can mean more bed-wetting.


• Deep sleepers. “Families have been telling us for years that their children who wet the bed sleep more deeply than their kids that don’t,” says Bennett. Research confirms the link. “Some of these children sleep so deeply, their brain doesn’t get the signal that their bladder is full.”


• Smaller “functional” bladder. Although a child’s true bladder size may be normal, “during sleep, it sends the signal earlier that it’s full,” says Bennett.


• Constipation. Full bowels press on the bladder, and can cause uncontrolled bladder contractions, during waking or sleep. “This is the one that’s hiding in the background,” says Bennett.


4 Bed-wetting: when is it worth worrying?


Bed-wetting that’s caused by medical problems is genuinely rare – 3% of cases or less, according to Bennett. Urinary tract infections, sleep apnea, diabetes, spinal cord problems, and deformities of the bladder or urinary tract – all are worth mentioning, but probably not worrying over. Medical causes of bed-wetting are nearly always uncovered by simply talking to a child and her parents, performing an exam, and testing the urine, says Bennett.


“The vast majority of kids who are wet at night have nothing medically wrong with them,” he emphasises.


Children who have gained night-time bladder control, then “relapsed” into bed-wetting, are slightly more likely to have medical causes. Psychological stress (such as divorce or the birth of a new sibling) is an even more common cause, though.


Pediatricians don’t diagnose primary nocturnal enuresis (the medical term for bed-wetting) until age 6.


5 Bed-wetting treatment


The potential harm of bed-wetting is more often psychological than medical. “After age 6, many children start to have sleepovers, and that’s when bed-wetting can be particularly embarrassing and stressful,” says Bennett.


“It’s just as important to know what doesn’t cause bed-wetting – the myths around it,” says Bennett. “No child wets the bed on purpose, or from being too lazy to get up to urinate.”


Dragging themselves out of bed to change wet sheets on yet another night, parents frequently become frustrated. “Intentionally or unintentionally, parents express disapproval that this is happening,” says Bennett. “It’s understandable, but it makes the situation worse.”


Some bed-wetting treatments include: • Encouraging a child to go to the toilet before bedtime. • Restricting a child’s fluid intake before bed. • Covering the mattress with plastic. • Bed-wetting alarms. These alarms sense urine and wake a child so they can use the toilet. • Medications.


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