How To Deal With Toddler's Bedwetting: Causes & Strategies

Bedwetting refers to uncontrollable urination while being asleep. It is commonly seen in some children as it is viewed as part of growing up. However, it can be worrisome and stressful for the parents if the problem persists beyond early childhood.

Most three to four year old children are able to achieve daytime control, and most by age four to five will achieve night-time control. However bedwetting occurs when there is regular (≥ 2 times a week) involuntary passage of urine while asleep in children who are 5 years and above of age.

Bed wetting may be classified into two categories, primary bedwetting and secondary bedwetting. It is important to differentiate between the two categories as secondary bedwetting in particular may be attributable to an underlying medical or psychological condition.

1. Primary bedwetting: This applies to children who have never been consistently dry at nights for a period of ≥6 months.

2. Secondary bedwetting: This applies to children who have previously stayed dry at nights for ≥ 6 months.

Causes of Bedwetting

Bedwetting is believed to be caused by the interplay between the following three factors:

• Increased urine production during sleep
• Reduced bladder capacity
• Lack of arousal from sleep

Bedwetting is also often due to:

• Hereditary cause: Approximately 70% of children who experience bedwetting have a sibling or parent who had faced the same condition
• Psychosocial factors: Teasing and bullying may result in primary bedwetting. Secondary noctural bedwetting can often be due to psychosocial stressors such as parental separation, problems in school, or welcoming a new baby in the family
• Underlying medical conditions, such as urinary tract infection, constipation, diabetes mellitus, and spinal cord disorders

Types of foods that might trigger bedwetting

Limiting the amount of fluids before sleep, and avoiding caffeine containing food and drinks such as tea, coffee, energy drinks, chocolates are often recommended. There is no need to ban these foods completely, but they can be enjoyed earlier in the day to wear off some of the effects before bedtime.

Some parents are concerned about spicy or citrus foods as they believe that such foods may irritate the bladder. However, there is no scientific evidence that shows the relationship between spicy or citrus foods and bedwetting currently.

Continue reading on the next page for strategies and tips...

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What are some top 5 or more strategies or tips parents can adopt in preventing their kids from wetting the bed?

Here are some tips that parents can use to help their child who is bedwetting:

1. Communicate with your child

• It's very important to reassure your child that bedwetting is very common, and that he or she is not alone. Talk to your child about what he or she feels and thinks and offer support. Remember that bedwetting is not something your child has complete control over

2. Limit liquid intake two hours before bedtime

• Encourage your child to drink most of the liquids earlier in the day, and limiting liquid intake two hours before bedtime can be helpful. At the same time, there is no need to restrict excessively to the point that your child is thirsty
• Avoid letting your child have caffeine containing food and drinks such as tea, coffee, energy drinks, chocolates in the evening

3. Establish a toilet schedule

• Make sure your child goes to the toilet before he or she sleeps. Parents may also consider a double-voiding routine whereby child goes to the toilet 30 to 60 minutes prior to bedtime, and again right before child heads into bed.

4. Awakening routine

• If your child is able to wake up at night, encourage him or her to go to the toilet then. Get your child to rehearse the steps needed in getting up from his or her bed to use the toilet prior to going to bed every night.
• Alternatively, if your child has trouble with the self-awakening approach, you may need to wake him or her up about two to three hours after bedtime or just before you sleep. However, avoid carrying your child and let him or her find the toilet independently instead.
• Place a night light in your child's bedroom, in the hallway, and in the toilet, so that your child is less afraid to go to the toilet at night.

5. Waterproof your mattress

• Parents can consider investing in a waterproof mattress cover or protector, as this will make it easier to change the bedsheets. Involve your child while changing the wet sheets may be helpful too, as it can make him or her feel like a part of the solution rather than the problem. Prepare an extra set of pajamas by the bedside to allow a quick change of clothes in the middle of the night.

6. Use positive reinforcements

• Consider a positive reinforcement system such as praising your child when he or she did not wet the bed the night before. For instance, you can create an incentive chart where your child can earn points or stars to get a small reward.

What are the options for bladder training?

Bladder training usually consists of exercises to strengthen the muscle that controls the release of urine from the bladder, and increase the amount of urine the bladder can hold.

Muscle strengthening exercises (also known as start-stop training) often involve asking your child to practice starting and stopping the urine stream while urinating, while the bladder stretching exercises (also known as retention control training) involve getting your child to drink lots of liquids during the day, and have him or her practice holding his or her urine for successively longer intervals, with the aim of  increasing his or her bladder capacity.

While bladder training is sometimes considered as part of a multi-modal therapy program, especially for children who also have daytime wetting symptoms, there is currently insufficient evidence to recommend bladder training  as an initial treatment for children who experience bedwetting.

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Dr Tan Zhen Han

Paediatrician

SBCC Baby & Child Clinic

MBBS (S’pore), MRCPCH (UK), FAMS (Paediatrics)

This article is brought to you by Healthway Medical.