Hi Dr Deb,
I have been counseling the parents of an 8y/o girl. Her mother describes her issue with bedwetting as follows.
” She was in pull/ups at night until she was 6.She is a really heavy sleeper. She started wetting the bed in September right when she started 3rd grade and 2 weeks after Will (a 2y/o friend offamily) died. She is able to control it when we stay away from home but otherwise it is fairly consistent – maybe 1-2 nights of dry bed a week.”
Dr Deb do you have any ideas or professional reading material to share with me? Thanks
Hi Dr. Denise,
Thanks very much for your question. Nighttime bedwetting (or “enuresis” as it is called if the bedwetting is followed by 6 months or more of nighttime dryness), can be a very stressful situation for both the affected child and his/her parents.
Typically, I am not concerned when I hear that a child does not achieve daytime dryness until age 6. In fact as many as 10 – 13 % of 6-year-olds and approximately 7% of 7-year-olds still wet the bed at night. For deep sleepers especially, the physiological mechanism that alerts them to wake up when their bladder is full, may not develop as quickly as same-age peers. For these children, typically specific strategies are utilized to help them wake up, and stay dry at night. These same strategies that are used to help younger children stay dry at night can be utilized here for this young lady.
I would first of all, have her visit her pediatrician to ensure that there are no medical issues underlying her bedwetting (e.g. bladder infection, etc.).
However, in her particular circumstance, since she had 2 – 3 years of dryness, and then reverted to nighttime wetting, I would say that likely we would need to address these concerns in a twofold manner: First – using practical behavioral strategies, and Second – pinpointing and managing the underlying emotional stressors/triggers that are provoking this regression.
The first approach – practical- is actually an easier approach to implement at first. Simple strategies can include: 1. Preventing nighttime drinking 2 hours before bedtime, 2. Taking her to the bathroom at night before she goes to bed, 3. Waking her to take her to the bathroom before her parents go to bed ‘e.g. 10:30/11:00’, 4. Buying her a bedwetting alarm (note – if she is a very deep sleeper make sure you invest in one with a volume control switch), 5. Setting her bedroom alarm to wake her at some point in the night, if you are able to pinpoint when wetting occurs. (Many bedwetting accidents are in the early morning hours before waking – therefore sometimes a 4am alarm is what is needed).
The second approach – pinpointing and addressing the probable triggers – can require more time and patience. From your message, it sounds like she was deeply affected by the death of a dear family member. This is certainly understandable – therefore, she may benefit from grief counseling at school or with a therapist to help her cope with her emotions surrounding this tragedy. Also, given she was just starting third grade at the time the bedwetting began, I would check with her teachers to ensure that there aren’t any academic or social challenges she began to experience at the start of 3rd grade that she is still struggling with. Children who are naturally not good ‘talkers’ in terms of their abilities to share intimate feelings, inner struggles, and heartfelt emotions with others often have behavioral symptoms of their distress instead …So it may require some ‘digging’ on the part of her parents or the potential therapist to get at the heart of the issue.
It should be kept in mind that most older children are very vulnerable and ashamed about their bedwetting problem. Their self-esteem is affected, and they are usually feeling very hopeless and helpless in terms of what to do. Above all, it will be important to provide her reassurance that she is normal (e.g. there is nothing ‘wrong’ with her), and that adults around who care about her will help her to resolve this problem.
I know there are many books to be found on nocturnal eneuresis , although I can’t say I have read any that stuck out in my mind. Perhaps a good counselor working with her instead could be just what the Dr. ordered.
I hope this helps.