Saying goodbye to the night-time nappy is a cause for pride and celebration, but it is often difficult to predict when this will occur. For many children it is between the ages of three and four, but others will be at school before they are fully dry. For all children this will mean they willl be able to recognise the sensation of a full bladder during sleep and 'hold on' or wake up to find the toilet.
Bedwetting is not unusual in younger children. Studies show about one in six five-year-olds and one in seven seven-year-olds regularly wet the bed, with more boys affected than girls.
We know it causes stress and embarrassment for families who often struggle to cope alone with a problem that is not easy to discuss outside the family. Many are unsure what to do, particularly if their child starts to wet the bed after a period of being dry.
Nursery staff are ideally placed to support and reassure parents, although they may not always know if a child is wetting at night. Displaying information about the help available, both locally and nationally, is a good start and may encourage parents to discuss the problem in confidence.
Rather than being due to a child's laziness or lack of training, research indicates that bedwetting may be the result of one or more factors:
* The system that slows down urine production during sleep (by producing a hormone called vasopressin) is not yet in place. This means the bladder fills up quickly and has to deal with large volumes of urine at night. An artificial form of this hormone, desmopressin, may be prescribed for children over five years old.
* The bladder holds smaller than average amounts of urine before giving a signal that it is full. The bladder muscle may also be 'over-active' and give an urgent signal to empty before it is full (the nursery nurse might be aware that a child needs to go to the toilet frequently, has wetting accidents or smells of urine). Drinking six to eight cups of fluid over the course of the day and emptying the bladder regularly is helpful. A drug called oxybutynin can relax the 'over-active' bladder, again in the older child.
* The signal from the full bladder to the brain does not 'get through' when the child is asleep. This is outside conscious control. Older children can be helped by using a small, body-worn alarm that detects urine and makes a sound to help the child wake up.
* Changes or anxieties in the child's life, such as starting nursery or school, a new baby or other family events, can interrupt the process of gaining bladder control, or trigger wetting accidents after a period of being dry (nursery staff may be aware of these factors and offer support).
* There is a known genetic predisposition in some families.
Establishing a routine
Appropriate advice for parents will depend on the age of the child and the family situation. Some general tips to help children of all ages include:
* drinking six to eight cups of water-based fluid at regular intervals throughout the day
* establishing a regular daily routine for going to the toilet
* emptying the bladder fully
* having a small drink before bed
* going to the toilet last thing before going to sleep
* leaving a soft light on so the child can find the toilet
* using bedding protection instead of absorbent pants (available from ERIC)
* using incentives and rewards for goals that are achievable
* avoiding constipation
* offering details of ERIC for support and resources.
Many children become dry after following these guidelines. But if not, the health visitor, family doctor or school nurse may refer the family to a bedwetting clinic, usually from the age of seven. Most children who only wet at night have no underlying medical problem. However, before treatment, a general health check is advisable to detect urine infection, constipation or other physical causes that may contribute to bedwetting.
It is important to seek help early rather than hope a child will 'grow out of it'. Research shows that many of the 1 to 2 per cent of teenagers who continue to wet the bed did not receive treatment at an earlier age.
FURTHER INFORMATION
* ERIC offers a pack for parents including a helpful publication, Bedwetting: A Guide for Parents, a leaflet,Nights Away No Worries and a catalogue of bedding protection, alarms and publications.
Contact the helpline on 0845 370 8008 (Monday to Friday, 10am - 4pm) or visit www.eric.org.uk or www.ericshop.org.uk
