Clinical tips for helping patients overcome bedwetting

I have been interested in helping children with nocturnal enuresis since I completed pediatric residency in 1980. Over the past 25 years, I have fine-tuned my approach to bedwetting, incorporating techniques from both the pediatric and urologic literature, and would like to share some of the tips I've learned along the way. The mainstay of the treatment program I use is the enuresis alarm; I encourage all children 7 years and older with bedwetting to use this device. (Some 12% of 6 year olds are wet at night; 15% each year become dry spontaneously. By 16 years, 1% still wet the bed. Most pediatricians do not consider bedwetting to be a "problem" in children younger than 6 years.)

Involve the child in the treatment plan

Children are more motivated to work on becoming dry if they are actively involved in the treatment plan. Here are some ways to help children feel that they are part of the team.

Reassure the child: "You aren't alone"

Nocturnal enuresis affects 5 to 6 million children in the United States. Because bedwetting is a private matter, however, most people do not talk about it outside the home. This leaves many children (and some parents) thinking they are the only ones with the problem.

One of the first things I tell patients who come to me for bedwetting is that lots of children have trouble staying dry at night. To help the child understand how big the number 5 million is, I explain that if you invited 5 million kids to see a professional baseball game, you would need 100 stadiums to find them all seats.

It's important to present statistics in a way that a child can grasp. If you tell an adult that 5% of 10-year-olds wet the bed, the adult easily understands what you mean. Such a figure conveys little information to a child, however. To present it in child-friendly terms, I convert standard bedwetting data to school-based statistics. For example, in an elementary school of 500 children, 50 are wet at night. In a middle school of 1,000 children, 31 are wet at night. By using simple algebra, you can rework these numbers to educate the child about how many students wet the bed in his school.

Debunk the myths

Misinformation about bedwetting abounds. It is important to debunk the following myths that children and parents may hear from peers or family members to make it clear that bedwetting is not the child's fault: