Nocturnal Enuresis

WHAT YOU SHOULD KNOW:

• Nocturnal enuresis is when a child, five years of age or older, wets the bed while sleeping. When your child has nocturnal enuresis, he cannot control when he urinates during the night. Your child will wet the bed at least two nights each week, and up to every night. Some children with nocturnal enuresis have never had a dry night. Other children may have been dry for at least six months before beginning to wet the bed. The exact cause of your child's nocturnal enuresis may not be known. Your child may have nocturnal enuresis if his body makes more urine at night than his bladder can hold. Children who sleep very deeply, and are hard to wake up, may also have nocturnal enuresis.
  
  
• The risk for nocturnal enuresis is higher for children who have constipation (hard, dry bowel movements). Your child's risk also increases if he has diabetes (high blood sugar) or attention deficit hyperactivity disorder (ADHD). Stress from a new school, divorcing parents, or sexual abuse can also lead to nocturnal enuresis. Your child may stop wetting the bed on his own without treatment. Treatment for nocturnal enuresis includes medicines, alarm systems, and limited liquids before bedtime. Your child may feel embarrassed that he wets the bed, and may be teased by other children. It is important that parents support their child during treatment, and never punish the child for wetting the bed. Treatment may help your child stop wetting the bed and help him feel better about himself. Treatment may allow him to be a part of activities, such as sleepovers and overnight camps.

AFTER YOU LEAVE:

Medicines:

• Keep a current list of your child's medicines: Include the amounts, and when, how, and why they are taken. Bring the list and the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency. Throw away old medicine lists. Give vitamins, herbs, or food supplements only as directed.
  
  
• Give your child's medicine as directed: Call your child's primary healthcare provider if you think the medicine is not working as expected. Tell him if your child is allergic to any medicine. Ask before you change or stop giving your child his medicines.
  
  
• Anticholinergic medicine: Anticholinergic medicine helps your child's bladder hold more urine. The medicine may help keep the bladder muscles relaxed, and decrease your child's need to urinate while he sleeps.
  
  
• Antidiuretic medicine: Antidiuretic medicine helps decrease the amount of urine your child's body makes at night.
  
  
• Tricyclic antidepressants: Tricyclic antidepressant medicine may help decrease how often your child wets the bed.

Ask for more information about where and when to take your child for follow-up visits:

For continuing care, treatments, or home services for your child, ask for information.

• Your child's caregiver may have you keep a diary to record your child's wet and dry nights. Bring the diary with you to your child's follow-up visits. The diary may help your child's caregiver see if changes should be made in your child's treatment plan.
  
  

Ways to help manage your child's nocturnal enuresis:

• Follow the treatment plan: It may take many months before your child stays dry at night. If your child has an alarm system, get up to help your child when the alarm sounds. You may need to wake your child and help him to the bathroom. Following the treatment plan may help your child become, and continue to stay, dry at night.
  
  
• Have your child go to the bathroom regularly:
  
  
  • Ask your child to urinate about every two hours, or at least 2 to 3 times during the school day. Your child should also urinate right before going to bed each night. Leave a soft night light on in the bathroom for your child. Tell your child to relax when he urinates so his bladder can empty completely. Boys should unzip their pants all the way, or pull their pants down, so the penis is not bent. This will allow urine to flow more easily out of the bladder.
    
    
  • Your child should have a bowel movement (BM) every day to decrease his risk for constipation. Ask your child to try to have a BM each day after breakfast, or before going to school. Make sure your child is not rushing when trying to have a BM. A child's toilet seat or a stool to support his feet while sitting on the toilet may help. If your child has constipation, he may need medicine to soften his BMs. Ask your child's caregiver for information about this medicine and if your child needs it.
  
  
• Limit liquids before bedtime: Limit the liquids your child drinks to small amounts in the late afternoon and evening. Try to avoid giving your child liquids right before bed. If your child has liquids in the evening, have him avoid drinks with sugar or caffeine, and fizzy drinks. This may include fruit juices and soft drinks. To decrease your child's thirst at night, have him drink up to eight cups of liquid during the day. Drinking liquids should start at breakfast and continue until late afternoon.
  
  
• Support your child: Praise your child when he has a dry night. You may want to make a sticker or star chart to show your child's successes. You may want to reward your child with a prize after he has a certain number of dry nights. If your child is afraid of the dark, try sitting with your child while he falls asleep. Never punish or shame your child for wetting the bed.

For support and more information:

Nocturnal enuresis can be hard for you and your child. It is important to remember that your child cannot control his bedwetting. Children who wet the bed often feel embarrassed and upset. They may worry about activities, such as sleepovers, and about being teased by others. As a parent, having a child with nocturnal enuresis may make you feel worried and angry. You may be unsure about how to help your child. These feelings are normal. Talk with your child's caregiver or contact the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village , IL 60007-1098
  Phone: 1- 847 - 434-4000
  Web Address: http://www.aap.org
  

CONTACT A CAREGIVER IF:

• Your child has a stuffy nose, sore throat, cough, or trouble seeing well.
  
  
• Your child has stomach cramps, no appetite for food, or a bad taste in his mouth.
  
  
• Your child is having nosebleeds.
  
  
• Your child is not sleeping well, or is sleeping more than usual.
  
  
• Your child seems depressed (very sad), or suddenly angers easily.

SEEK CARE IMMEDIATELY IF:

• Another child takes the medicine used to treat your child's nocturnal enuresis.
  
  
• Your child's face, lips, tongue, or throat swell.
  
  
• Your child seems very confused, and is very sleepy or hard to wake during the day.
  
  
• Your child suddenly gets a headache, feels sick to his stomach, and vomits (throws up).

Learn more about Nocturnal Enuresis (Discharge Care)