Welcome to our weekly online series on parenting advice with local expert Dr. Deborah Wood.
Dear Dr. Debbie,
My son is 5 and still wears Pull-Ups at night. Although he was previously fully potty trained, recently he even sometimes still has accidents during the day. Is this normal? What can we do to help him stay dry?
Dear All-Wet Parents,
Through age five, releasing urine at night is a normal, though inconvenient, occurrence. Infrequent accidents could happen at any time in childhood (by some estimates, 10% of five-year-olds and 5% of 10-year-olds). By the teen-age years it is rare, but not unheard of. No one brags about it, so it’s understandable to wonder if your son is “abnormal” with this problem. Please recognize that he is probably as displeased as you are about it. As he matures, your son’s bladder not only holds more, his brain gets more regular with the hormones that slow down urine production at night. In some families, the regular production of the hormone -known as ADH for anti-diuretic hormone -arrives later than in other families. And since we can’t control our genetics, we might as well learn to live with their inconveniences.
There are several things you can do to help your son manage. If he doesn’t mind them, the Pull-Ups may be the perfect aid for allowing him to continue sleeping undisturbed. If he is ready to do away them (he might be comforted to know that other children his age and older still wear them), you can minimize the spread of urine by placing an absorbent towel between the bottom sheet and the mattress. If you don’t have a waterproof mattress, you probably have a waterproof mattress cover on his bed. The goal is to help him sleep through the wet bed because everyone will manage laundry, bathing and clean clothing better in the morning.
Be sure he has pajamas that are easy for him to manage when he’s half asleep and the urge is urgent. Use nightlights to help him see his way to the bathroom, should he wake up needing to go. Before he goes to bed, he can help to make sure toys and other items are not cluttering the way. When you think he’s old enough, you might show him what to do with the wet pajamas and bedding (maybe put them in the bathtub) and give himself a “bird bath” at the sink with a washcloth. Then he can dry himself and put on clean pajamas. At this point, he needs to know where he can go to finish sleeping. If you’d rather he not climb in bed with you (“dry and quiet”), a simple sleeping bag might be kept in his room for him to throw on top of the bed (just in case he wets again).
In some cases, a “last call” for drinking helps lessen the amount of liquid in his body at bedtime (two to three hours prior), but in other cases, due to the lack of ADH, this has no effect . You might discreetly watch to see if there is any pattern before putting him through false hopes that timing his liquid intake will help.
Awakening him to use the bathroom when you go to bed may save the sheets, but might make him groggy tomorrow. It also doesn’t contribute to him being alert to the feeling of fullness in the bladder. Some success in “training” a child to waken himself has been achieved with a specialized alarm system. It either attaches to his underwear or the sheet and goes off at the first drip of urine. After several weeks’ use, he will have learned to recognize how his bladder feels as the alarm is sounded and be able to wake himself to avoid the alarm. If your child is eager to consider this option, it should be discussed with your pediatrician or a continence/incontinence specialist.
The doctor’s office is also a good place to discuss whether hormone therapy would be appropriate. It would be helpful to ask the grandparents if bedwetting runs in either side of the family. If this is the cause, the artificial ADH can be given nightly as a pill, nasal spray or nose drops.
Low-stress activities should be part of every day, particularly when we are dealing with things out of our control. These will be different for every child – coloring, singing, taking a walk, swinging, playing catch, being read to, flying a kite.
Since you mentioned that your son is recently having accidents during the day, there may be some new stress in his life that is causing this. It could be something at school, changes in the family, peer conflicts, or his own anxiety over the bedwetting (and your reactions to it). Make time to talk with him about things and be a good listener. Let him know he can safely share his feelings with you. He can count on you to fix some of his problems (if he lets you know about them), and to commiserate about the ones you can’t. Professional counselors – for children and for parents – can assist with understanding how stress affects us and in seeking solutions.
Dr. Deborah Wood is a child development specialist in Annapolis. She holds a doctorate in Human Development from the University of Maryland at College Park and is founding director of the Chesapeake Children’s Museum. Long time fans and new readers can find many of her “Understanding Children” columns archived on the Chesapeake Family Magazine website. You can find her online at www.drdebbiewood.com
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