Kids and Bedwetting

girl laying on bed
CAUSES AND SOLUTIONS
Bedwetting (nocturnal enuresis) can frustrate parents and children who often feel embarrassed and anxious about this problem and suffer from low self-esteem. Bedwetting occurs more frequently in boys than in girls and Dr. Khoury says the problem typically stops once the child is motivated and ready to work on staying dry at night. “It’s not the kid’s being lazy or irresponsible” says Dr. Khoury. “It’s not a reflection of the child’s intelligence, and in fact, a majority of children with bedwetting say math is their favorite subject at school.”

CAUSES
“The problem with bedwetting is not that the kidneys produce too much urine. The issue is: is the brain waking up to the full bladder and the need  to go to the bathroom when the bladder is full?” explains Dr. Khoury. “In a child with a bedwetting issue, the communication between brain and  bladder is incomplete and inefficient. You need the brain and bladder talking to each other so you can be responsive and awaken to that stimulus.”

BEST SOLUTION
Ideally, reducing the intake of liquid before bed will help reduce bedwetting. But training the brain to respond to the need to urinate is the goal. A wetness alarm with sensors can be placed on the child’s underwear and when wetness is detected, a buzzer goes off and wakes the child. “After three to four weeks, the brain realizes it isn’t keeping track of the bladder at night,” says Dr. Khoury. “If your brain is now  expecting a buzzer every time the bladder begins to wet, the brain begins to wake up before it wets. So you get up and go to the bathroom. The brain begins to communicate with the bladder and tells the bladder to wait, and you can sleep all night.” Medication that reduces the amount of urine produced by the kidneys at night, a safe and common treatment, can also be used, Dr. Khoury says.

WHAT IF MY CHILD ISN’T MOTIVATED TO WORK ON STAYING DRY AT NIGHT?
“If the child isn’t ready, wait and when the child is ready, that will be the time to start talking to them about the alarm. It has to be used properly,” says Dr. Khoury.

FAST FACTS

  • Number of U.S. children overage 6 affected by persistent nighttime bedwetting: 5 Million
  • Percentage of 5-year-olds that wet the bed: 15%
  • Chance that a child will be a bedwetter if both parents were: 50%

View the full feature on Kids and Bedwetting

Dr. Khoury
Dr. Antoine “Tony” E Khoury

PHYSICIAN FOCUS: Antoine “Tony” E Khoury, MD

Dr. Khoury completed his residency in urology at the University of Toronto in Canada. He completed a clinical fellowship and a research fellowship  in pediatric urology at the Hospital for Sick Children in Toronto, followed by a research fellowship at the University of Calgary in Alberta, Canada, in the area of biomaterial-related infections. He is recognized for his expertise in complex urological reconstruction of major birth defects.

Dr. Khoury’s philosophy of care: “I take a very analytical approach to the patient’s medical issues and listen to the family. With that in mind, I tailor their diagnostic studies and surgical intervention to the patient’s needs without putting them at risk for under-investigation or over-investigation.”

EDUCATION:
Ain Shams University Medical School in Cairo, Egypt

BOARD CERTIFICATIONS:
Urology

More about Dr. Khoury

This article was featured in the Orange County Register on January 21, 2014 and was written by Amy Bentley.

What if My Child Isn’t Motivated to Work on Staying Dry at Night?

iStock_000011371901Small“The problem with bedwetting is not that the kidneys produce too much urine. The issue is: is the brain waking up in response to the full bladder and the urge to go to the bathroom when the bladder is full?” explains CHOC Pediatric Urologist Dr. Tony Khoury. “In a child with a bedwetting issue, the communication between brain and bladder is incomplete and inefficient. You need the brain and bladder talking to each other so that the child can awaken in response to that stimulus.”

Training the brain to respond to the need to urinate is the goal, so one treatment option is the use of an alarm. An alarm with sensors is placed on the child’s underwear and when wetness is detected by the sensors, a buzzer goes off and wakes the child.

“If the child isn’t ready, wait and when the child is ready, that will be the time to start talking to them about the alarm. It has to be used properly,” says Dr. Khoury.

Dr. Khoury suggests that parents not push their child to stop wetting the bed or use the alarm unless the child is ready and motivated to stop. To help motivate your child to work on staying dry and to work with the alarm, parents can try taking off the potty training pants and put the child in regular underwear. Parents also can have their child help do his laundry and change the sheets to get him more motivated, Dr. Khoury says.

In cases where the child isn’t ready or motivated and still wets the bed despite using the alarm, it’s not the alarm that is failing to work.

“The alarm requires them to wake up. The alarm is doing its job and buzzing when the urine is coming out but the child is not responding,” Dr. Khoury says. If this is the case, Dr. Khoury says, “Have a parent or older sibling sleep with the child the first few nights of using the alarm and the parent or sibling can make sure he is waking up. If the child fights this, then there isn’t enough motivation so wait a few months and try again. The problem is, families give up. Wait until the child is ready. The child has to want it. If he is ready to be dry, he will work very hard with the alarm.”

The success rate of wetness alarms is excellent – provided the child wakes up to the alarm. In fact, 75 percent of children in three weeks manage to respond to the alarm and wake up as they are wetting or right before they wet, and then they sleep through the night.

“They begin to wake up on their own to go to the bathroom,” says Dr. Khoury. “I tell parents to keep putting the alarm on for six months past the child’s last wet night.”

Parents can tell their child is motivated to stay dry if he starts to notice that he is wet in the morning and doesn’t like it, if he says he doesn’t want to wear potty training pants anymore, and if he avoids sleepovers he wants to attend.

View our Health Feature on Bedwetting.

Related content:

  • Kids and Bedwetting
    Bedwetting occurs more frequently in boys than in girls and Dr. Khoury says the problem typically stops once the child is motivated and ready to work on staying dry at ...
  • How to Cope with Bedwetting
    Bedwetting that continues beyond the age of 5 can impact a child’s self esteem and create a sense of isolation, according to Dr. Christopher Link, post-doctoral fellow in CHOC Children’s ...

How to Cope with Bedwetting

Bedwetting that continues beyond the age of 5 can impact a child’s self esteem and create a sense of isolation, according to Christopher Link, post-doctoral fellow in CHOC Children’s Pediatric Psychology Department. Chris recently sat down with CHOC Radio host Bryan Mundia to talk about what parents can do to help their children cope with bedwetting.

First, it’s important to see a physician to rule out any medical causes for bedwetting occurring in older children. After medical issues have been addressed, there are some things parents can do, including limiting their child’s fluid intake before bedtime, making sure their child goes to the bathroom before getting under the covers, and avoiding caffeine.

Chris says parents need to understand that bedwetting is not a child’s fault; it’s not intentional. Instead of punishing children, parents need to reassure their children that they will grow out of it. For more helpful tips on this subject, tune into the show.

Enjoy the show!