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Sleep Disorders: Behavioral Treatments for Bedwetting

Bed-wetting treatment may or may not be necessary. While bed-wetting can create embarrassment and anxiety in the child (and the parents), it usually isn't caused by a serious medical problem. If your child is younger than 5 years of age and has no other symptoms, the doctor will likely suggest taking a 'wait and see' approach. This is because most children older than 5 spontaneously stop bed-wetting on their own. However, if your child is older than 6 and is still wetting the bed regularly, the decision to treat becomes more complicated. It will depend on the attitudes of the child, the parents/caregivers, and the doctor.

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First Step

Before starting any treatment, the doctor will rule out underlying medical or emotional conditions as the cause of bedwetting. If an underlying medical condition is to blame, treating the condition should put an end to bedwetting. If there is no medical explanation for why your child continues to wet the bed, there are many treatment approaches to try, including behavioral modifications, medications, and even surgery for children with anatomical problems. This article will focus on non-medical steps you can take to treat bedwetting.

Keep in mind, for any treatment to be successful, commitment and motivation are required on the part of the child and the parent.

Behavioral Modifications

There are several different types of behavioral modifications that can be used. These include:

Positive Reinforcement Systems

In a positive reinforcement system, the child is rewarded for displaying a desired behavior. No action is taken for the display of undesired behavior. For example, when a child has a dry night, he or she will receive a point or sticker. After a pre-determined number of points or stickers have been accumulated, a prize is given to the child.

Awakening Programs

There are two types of awakening programs: self-awakening and parent-awakening. Self-awakening programs are designed for children who are capable of getting up at night to use the toilet but do not seem to understand its importance. Parent-awakening programs can be used if self-awakening programs fail.

How it works

One technique is to have your child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night. Another strategy is daytime rehearsal. When your child feels the urge to urinate, he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet.

If your child has trouble with the self-awakening approach, you may need to awaken the child to go to the bathroom. In the parent-awakening approach, it is recommended that a parent or caregiver awaken the child, typically at the parents' bedtime, and have him or her go to the bathroom. For this to be productive, the child must locate the bathroom on his or her own and the child needs to be gradually conditioned to awaken easily with sound only. When this is done for 7 nights in a row, the child may be cured or is ready to re-try self-awakening or alarms (see below).

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