Nighttime Routines That Can Lead to Dry Nights

Try these tips to control your child's bedwetting problem.

From the WebMD Archives

When your child wets the bed, nights can be filled with anxiety and upset. You’re not looking forward to washing yet another set of sheets, and your child hates waking in the morning feeling embarrassed and ashamed.

Bedwetting, or nocturnal enuresis, doesn’t have to ruin your and your child’s evenings. There are routines you and your child can try to help control the problem. At the same time, taking steps to address bedwetting in a productive, positive manner can improve your relationship with your child and improve your child’s overall state of mind.

Bedwetting: It’s More Common Than You Think

One of the important things to remember about bedwetting is that it’s a very common problem, affecting millions of children.

That may not be much comfort when you’re dipping that teddy bear in vinegar for the umpteenth time to get rid of the urine smell, but almost all children with nocturnal enuresis stop wetting the bed before they hit puberty. Without treatment, 15% of children who wet the bed outgrow it in each passing year. Children who are helped with behavioral therapy, bedwetting alarms, and medications may outgrow bedwetting sooner.

Behavior therapy to stop children’s bedwetting includes developing and practicing routines that reduce the likelihood that your child will wet the bed. Some suggestions that might work for you and your child include:

Bedwetting Busting Routine No. 1: Stick to a Regular Bedtime

Following a regular routine can benefit anyone with incontinence issues.

“Predictability is good, routines are good,” says Gregory Fritz, MD, professor and director of the Division of Child and Adolescent Psychology at Brown Medical School.

By helping your child stick to a regular schedule, you can help train them to empty their bladder at the appropriate times throughout the day and night.

Of course, you don’t need to be militant about timing -- it’s fine to allow your child to stay up a little later than usual on the weekends or during vacations from school.

Bedwetting Busting Routine No. 2: Limit Liquids in the Evening

There’s no need to restrict water and other fluids excessively, but tapering your child’s consumption of fluids during and after dinner is worth trying. Remember that bedwetting is not caused simply by having a full bladder overnight, but by failing to wake up to urinate when the bladder needs to be emptied. So, be careful not to restrict water and other fluids to the point that your child is uncomfortably thirsty.

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It may also be helpful to cut back on drinks containing caffeine, like cola or hot chocolate, in the evening hours. Caffeine can increase the rate at which urine is produced.

Another way to cut back on fluids at night is to encourage your child to drink more fluids during the day. Save the treats such as cola, sweet teas, juice, or hot cocoa for after school. Encourage the whole family to drink just a small glass of water with dinner.

Bedwetting Busting Routine No. 3: Use the Bathroom Before Bed

Just like brushing her teeth, your child should be sure to urinate right before she goes to bed so that she starts the night with a completely empty bladder. But what if your child is anxious about using the potty or rushes to get out of the bathroom?

“Sometimes kids run into the bathroom and partially void, so it's a good idea to remind them to relax and let all of their urine out,” says Howard Bennett, MD, author of Waking Up Dry: A Guide to Help Children Overcome Bedwetting. “If a child has difficulty following this rule, I ask them to do a double-void before bed -- pee 30 minutes before they go to sleep and then again right before they get in bed.”

Bedwetting Busting Routine No. 4: Keep or Review a Bedwetting Journal

Experts found that allowing children to “own” their problem, and take some responsibility for fixing it, can be very helpful, especially for bedwetting in older children. The goal is not to shame them into staying dry overnight, but to give them a sense of control and optimism that they can stop wetting the bed.

One way to do this is to help your child keep a bedwetting calendar or journal. It can be something as simple as putting stars on a calendar every day a child stays dry overnight, or something much more scientific.

Fritz has found that some children, depending on age and level of interest, become quite involved in testing things that might be contributing to their bedwetting problem. You can help your child come up with theories to test. For example, does he stay dry every time he pictures himself waking up to pee right before he goes to sleep? Or does he notice that he wets the bed every time he drinks a big mug of root beer after dinner?

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“Some kids get really into it, coming up with hypotheses about what it was that made the difference,” Fritz says. “It doesn’t much matter what they test. The most important thing is the kid getting into the process and feeling some control. They’re realizing they’re not a bad kid -- they’re owning their problem and working on it.”

You and your child can work on the journal in the evenings together, or use it to review your child’s recent successes before you tuck him into bed. You can also use the calendar in the evening to record whether your child has done all of his bedwetting “homework.”

“Some kids like to keep a calendar so they can make a check mark showing they did their bedtime bladder work before going to sleep,” Bennett tells WebMD.

Bedwetting Busting Routine No. 5: Make Bedtime a Pleasant Time

Experts say that the emotional damage that can be done by the repercussions of bedwetting can be far worse than bedwetting itself, which causes children no lasting damage.

So, bedtime is an opportunity to bond with your child and address the bedwetting in a positive way. You can act as a cheerleader for your child, or read one of the many children’s books about bedwetting that are available.

The key to talking about bedwetting, whether at night or during the day, is to strike the right balance. You don’t want to ignore the problem entirely, nor do you want to spend every second of every night focusing on whether or not your child will wet the bed.

“The goal is always the same -- to have the child be invested but not consumed by this symptom, and to have families be matter of fact about it, just like any other problem,” Fritz says.

WebMD Feature Reviewed by Roy Benaroch, MD on February 25, 2012

Sources

SOURCES:

American Academy of Family Physicians, Familydoctor.org: “Enuresis (Bed-Wetting).”

Thiedke, C.C., “Nocturnal Enuresis,” American Family Physician, April 1, 2003.

Gregory Fritz, MD, professor and director, Division of Child and Adolescent Psychology, Brown Medical School.

Howard Bennett, MD, author, Waking Up Dry: A Guide to Help Children Overcome Bedwetting.

Nemours Foundation, Kidshealth.org: “Bedwetting.”

American Academy of Child and Adolescent Psychology web site: “Bedwetting.”

Johnson, M, “Nocturnal enuresis,” Urologic Nursing, December 1998; 18(4): pp 259-273.

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