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    Bed-wetting

 
 

Bed-wetting

Responding helpfully to a child or young person who wets the bed

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About bed-wetting                                                                                                   printable pdf

Usually children are able to control their bladder reliably by the age of five during the day and night. They generally learn to stay dry during the day before then, but still have the occasional bed-wetting accident (see general information on toileting).  This is completely normal, and most children wet the bed occasionally for no serious reason. However, if they wet the bed frequently after age six, it is important to examine the reasons behind it.

Firstly it is important to work out whether the child has ever had a continuous period of six months without wetting the bed.

If the child has never had a six month period without a wet bed, there is a strong possibility that this is because they have not yet developed full control of their bladder when sleeping. This is thought to be due to the brain not recognising that the bladder is full. The bladder then empties automatically leading to the wet bed. Many young people who wet the bed are very deep sleepers, which may explain why they can sleep undisturbed until morning. It is common for the young person to get used to the sensation of lying in a wet bed and stop complaining.

If the child has had a period of being fully dry for more than six months and returns to frequent wetting, other factors should be explored, such as physical problems or worries.


Things to think about                                                                                            
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In most cases, bed-wetting is not a serious problem, and will get better with time. It is important to rule out any physical problems, such as injuries, infections, or constipation, as these can directly cause bed-wetting. However, a common problem with bed-wetting is often that the children and young people feel embarrassed about it, and worry that they are misbehaving and disappointing their carers, especially if their response to the wetting is negative. It is therefore important that carers, teachers and other adults stay calm, reassuring and supportive of the young person. Often, all the young person needs is for adults to be understanding and to help them keep this matter private.

Unfortunately, bed-wetting is often wrongly perceived as a weakness or a sign of general immaturity. This leads to children feeling even more embarrassed about it, and can result in low confidence, ridicule and social exclusion. For many children and young people who wet their bed, it is very important that this matter is kept a secret.

It is important that the child feels understood and supported. The discrete use of absorbent night pants and ensuring that they receive assistance with hygiene (and getting praised and encouraged to do so) can go a long way to offset the embarrassment they feel.

When trying to help, it is important to take the social aspect into consideration. The fear that friends will find out and tell others can lead children and young people to restrict their social life. For example, being invited to sleep over at a friend’s house or going on a school trip involving an overnight stay can lead to considerable difficulties for these young people. Often the only solution is to make an excuse not to go.

Bed-wetting is mostly nothing serious, but it can occur when a child is unhappy or worried but is by no means a direct indication that this is the case. If the child has been dry for a long time, and suddenly starts wetting their bed frequently this can be a sign that they are anxious or worried about something.


Think about yourself                                                                                             
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When a young person continues to wet the bed long after you would expect them to be dry, it can lead to frustration and angry feelings which are not helpful to the young person.  The messy work involved in cleaning up, especially when tired, can inadvertently lead carers to give off signals of annoyance or even revulsion.  The young person will inevitably pick up these messages and this can lead to low confidence or sense of self-worth.  So, it is important to understand how this behaviour affects you and the messages you are giving out so that you can respond encouragingly.

For more information, see section on being aware of yourself and your own response.


What you can do                                                                                                    top of page

If the child or young person has never been dry for a full six months at night

  • If they are over the age of six, the child should be taken to a doctor for an examination to investigate the possibility of a physical cause such as injury, infection, diabetes etc.
  • Don’t punish them for wetting the bed - bed-wetting is rarely a deliberate act.
  • Tell the child or young person that bed-wetting is normal and they should not feel embarrassed.
  • Avoid showing them that you are angry or repulsed when they have a wet bed, as this may lower their confidence, or lead to stress or denial.
  • Try to remain neutral - too much positive attention or reassurance can give them the message that you are happy for them to continue to wet the bed.
  • Try to give them the message that you are keen for them to become dry but you are not disappointed if it takes a long time.
  • Praise them when they wake up dry but avoid lavishing praise for a dry bed as they may not be able to repeat it easily. Think about using a behavioural reward chart (see section on behavioural techniques).
  • Encourage them to take some responsibility for their own hygiene by getting them involved in changing/washing the wet bed clothes, but not as a punishment.
  • Ensure they have easy access to the toilet, e.g. that they are not on the top of a bunk bed.
  • Reduce their drinks two hours before bedtime, but don’t refuse them if they are thirsty.
  • Encourage them to go to the toilet just before bed.
  • Ask if they are frightened of going to the toilet at night, e.g. is it too dark, are they afraid of ghosts etc.  For more information, see section on counselling techniques.
  • Protect the bed with a waterproof mattress cover. If they are wet every night think about using absorbent night pants for a few months until they show some signs of improvement.
  • Try using a bed-wetting alarm. This is an electronic device that detects moisture and sets off a buzzer to wake the child or young person as soon as they wet. These are successful with around 70% of young people if used properly. They can be purchased on the internet or borrowed from the local Health Service.
  • You may want to wake the child during the night to take them to the toilet, however this is unlikely to improve their ability to waken themselves.
  • Simply being aware of the challenges that face these young people to keep this issue from friends can be very helpful.

If the child or young person starts to wet the bed frequently after being dry for more than six months

  • Firstly, the child should be taken to a doctor for an examination to investigate the possibility of a physical cause such as injury, infection, diabetes etc.
  • Don’t punish them for wetting the bed - bed-wetting is rarely a deliberate act
  • Be aware of and record their bed-wetting to see what is happening when they wet the bed less often.  For more information, see section on solution-focused techniques.
  • Tell the child or young person that bed-wetting is common and they should not feel embarrassed.
  • Avoid showing them that you are angry or repulsed when they have a wet bed as this may lower their confidence, or lead to stress or denial.
  • Try to remain neutral - too much positive attention or reassurance can give them the message that you are happy for them to continue to wet the bed.
  • Try to give them the message that you are keen for them to become dry but you are not disappointed if it takes a long time.
  • Praise them when they wake up dry but avoid lavishing praise for a dry bed as they may not be able to repeat it easily. Think about using a behavioural reward chart (see section on behavioural techniques).
  • Encourage them to take some responsibility for their own hygiene by getting them involved in changing/washing the wet bed clothes, but not as a punishment.
  • Ensure they have easy access to the toilet e.g. that they are not on the top of a bunk bed.
  • Reduce their drinks two hours before bedtime, but don’t refuse them if they are thirsty.
  • Encourage them to go to the toilet just before bed.
  • Ask if they are frightened of going to the toilet at night, e.g. is it too dark, are they afraid of ghosts etc.  For more information, see section on counselling techniques. 
  • Protect the bed with a waterproof mattress cover.
  • Try using a bed-wetting alarm. This is an electronic device that detects moisture and sets off a buzzer to wake the child or young person as soon as they wet. These are successful with around 70% of young people if used properly. They can be purchased on the internet or borrowed from the local Health Service. These are often successful when used with a behavioural reward chart (see section on behavioural techniques).
  • You may want to wake the child during the night to take them to the toilet, however this is unlikely to improve their ability to waken themselves.
  • Simply being aware of the challenges that face these young people to keep this issue from friends can be very helpful.


When to contact a specialist                                                                               top of page

When to contact a doctor/health worker

  • If the child is complaining of pain or discomfort.

  • If their urine has a strong smell.

  • If the child appears regularly constipated.

  • If the child still wets the bed regularly and persistently by age seven.

  • If the bed-wetting suddenly occurs much more frequently.

  • If the child starts to wet themselves regularly after a six month period of having been in full control of their bladder.


When to contact a mental health specialist

  • If the problem is persistent and longstanding after the age of five and is causing the child to feel distressed and embarrassed.

  • If other significant behavioural or psychological problems are present.

  • If your efforts to help uncover issues that you do not have the experience to deal with, e.g. sexual abuse.


How to contact a mental health specialist

You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.

Remember - you can contact your local mental health specialists for a number of reasons, for example:

  • For advice on how to make a referral about a named child.

  • For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).

  • For advice about what to do (once again there should be no necessity to name the child).

By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.

 

printable pdf

 

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