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Expert Q&A

	By Dr. Vincent J. Kopp Pediatrician Pediatric Anesthesiologist

When should I start to worry about my child's bedwetting?

Nocturia, or nighttime bedwetting, is common through age 4. Normally, it subsides dramatically thereafter with a small number of children experiencing persistent problems into the preteen years. Often there is a family history of one or both parents also having a problem with nocturia in childhood in such cases.

Rarely is nocturia caused by true urinary incontinence in children, though children with spina bifida, a history of urinary tract anomalies or surgery, bladder infections, seizure disorders, or patterns of excessive fluid intake before bedtime can have nocturia. Willful daytime wetting is slightly more worrisome. It may be a sign of an unrecognized physiologic abnormality or serious behavioral problem.

Most toilet trained children will have occasional "accidents." These should not be cause for worry to a parent. Yes, children with new siblings, as well as children who have had other "traumatic events" such as anesthesia and surgery, emotional stresses such as loss of a family member or pet, or even sexual abuse, may regress with respect to urinary continence. That said, in most cases the cause is not serious. If a deep psychological cause is suspected a consultation with a pediatrician with referral to a pediatric psychiatrist is mandatory.

For the child age 3 to 6 who is having lapses in urinary continence, a number of simple measures can be taken. Because children are very concrete thinkers, they love stickers on charts as a way to track their progress in mastering any new skill. Sit down with your child, make a chart for use in tracking "dry nights" and agree on a simple reward for successes. Have the child agree with you on these points and resist the temptation to cave in to calls for rewards without success. Keep the chart in case you need to consult a physician at a later date so you have a record of the child's behavior.

Another important goal is to reduce the amount of fluids drunk by the child ahead of bed time. If the child goes to bed at 8:00 p.m., no fluids should be allowed after dinner and dinner fluids should be monitored. Thirst from playtime should be quenched before dinner. It is also important to avoid caffinated beverages. Caffeine acts as a diuretic -- it stimulates urine formation -- as well as interferes with sound sleep and early bed times.

Finally, the child who has bladder control should empty their bladder before bed.

Older children with persistent problems need additional strategies. Making them change wet sheets and pads, place bed wear in the wash and take responsibility for their behavior is important as a way to get "buy in" to developing bladder control. Kids who lack nocturnal bladder control may be unwelcome guests at friends homes. This should be made clear at the social appropriate ages.

Interventions should be managed through a caring pediatrician. Children suspected of having organic reasons for urinary incontinence should also be followed by a pediatrician and referred to a pediatric urologist.

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