Transcription:
Childhood Bedwetting: More Common Than You Think

Bill Klaproth (Host): It’s a problem that nobody wants to talk about even though one out of five five-year-olds experiences it. We’re talking about bedwetting. Though it often gets buried under the covers, it’s a common experience that can be helped with proper diagnosis and treatment. So let’s talk with a Le Bonheur Children's Hospital urology expert, pediatric nurse practitioner Jill Travis, who will answer the most asked questions she gets everyday in her practice. This is the Ped’s Pod, a podcast by Le Bonheur Children's Hospital. I'm Bill Klaproth. So Jill, what causes bedwetting?

Jill Travis FNP, NP-C (Guest): That’s probably one of the most common questions that we get in the office. There are a lot of theories behind what causes bedwetting. In my experience, I would say the most common causes are children that sleep heavy and then children that are constipated, especially school aged children.

Host: Okay, you just mentioned school age children. Is any age of bedwetting normal at all?

Jill: Well, yes. We all start off in diapers. Then as we progress in age, potty training usually happens sometime during the toddler years. Most children are consistently dry when they're awake at about age five. They may still wet at naptime and then at nighttime, but at about age five is when you start really noticing that things get better. About 20% of kids five and up will still wet when they're asleep. So this rate decreases slightly as they get older. So around age six, that number would decrease to probably 18/19% and then continues as they age.

Host: So you just said earlier that bedwetting occurs sometimes for heavy sleepers or kids that are constipated. So let me ask you this. Is there another factor? Is bedwetting genetic, by chance? Is there anything we can do to prevent it?

Jill: Bedwetting is not genetic. There has not been a gene that’s been established or found to cause it specifically, but it does seem to run in families. We call that familial. So you may have a father or cousin, an uncle, an older child that had the same problem. Sometimes you can talk about that and figure out about what age that went away for the older family members to determine when it might go away for your child. That’s not always 100% accurate, but it can be very helpful information.

Host: So as we start this process, is there a right age to start potty training?

Jill: So potty training is best when it’s done when the child first shows interest. If you start too early, then you can help them establish some habits that may cause problems later on. For example, if you're taking them to potty and teaching them to strain to empty their bladder, they're learning a bad behavior. They need to actually relax to empty their bladder and not try to make something happen that isn’t ready to happen. So when you have a child that’s at the correct age, you'll notice that they’ll start wanting to mimic your toileting routines. They’ll want to sit on the toilet. They’ll want to be around the toilet, and they’ll ask you when they can start trying that. If you notice those behaviors, then you start with potty training. When you start, it’s most important that you’re very consistent. You can't switch back from diapers one day and then panties the next and go back and forth because that’s very confusing for the child. So when you notice behaviors that show that they're interested, the most important things are to just make it fun, make it interactive, and stay very consistent.

Host: So wait until they show interest and then be consistent. So let me ask you this Jill. If a parent feels like there is a problem, would a parent need a referral for the child to see a urologist?

Jill: It really depends on the insurance. Some insurance providers require referrals to see us and then some do not. So to answer that best would be to just give a quick call to your insurance. There’s usually a number on the back of the card. Ask them if they require a referral.

Host: Then what is the appointment like and what type of tests do you run?

Jill: Well, our appointments are long. Especially the first one. We try to make it fun and interactive and we spend a lot of time speaking directly to the child. By the time they come see us for bedwetting, they’re usually six/seven/eight years old and very capable of answering their own questions about their habits and routines. That helps us for several reasons. It helps us build a relationship with the child, and it helps us understand what they're doing when they're not with their parents because they are school age and so they're not always with their parents any longer. So we will spend a lot of time talking to the child and trying to get them motivated and kind of see where they are in the bedwetting problem. Does it bother them? Is it embarrassing to them? Is it not really a big deal yet? Those kinds of things. Then any kind of imaging or labs would be determined after we talk to them and kind of get a better idea of what’s going on.

Host: So are there bedwetting products or treatments that you like?

Jill: I would say the most important thing would be to structure at home before you go into looking for any kind of products or treatment options. We need children to start off in their preschool and toddler years drinking things that are healthy for them. Like plain water. That’s really the only thing our bodies need and that is very important from a very young age. We need to keep children away from things like soda and Gatorade and Kool-Aids and tea. When we do those, then they're gonna have a better chance of being able to stay dry and night. So structure with what we’re drinking, structure with bedtime habits, making sure that we’ve established a bedtime. That we’re careful how much they drink right before bed, and that they know that they have to potty before they jump into the bed. All of those things are very important, and those are the pre-steps to being able to be ready for any kind of product or treatment.

Host: So out of all those things, is there one thing that seems to be most helpful for people?

Jill: No. It needs to be consecutive and consistent. So you need to follow all the rules together consistently every night to really see what the child can do in a perfect situation.

Host: Consistency and structure. That’s what I seem to be getting from you Jill. So what is your top advice then for parents struggling because it can be a struggle to help their kids who are wetting the bed?

Jill: It’s very frustrating for families. It really is. It’s a big concern for parents that there’s something just not quite right anatomically. That they're not getting the right sensations and that they just don’t know when they need to go. So I think a lot of the first steps are just kind of alleviate those fears. So we do try to make sure that all the day time functions are working correctly. That we’re not having a lot of daytime accidents, a lot of stool accidents, things like that to make sure that there’s no underlying problems that we’re missing. Just concentrating on the night. Then beyond that, just patience and time are really helpful. If parents are supportive of the children and try not to make it a bigger deal than they have to, that really helps because stress can really aggravate the problem. If the parents are very stressed about the wetting, then the child becomes very stressed about the wetting. Then it’s kind of a vicious cycle. So if we can alleviate all the fears of anything being structurally wrong and then really just concentrate on good behaviors and good habits, a lot of times it will take care of itself and we won't need anything additional.

Host: Jill great advice and thank you for your time. To learn more, please visit lebonheur.org and be sure to subscribe to the Ped’s Pod in Apple Podcasts, Google Play, or wherever you listen to your podcasts. Please check out the full podcast library of topics of interest to you. If you found this podcast helpful, please share it on your social channels. This is the Ped’s Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Thanks for listening.