Incontinence

Updated 17 February 2016

What to do if your child wets the bed

Punishing your child for bedwetting will only worsen these cases. In the final of a three-part Health24 series on enuresis, here are some tips to help parents with children who wet themselves.

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Parents who beat their children for wetting themselves risks further exacerbating this condition, experts have warned.

The first rule when it comes to dealing with children who have a problem with going to the loo is never to be negative and punish them, according to Dr Christel du Buisson, Paediatric Nephrologist and Senior Specialist at Tygerberg Children’s Hospital and University of Stellenbosch.

"Negative feedback in children who wet, either occasionally before the age of 5 or after 5, exacerbates the problem," she said. "So try positive things. Star charts work. When they are dry reward them, but if they are not, encourage them."

Read: More effective treatments for bedwetting

Enuresis, which is the medical term used to describe bedwetting can broadly fall within two categories.

Primary enuresis is when your child has never had the ability to be dry at night or for a short period, for no longer than 6 months. Whereas secondary enuresis is when your child was dry at night for 6 months or longer.

Dr Du Buisson suggested starting healthy habits, such as:

1. Letting children drink water, rather than caffeinated drinks

2. Letting children consume liquids in the morning and early afternoon, especially when children are in play school.

"Logically, if you are going to drink tons just before bed and late afternoons, you will need to go to the toilet in the middle of the night."

3. Regular toilet times. This will prevent children from holding in their pee.

"This is very important, especially in children that get lost in their own world playing and end up holding for hours, or children who are slightly hyperactive. They usually know they need to go, but keep holding just to finish one more game."

4. Make sure your child is not constipated. 

"You have to look at the stool passed to see and also how hard they have to strain to do so. To prevent this, encourage enough water drinking, fibrous food such as fruit and vegetable. Avoid white bread; refined foods; keep rice to a minimum and not to eat to many bananas."

Read: Bedwetting can be due to undiagnosed constipation

Wetting a bed is no reason for harsh or corporal punishment, said clinical psychologist Dr Ian Opperman, who is in private practice in Johannesburg and serves on the Executive Committee of the Psychological Society of South Africa (PsySSA),

"This certainly doesn’t alleviate the problem of bedwetting, but only makes it far worse. Parents can attend parental guidance workshops or therapy to help guide them through this phase of development".

Dr Opperman outlined the following tips to help parents with children who wet the bed:

1. Keeping bedwetting a secret can exacerbate bedwetting, as children think that they are the only ones who wet their beds, which causes the child to feel worse about the situation.

2. Parents can have their children checked for urinary infections, diabetes, food allergies, etc, as any of these can also cause bedwetting.

3. Some suggest that restricting the child’s fluid intake before bed is also helpful and waking the child up, before you go to sleep, to urinate in the toilet at night may also be helpful.

"However, some believe that this could increase the occurrence of bedwetting when parents stop waking the child to urinate at night."

4. Parents should be concerned about bedwetting when it is possibly caused by medical problems, when children have gained night time bladder control and then relapse into bedwetting again as this could be a sign of psychological stress, or when the child is still wetting the bed after 6 years of age.

5. Showing love, warmth, and affection, and giving your children attention can alleviate the anxiety or fear they might be experiencing that may be causing the bedwetting.

6. Parents should educate themselves and their children about bedwetting.

"It is important to explain to the child that bedwetting is part of growing up, it is normal, the child is not naughty for wetting the bed, that everyone has wet their bed before; and explain what rules and routine needs to be applied and why, to try avoid wetting the bed at night. This is an important part of discipline."

7. Use star charts to praise the child on mornings that he/she did not wet their bed. The child requires positive reinforcement.

8. Help the child maintain self-respect despite his embarrassing trouble.

9. Leave the bathroom light on.

10. Give verbal cues before such as "try to get up and use the toilet if your bladder feels full", in a subtle and casual manner, not in a harsh and belittling manner.

11. To a degree that may be age appropriate, ask the child to participate in the clean-up process, such as washing out his/her pyjamas, changing the bedding, taking a quick bath in the morning, etc.

"This should NOT be presented as punishment, but as a routine."

Some tips for potty training

Dr Du Buisson also went to on to point out that when it comes to potty training, the main points are to:

1. Let your child see you using the toilet from a young age to start making the association

2. At the correct age, or when you see that they are sensing a full bladder, start a potty regime.

"Take them regularly, in the beginning it is going to be a hit or miss, but when success is reached the first time, you should make the biggest fuss about it that you have ever done."

3. Start with the day times first, the night time will only follow when daytime success and dryness is reached. This will also be a hit or miss.  

4. The same go for passing stool. A regular routine should be encouraged from a young age.

"They should never feel or be made to feel ashamed of passing stool, so yes, if they need to pass stool whilst shopping, take them.  Never hurry them along, let them take there time."

5. Sitting position is extremely important.

For girls: Teach them that their underwear should be down by the ankles and not by the knees. This helps them to relax the pelvic floor. The feet must be flat and they must sit comfortable, relaxed, knees apart.

"Thus, if you get one of the toilet seat adapters, also place a foot stool down so their feet don't dangle and they end up with their feet on their toes (which actually contracts the pelvic floor and makes both urination and defecation through a tightened pelvic floor, most difficult) and have the fear of falling into a big hole."

6. Boys have a tendency to be too hasty.

For boys: They should relax, stand with their feet apart. Best is to first let them sit down, as for girls, until they get the basic principles right and then they can stand.

Do you have concerns over bedwetting? Ask Health24's incontinence expert Prenevin Govender.

Also read:

Bedwetting accidents: When parents kill... (Part 1)

Why do children wet their beds? (Part 2)

Image: Bedwetting graphic from iStock


 

Ask the Expert

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Incontinence Expert

Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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