In this episode, Janelle Marie Traylor, RN, explains common reasons children continue to wet the bed, what’s normal in development and when parents should seek medical help.
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Why Does My Child Keep Wetting The Bed?
Featured Speaker:
Janelle Traylor, RN, MSN, FNP
Janelle Marie Traylor, RN, MSN, FNP, is a certified nurse practitioner who specializes in caring for children with urological issues, including daytime and nighttime wetting, recurrent urinary tract infections (UTI), urinary frequency and painful urination. Since 2010, she has been helping Children’s Health℠ patients restore independence and improve quality of life.
“When I treat kids for urinary incontinence and they come back for follow-up appointments and have been dry, you can see the renewed confidence that they have,” she says. “There is something about their smile and the way they carry themselves. They are so proud. That’s why I go to work every day.”
Janelle provides family-centered care that supports both child and parent. She believes in engaging parents in the care process, and she strives to help parents become active in their child’s care through open communication and understanding.
“As a mom who had a child in the hospital, I understand the stress a medical condition can cause a family,” says Janelle. “I understand that parents worry. I want to do my best to comfort the parents, while helping their child.”
At Baylor University, Janelle earned a Bachelor of Science in nursing, a Master of Science in nursing and a Family Nurse Practitioner (FNP) degree. She is certified by the American Academy of Nurse Practitioners.
Janelle has been a co-investigator on a number of research projects assessing the diagnostic techniques used in pediatric urology, as well as new treatments. She is also an active lecturer, presenting at local universities. Janelle serves as a preceptor for the University of North Texas Health Science Center, University of Texas at Arlington (UTA), Baylor University and Texas Woman’s University. In this role, she teaches nurses, nurse practitioners, physician assistants and other health care professionals about the field of urology. She is currently on staff at UTA as clinical faculty for the Family Nurse Practitioner program.
She is a member of the American Academy of Pediatrics with a urology affiliation, the American Academy of Nurse Practitioners and the American Urological Association.
Janelle enjoys spending time outdoors, reading and visiting with friends and family. Most importantly, she loves spending time with her husband and two children.
Transcription:
Why Does My Child Keep Wetting The Bed?
Why Does My Child Keep Wetting The Bed?
Melanie Cole, MS (Host): Welcome to Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Melanie Cole. And today, we're answering the question, why does my child keep wetting the bed? Joining me is Janelle Traylor. She's a nurse practitioner at the Urology Clinic at Children's Health. Janelle, thank you so much for joining us today. So, tell us a little bit about the prevalence of kids that wet the bed. Is this a really common thing or is it kind of unusual?
Janelle Traylor: I will say bedwetting is the most common thing that I see in the urology clinic on a day-to-day basis. I looked at some stats and about 10% of seven-year-olds continue to wet the bed, and about 1% to 2% of all teenagers experience bedwetting. It's a secret that no one talks about, but it's very, very common.
Melanie Cole, MS: So, why do some children continue to wet the bed? Do we know?
Janelle Traylor: I'd like to say it's multifactorial. It's more of a developmental condition versus them being lazy. A lot of them sleep super heavy. It runs in families, and they continue to produce large amounts of urine when they're sleeping at night to where they have these overflow incontinence. They can't really hold it too well.
Melanie Cole, MS: Wow. So, it's pretty common. And at what age? Is it first of all when we're potty training our children? I know, you know, sometimes when they have mistakes and that's why we use pull-ups and things like that. But when is it considered normal, and when do families typically get referred then to pediatric urology?
Janelle Traylor: I'll say bedwetting is very common. Most families get referred around their seventh birthday or when bedwetting starts to affect the child's quality of life. That's when we really start to treat bedwetting.
Melanie Cole, MS: So before we go see a pediatric urologist, what are some common mistakes parents may make when they address bedwetting as soon as they start to notice it?
Janelle Traylor: One of the most common mistakes that parents make is that they shame their child or they punish them. They'll say their child is lazy, and that's not always the case. They'll restrict fluids all day instead of timing the fluids appropriately. They wait too long to seek help, which is so important to seek it sooner than later. They wake their child up every night as a strategy, which doesn't really help. I always tell parents, children, they don't wet the bed on purpose. No child wants to wake up in a pool full of urine.
Melanie Cole, MS: No, you're right about that. And so, sometimes children get potty trained and we're all very excited about it, and they've been dry all night. And suddenly, then they start wetting the bed again. What do you think or what have you seen might be causing that change?
Janelle Traylor: Yeah. So, we have primary nocturnal enuresis, and that means that they've never been dry for longer than six months. And then, you have secondary nocturnal enuresis, and that's where they've been dry for longer than six months and they start having accidents. Most causes of secondary nocturnal enuresis, it could be constipation, a urinary tract infection, or different social stressors like parents getting divorced, they move, or they're starting a new school, different things like that.
Melanie Cole, MS: So, stress can add to this?
Janelle Traylor: Absolutely. It's one of the big causes for secondary nocturnal enuresis.
Melanie Cole, MS: So, what signs might indicate, Janelle, that bedwetting is related to an underlying medical condition rather than typical development?
Janelle Traylor: Yeah. So, you think about do they have only nocturnal enuresis or are there any daytime symptoms? So, daytime wetting, painful urination, excessive thirst throughout the daytime, frequent daytime accidents, they snore super loud, a weak urinary stream, or they have difficulty walking or some other neurological symptoms. Constipation's a big one too.
Melanie Cole, MS: So, those two things can go together to signal that there's a red flag.
Janelle Traylor: Absolutely. Yeah. I always say most bedwetting is benign, but daytime symptoms are often what tell us that we need to look deeper, coupled with constipation. a lot of times if we treat the constipation, the bedwetting will improve.
Melanie Cole, MS: Then, let's talk about treatments. But before we do, what happens when families come to your clinic at Children's Health? What does that look like, and how do you work with these children? Because you said kids can be ashamed of it and they can feel bad about themselves because of it. Tell us about your team and how you work with these children in a very sensitive, compassionate way.
Janelle Traylor: Yeah. So, I think it's something that we're all very well prepared for. When they come see us, we try to be non-judgmental and just let them know, "Hey, this is normal. It's okay. It's very common." I let kids know that you are not the only one in your classroom that does this, it's a secret, and just do my best to make them feel comfortable before I jump in and start talking about different options. I let them know that more than likely they'll outgrow it and they'll be okay.
So when they come to our clinic, they'll first be greeted by one of the medical assistants, and they'll get a urinalysis on them. That way we can check the urine to make sure everything's okay, no urinary tract infections or other things that could make us think other causes. Sometimes we get a bladder sonogram to make sure they're emptying their bladder appropriately and there's not a significant amount of constipation. Sometimes we'll get a sonogram of their kidneys to make sure their kidneys look good. And then, they'll meet with us, the nurse practitioners or a physician, whichever they have an appointment with. And during those visits, we get a nice little history, get to know the child a little bit better, find out if there's any social stressors or any other things that we may be missing.
Melanie Cole, MS: So, that sounds like it's a more comfortable environment, at least for the child and their parents, because, you know, obviously, it can be a worrisome time for both thinking that there are medical reasons for this. So, what treatment options are available for children who struggle with bedwetting?
Janelle Traylor: Absolutely. So, the first-line treatment is always different behavioral interventions. You think about good voiding habits during the daytime, constipation management. You tell them about decreasing fluids, limiting caffeine, and encouraging good bladder emptying before they go to sleep at night. I spend some time talking to the parents about positive reinforcement and not shaming the kids or punishing the children. Those are the initial things that we discuss.
Other things we could think about is the bedwetting alarm, which has a really good success rate long term. But initially, it's a little bit more challenging. There's desmopressin, which is a medication. It's particularly helpful for kids for sleepovers and camps and vacations. It works really well initially, but it does have a high relapse rate.
Melanie Cole, MS: So, what have you seen as far as outcomes when you try some of these treatments? And if they are not working, what's sort of next on that list?
Janelle Traylor: I'd like to say most of the treatments work really well, and we get really good feedback and success rates. Every now and then, we do have a little bit more of a difficult case where the patient is not progressing as well as we'd like to. So, that's when we do further imaging just to make sure we're not missing anything.
And I like to provide a lot of reassurance to kids and just let them know, "Hey, it will get better." I let parents know on the other side that 1% of adults wet the bed just so they can be aware.
Melanie Cole, MS: That's really great information, Janelle. And so, wrap it up with us. With your best advice, tell parents listening what you want them to know about bedwetting, about these behavioral issues versus what might be a medical situation, and how you can help them at Children's Health.
Janelle Traylor: The good news is that almost every child with bedwetting can improve. It's my job to identify what's contributing to it and choose the right treatment for that family. I want the parents especially just to provide that positive reinforcement and just let them know that it's okay. Different options though, there's medication that works well for sleepovers and camps that we could always try. The bedwetting alarm is a great option. I've had family members that have tried both, and we always get really good success. I like parents to be patient, and children just to be open and willing to try and let them know that they are not alone.
Melanie Cole, MS: Thank you so much for joining us today, Janelle. That was really informative and educational. Thank you again. And for more information, please visit childrens.com/urology. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode, and please follow Children's Health on your social channels.