Scott Webb (Host): Bedwetting is common for many kids, and though a family history of bedwetting is the most common reason for it, there are some things that parents and kids can do to help themselves. And joining me today to share some tips on bedwetting is Dr. Nivedita More. She's a pediatrician with Stanford Medicine Children's Health.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Dr. More, it's lovely to speak with you again. Today, we're going to talk about bedwetting. And I have to confess, I don't know if I've ever confessed this publicly, but I was a bedwetter as a child. And I sort of have a sense over the years, but I'm actually a really interested party today to listen to you, an expert on why kids wet the bed, practical tips for parents as they try to deal with that and help their kids deal with that. So, let's start with maybe the most obvious one. What causes bedwetting?

Dr. Nivedita More: Pregnancy can be caused by a variety of factors, and it may be due to a genetic predisposition. Like you just said, you know, you were a bed wetter, there's a likelihood that your child might be bedwetting as well. Delay in bladder control can be one of the contributing factors, hormonal imbalance, anatomical abnormalities, or even emotional stress can lead to bedwetting. The commonest of all of them being the family history of bedwetting.

Host: Yeah. And you know, of course, this is in hindsight, right? The benefit of so many years later looking back and trying to figure out, "Was I just a heavy sleeper? Was I just lazy? Was it just too far to go to the bathroom?" It's hard to remember. It was so long ago. I'm wondering how common bedwetting is. I'm guessing it's more common than we would think. But again, we tend to talk about some topics that folks don't really want to talk about, but how common is bedwetting?

Dr. Nivedita More: More than five million children in the United States continue to wet the bed past age six, believe it or not. Bedwetting occurs in approximately 20% of children at age five. By about age seven, the prevalence of bedwetting is about 6-10%, I would say. And in between eight t o 11, that prevalence falls down to about 4%. So, it does get better with age, for sure. I always tell parents, you know, "I still know a college-going kid who wets their bed, so don't worry." It's essential for parents to understand that it's a common problem, it's a common concern, and it can often be outgrown with time and appropriate guidance.

Host: Yeah, it does seem with time it usually tapers off for almost all kids. You mentioned that it's most common or the most common cause of bedwetting is family history, genetics, that kind of thing. So, wondering what parents can do to help prevent or manage bedwetting.

Dr. Nivedita More: Combination of a motivated child and a cooperative family is the best predictor for positive outcomes in terms of managing bedwetting. Decreasing the amount of fluid intake, any sort of fluid, so it could be juice, water, milk, any of that, several hours before bedtime always helps. Decreasing foods or liquids in the daytime that cause increased urinary volume or production of urine, these foods or liquids are called diuretics. And just to make it easy for the listeners to remember, these are the famous four Cs, I call them. They're chocolate, caffeine, all the carbonated drinks, including carbonated water, and coconut water. So, those are my famous four Cs that all children need to avoid to prevent bedwetting.

Voiding or urinating before going to bed minimizes the urinary volume in the bladder at night; and hence, it won't be over full and won't overflow. A child may also be awakened and taken to the bathroom to urinate before parents go to bed. So, if somebody goes to bed at 7:00 p.m. for example, or 8:00 p.m. as a child, and the parents are not going to bed until 11:00, then yes, they can take their child to the bathroom at 11:00 p.m. before they go to bed. Parents can make it easier for the child to get to the toilet in the middle of the night by putting a little night light in the bathroom to find the bathroom at night also helps. You know, sometimes I say if they've just recently been potty trained and are now dry at night, you might want to keep a portable potty next to their bed if they want to use one, making it super easy for them to use one in the middle of the night.

Younger children can be asked to fill out a chart showing wet and dry nights symbolically, mainly for positive reinforcement, that helps them a lot. For older children, they can be managed by bedwetting or moisture alarms, we call them. These are available online nowadays. And this is a small alarm that children or teens can wear at night when they go to bed. And it's got a sensor, which actually triggers the alarm when the underwear gets wet. So, there's one sensor that goes on the underwear, which senses the wetness of the underwear and then it alarms to wake the child up to use the bathroom. If everything fails, of course, us pediatricians or even specialists like urologists can prescribe medications to help these children. So, we do have ways to mitigate this process until the children are fully trained.

Host: So, doctor, as we were talking about, you know, over time it usually tapers off, and you've got that range of younger kids and older kids. Wondering why do older kids wet the bed?

Dr. Nivedita More: Most children who wet the bed have small bladders, and their bladders cannot hold all the urine that is made during the night, unfortunately. Also, they usually are very deep sleepers, like you said, you were a deep sleeper, or you thought you couldn't wake yourself up. So, they do not wake themselves up, when their bladders are full, there is a strong genetic predisposition to bedwetting, as I said, and most of the older kids who wet the bed have either had one or both parents who also wet their beds as teens. So unfortunately, these older kids who are wetting their beds are usually genetically predisposed to bedwetting and have to just go through the process to get dry at night.

Host: Well, I'm glad that you mentioned here this family history genetic component, you know, because I felt as a kid somehow I was failing in a way, and it was certainly not something I wanted to talk about with anyone, my parents or otherwise. So, some of the stigma about this, the embarrassment, if you will, about being a bedwetter, it feels like it's come a long way. Do I have that right?

Dr. Nivedita More: Absolutely. And this is when I tell parents what not to do. So, parents should not be blaming or shaming their child for bedwetting. And it is never the child's fault if they are wetting the bed. They should not be punished. The children should not be punished for wetting their bed. Ignoring the issue is not recommended either, because it is best to bring it up to the attention of the child's pediatrician since we have options available for this family to pursue or we give them options in terms of either bedwetting alarms or medication if need be to help their children.

Host: Yeah, you were saying there's a lot of sort of tools and things to help mitigate this, and that's what's going to be my next question is, when does it become a problem? When do we go to see the doctor and talk about this?

Dr. Nivedita More: Yeah. When passing urine causes pain or burning, that could be a urinary infection and that needs to be treated with antibiotics. So, if any child is experiencing pain when they're passing urine or burning, they should see a doctor. If they're wetting their pants in the daytime when they're awake, that is a separate concern and that should be brought to the child's pediatrician's attention right away because that has other causes and that's not the same as bedwetting. When bedwetting is not better after trying a bedwetting alarm on your own for three months or so and the child is still not staying dry at night, that should be brought to the child's pediatrician's attention.

When parents think that their child needs to be seen, they should be brought in. You know, if the parents think they've done everything that they have in terms of tools and everything they've tried and they want their child to be seen, absolutely, we are here to see them. When symptoms of frequency of bedwetting worsens, so say they were wetting their bed once a week and now they're wetting their bed five times a week, okay, that's a concern for us. So, that should be brought to our attention as well.

Host: I want to finish up today and talk about something that caused a lot of anxiety for me as the occasional bedwetter that I was as a kid. Any tips you have for managing situations like sleepovers or camp? I know for me, you know, there was a lot of dread and just praying, I guess, to myself that I wouldn't wet the bed on a sleepover, camp out, whatever it might be.

Dr. Nivedita More: Parents may want to talk privately with the other parent who is hosting the sleepover or the camp counselor, for example. Most adults and camp counselors understand bedwetting and want to help the child that is going to spend the night with them, actually. Parents need to remind their children not to drink a lot of water or any liquid one to two hours before bedtime. Remind them to use the bathroom before they go to bed while they are away at camp or at the sleepover. Using absorbable and disposable underpants for the overnight stays helps combat wetness in case of an accident, if it were to occur at the camp or at the sleepover. Packing extra clothes and underwear in case of an accident helps. And pediatricians can always prescribe medications to help with sleepovers and camps. In fact, I frequently ask them to try out medication at home like a week or two before the camp for three or four days straight before they even go to the camp just to see if it helps their child in addition to all the other steps that we already talked about, like minimizing the liquids, making sure they use the bathroom, all of those things. In addition to that, I sometimes prescribe a medicine that they can also take it with them to the camp.

Host: Well, as always, I appreciate your compassionate expertise. You're one of my favorite guests. I love having on. I look forward to having you on. And because your last name is More, I started singing Dean Martin, That's Amore. You know, I have a whole thing with Dr. More. So, great to have you on. Great to cover this important topic. You know, I think I said at the end of our last one, this is sort of a timeless topic in that it's something that's been going on since the beginning of time. And as you say, because of the genetic and family history component, it's going to continue. Great to know that sort of science and technology and medicine has come a long way. And as always, great to know that we can find you in the office. So, thanks so much.

Dr. Nivedita More: Thank you so much for having me on.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.