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Q: What should be done about bedwetting? continued...

A urine test could reveal a urinary tract infection or excess sugar in the urine as a cause. A physical examination might demonstrate constipation, for instance, which could push on the bladder and cause the bladder to release urine at inappropriate times. A sleep history may reveal that a child has a sleep disorder called sleep apnea, in which breathing stops for a brief time. Urine can escape during those episodes.

Sometimes, secondary bedwetting can occur if a child is psychologically stressed or if he has lived through a disaster recently, such as a hurricane or fire. Those children may need some counseling or other help.

Most of the time, however, your child will naturally outgrow bedwetting as he gets older. To help your child outgrow bedwetting, you can try a number of behavioral strategies outlined below.

Q: At what age should we do something about bedwetting?

If you and your entire family is OK with it, you don't necessarily have to do anything. Except wash the sheets, of course, and perhaps have your child wear disposable underwear. About 15% of bedwetters get better, or outgrow it, every year without any treatment. By age 18, only 1% to 2% still wet the bed.

But if you, or more importantly, your child, is so upset by this that it is disrupting your family, then talk about treatments with your pediatrician.

The best time to do this is when your child says he wants to deal with it. When the child gets sick of it, says he feels like a baby, or is embarrassed because he can't go to friends' houses for sleepovers, this is a good time to talk to your doctor about remedies.

Q: What bedwetting product or treatment works best?

There aren't a lot of great studies comparing treatments. But it's pretty clear that what works best are the urinary alarms. In a published review, researchers compared bed alarms with behavioral interventions and medications. They concluded that bed alarms are the most effective.

Many models of alarms are available, but all include a moisture sensor that you put in your child’s underpants that sounds an alarm when it detects urine. Once the alarms train the sleeping brain to inhibit the bladder contractions -- and prevent the urine from being released -- most kids stay dry. Better still, they remain dry even after the alarm is discontinued.

The downside of alarms? They take a while to work -- usually months. They require participation by the parents, who may have to get up with their child and take him to the bathroom when the alarm goes off. It requires a lot of commitment.

Another strategy is to wake your child two or three hours after he has gone to bed, and perhaps right before you go to bed, and have him pee. It has some effectiveness. You might also have your child wear disposable underwear until he or she outgrows bedwetting.