Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And we're joined today by Denise Galan. She's a board-certified pediatric nurse practitioner for the Pediatric Urology Practice within the Department of Urology at Weill Cornell Medicine. And she's here to talk to us today about bedwetting in our children.

Denise, thank you so much for joining us. How common is bedwetting in children? I'd like you to speak to parents right now. Is this a normal part of childhood development? Could it be a sign of some underlying medical issue? And does wetting the bed mean that a child might have issues controlling their bladder out in public?

Denise Galan: So, bedwetting is very common, Melanie. It all depends on the child's age range in regards to its commonality. The younger the child is, the more common. As they get older, they typically will outgrow the nighttime wetting. There are some factors that do contribute to nighttime bedwetting, especially family history. If there's a positive family history, then of course, there's a likelihood that that child will wet the bed until the parent wet the bed. So, there is correlation there.

In regards to there being another underlying bladder factor, those are possibilities as well. You have to take a look at how the child does during the day. If the child is dry during the day, and this is strictly just nighttime wetting, then this is something that the child will most likely grow out of over time, it's just a matter of when. And usually, parents will seek my care once the child reaches the age of seven, typically, when it starts affecting, say, sleepovers or going away on vacation, and the child doesn't want to take a pullup or wet the bed at a hotel. If the child does have some daytime symptoms such as urinary urgency, urinary frequency, even some daytime wetting, then that might be a sign that there is an underlying bladder issue that's just transitioning also into the night.

Melanie Cole, MS: When typically does it happen? Is this in deep REM sleep or is this near the morning? When do you typically see this happening for kids?

Denise Galan: So, bedwetting could really happen at any time. For some kids who are drinking a lot closer to bed, meaning towards the end of the day, they may see the wetting happen shortly after they have gone to sleep. Then, there are other kids that will wet more closer to the morning, right when they're closer to waking up, or they will start wetting and they will wake up, catch themselves, and then be able to make it to the bathroom. But then, there's also a handful of kids that can wet at any point in the night, again all depending on what their underlying bladder stability is.

Melanie Cole, MS: Well, full disclosure here, Denise, I am one of those kids. I was until 13 years old somebody who wet the bed. And then, I had a surgery from some guru back then, urologist and then, I was fine. And so, I was worried about my kids because you said there could be a familial history there. And I definitely was worried and I remember my son begging me to get him out of pullups and promising me he would not wet the bed. And I took him out of pullups and he never did. Neither of my kids did. So, I was really glad about that. But I know the effects on a child's quality of life.

I'd like you to first of all speak about steps parents can take to help manage bedwetting effectively. My parents woke me up. And they'd wake me up two, three times a night. And then, I went on some medication. I mean, that was a long, long, long time ago. But can you speak about what we're doing now? What do you recommend for parents to help their children if this is something that starts happening?

Denise Galan: So, for the first line of defense, I would usually recommend typically to parents to do behavior modification and see how that works. Because a lot of the times, behavior modification will control the nighttime wetting.

So, the behavior modifications that I usually recommend is make sure that the child is drinking enough during the day. So, I ask them to drink most of their fluids in the morning and in the afternoon, and know that they're well-hydrated. And a good way to know that you're well-hydrated is the color of your pee. So by afternoon, I usually recommend for kids to have the color of their pee a very light yellow or almost clear. So that way, if they're well-hydrated during the day, they won't drink so much at the end of the day, because kids have a tendency of not drinking well throughout the day because they're at school or they're in the middle of some activity. And then when they get home, that's when they kind of what we call fluid load and they take in most of their fluids. And even though maybe you're restricting fluids before bed, if you're drinking all those fluids at the end of the day, that's when you're going to make most of your pee. So, just shifting fluids more towards the morning and the afternoon will definitely be beneficial.

Another thing that they can do is two hours before bed, we recommend that the child does not drink anything at all. So, they restrict completely two hours before bed. And that includes things like ice cream, ice pops, even fruit, because those are all products that contain fluid. So, two hours before bed, there's nothing to drink. And then, we always recommend for the child to pee, brush their teeth, then do what they normally do, whether it's read a book, or watch a movie, or just snuggle with a parent before bed. And right when the child is ready to really put their head on the pillow and try to sleep, they should try to pee one last time. So, that's what we call double voiding. So, we usually initiate that first.

If the child continues to have accidents during the night, then what we're doing is really just a Band-Aid. It's not a cure for the nighttime wetting. It's just to help the child get through the night without having to wet. So, there are some parents that will decide just to wake the child up once before they go to bed. A lot of the times these kids are very deep sleepers and they'll sleep walk to the bathroom, and the parent will just put them on the toilet, they'll urinate, bring them back to bed, nothing gets interrupted whatsoever, and then they wake up in the morning dry.

And then over time, I usually recommend to the parents to stop waking them up and see if the child's able to do it on their own. And then, there are a number of parents who don't want to wake the child up because they're not such good sleepers. And then, the child is up for a number of hours afterwards because we just woke them up. So, I recommend the medication. The medication is called desmopressin or DDAVP. And it's a synthetic form of the hormone that your body would normally produce to help decrease the amount of urine you make during the night. So, the child can make it through the night without wetting the bed.

Melanie Cole, MS: Does this medication make the child drowsy, so it's definitely something they take at night?

Denise Galan: They would take it at night with a sip of water right before bed, that's correct. It can make the child a little bit drowsy, but we don't really see those side effects linger throughout the day.

Melanie Cole, MS: So, are there any other things? You've given us such great advice about the drinking and watching, you know, the lifestyle things. Children go to sleepovers, and sometimes it might be hard at a birthday party or something for them not to drink, but they certainly don't want to be so embarrassed. I mean, what do you do in that case? Put an eight-year-old child in like pullups so nobody knows? What do we do?

Denise Galan: Families handle this in a lot of different ways when they go to camp or they do a sleepover. The pullups are pretty thin. Usually, the other children don't even realize that a child has a pullup on. So usually, I'll recommend to the parents to just take an extra bag or to speak with the parent. That way, the parent knows that the child, when they wake up in the morning, that they will have a pullup and they will have a private area to dispose of that pullup, so nobody else who's sleeping over would know. Or if they're at camp, they can speak to the camp counselor and they can make arrangements that way as well.

So, a lot of kids do get by with just the pullup and nobody being aware. If a child is really uncomfortable and doesn't want to do the pullup, I definitely recommend trying the medication, getting established to see what dose works for that child, and then just use the medication as needed. So, they usually will just use it during a sleepover or when they're away at camp or if they're at a family member's house or on vacation. And they can use the medication periodically, knowing that it will work and keep the child dry during the night.

Melanie Cole, MS: I remember the conversations my parents had with the other parents at sleepovers and such. And I mean, it was always horrifying. I'd like you to wrap things up for us by letting parents know the best way to support their child during this time without causing that embarrassment or stress, because it can be a very stressful, self-esteem-affecting condition. And while there are medical conditions, as you said, Denise, sometimes it's not, sometimes it's just what it is. Can you speak to parents about what you want them to do, what you speak to them about every single day, about helping their children, encouraging their children and helping their children with that quality of life and embarrassment?

Denise Galan: My best piece of advice to parents are really just let the child be the one to drive this. If a child really wants to get dry, then they will follow all the rules and they will do everything possible to get themselves dry. If they really are doing behavior modification and things aren't improving and the child still wants to seek extra care, say medication, then come and see one of the pediatric urologists and we'll be happy to see them and check and make sure that there's no underlying bladder issue.

And another issue that can also be a proponent of nighttime wetting is constipation. So, also make sure that your child's not constipated, that they're having a good bowel movement every day because the space in the pelvic cavity that holds the bladder also holds the rectum and the colon. And if the child's backed up with stool, that can also be a contributing factor. So, definitely followup with a specialist. Speak to your child, be honest with your child, and make sure that the child is ready to start getting dry overnight.

Melanie Cole, MS: Thank you so much, Denise, for this great information for parents today. And they can always visit you and discuss these things with you because this is really an important topic and it does affect kids. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast.

We'd like to invite our audience to download, subscribe, rate and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out our Back To Health. I'm Melanie Cole. Thanks so much for joining us.

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