Bed-Wetting for Sheets Like the Sahara

For Sheets like the Sahara

Sally, age four, routinely wakes up in the mornings with a wet bed. Joe is five years older. But even at age nine, he tries to stay awake all night whenever he sleeps over at a friend's house. He's still terrified he will wet the bed in his sleep.

Sally and Joe share a common childhood problem: bed-wetting. About one in five 4 and 5-year olds wet the bed, and as many as one in ten boys still has a problem by age 12. ( For some reason, it's more common in boys than girls.)

''It's not unusual for children not to be dry at night at age four and five, and some of us really don't consider it something that should be treated until a child is at least six,'' says George Sterne, M.D., clinical professor of pediatrics at Tulane University Medical School and a pediatrician in New Orleans.

There may be some kind of physical problem or health condition that's causing your child to wet the bed. If you're concerned about that, you should definitely discuss your child's bed-wetting with a doctor. But usually bed-wetting can be cured without medical intervention, given enough time along with a healthy dose of patience. Here are the techniques the experts recommend.

Rid yourself--and Junior--of guilt. Realize that you're not a bad parent because your child wets the bed, and make it clear to your child that he isn't a bad child because he wets. ''Bed-wetting is a biological problem. It occurs in a child who, during sleep, has not learned bladder-control skills,'' says Barton D. Schmitt, M.D., professor of pediatrics at the University of Colorado School of Medicine, director of consultative services at the Ambulatory Care Center at Children's Hospital of Denver and author of Your Child's Health.

''I think it's so important to tell parents of bed wetters that this is rarely a psychological problem,'' says Dr. Schmitt. ''There's a lot of unnecessary guilt imposed on some very good parents because they see themselves as being somehow to blame.''

Ban punishments. One study found that nearly three-fourths of parents punished their children for bed-wetting. Never punish or scold your child for a wet bed, says Thomas Bartholomew, M.D., a pediatric urologist and assistant professor of surgery and urology at the University of Texas Health Science Center at San Antonio. ''Parents should understand that this is not going to help their child,'' says Dr. Bartholomew. ''I've never met a child who wants to wet the bed.''

Protect with plastic. A zip-up plastic mattress cover should be standard equipment on any bed wetter's bed. It protects the mattress, of course. But also it means there's less of a ''crisis'' when the child wets the bed, Dr. Schmitt points out. Both parents and kids will stay calmer if they know there's not much clean-up to worry about.

Encourage clean-up duties. You should, however, matter-of-factly tell the child he is expected to clean up the wet bed or at least help. ''Even at age four and five a child can take the sheets off the bed and put them in the laundry room,'' says Lottie Mendelson, R.N., a pediatric nurse practitioner in Portland, Oregon, and coauthor of The Complete Book of Parenting. ''It should not be punitive, just an acknowledgment that this is the child's responsibility. It also helps you. That way, you don't feel the child is doing this to you.''

Check out your child's motivation. Before taking active steps to cure bed-wetting, make sure your child wants to stop, says Jeffrey Fogel, M.D., a pediatrician in Fort Washington, Pennsylvania, and staff physician at Chestnut Hill Hospital in Philadelphia. '' When a parent asks me how to cure bed-wetting I ask, 'Does your child want to be dry?' If they say 'no,' I say, ' You can try all you want, but you probably won't be successful.' '' If a child wants to stop, she'll not only cooperate, but her conscious mind will also work on her subconscious to help her awaken at night, explains Dr. Fogel.

Recognize the signs. A child often becomes motivated to stop wetting when it begins to interfere with his social options, says Dr. Bartholomew. When the child starts to refuse invitations to spend the night away from home, or doesn't go to camp because of bed-wetting fears, you can point out the benefits of being able to do these things. Then suggest some ways your child can help himself get through the night with a dry bed.

Pick a good time. Before starting, choose a relatively peaceful period-not, for example, just before an exciting holiday or vacation, advises Cathleen Piazza, Ph.D., assistant professor of psychiatry at Johns Hopkins University School of Medicine and chief psychologist of the neurobehavioral unit at Kennedy Krieger Institute in Baltimore. '' You should pick a time when you're not having multiple stressors at work and in the household,'' she says.

Keep bedtimes calm. Lots of rough-housing or even an exciting television program close to bedtime can increase the risk of bed-wetting, says Patrick Holden, M.D., associate professor of psychiatry at the University of Texas Health Science Center. '' When kids are excited, they tend to produce more urine,'' he explains. Instead of letting your child watch television before bedtime, give him a book to read, have a quiet conversation or read a story to him.

Put the child in charge. You want your child to understand from the outset that staying dry at night is his responsibility. That means don't wake

your child at night to take him to the bathroom.

'' Waking the child doesn't teach him anything about bladder control, and it's probably counterproductive,'' says Dr. Schmitt. ''If the child goes to bed thinking his parent is going to wake him up at night, that's teaching the child that the parent is going to take care of his bladder and that he doesn't have to worry about it. Your child has to go to bed just a little bit worried to stay dry.''

Reward dry nights. Consistently reward or congratulate your child when she has made it through the night with a dry bed. '' You'll get a lot further if you give positive psychological support such as hugs and warm congratulations,'' says Dr. Bartholomew. Some kids might like happy faces drawn on a calendar or special stickers, says Dr. Piazza. Whatever reinforcement you use, do it first thing in the morning.

Mum's the word. But if your child wakes up with wet sheets, be careful not to grimace or say something like, ''Oh, no, your bed is wet this morning.'' Instead, say nothing, says Dr. Piazza. '' You only want to focus on success,'' she says. ''If we give as much attention to failure as success, we're defeating the purpose.''

Make getting up easy. Some kids are reluctant to leave their beds, and others have been ordered by parents never to get up after they've been tucked in, says Dr. Schmitt. ''So you need to give your kids permission to get up to go to the bathroom. They need a flashlight or a nightlight, and they need to be asked if they want a potty chair next to their bed. Some kids who don't want to go to the bathroom are perfectly willing to use the potty chair and go back to sleep.''

Give your child an alarm clock. If the child has a regular pattern of wetting the bed at the same time every night, furnish an alarm clock and explain how it works, says Barbara Howard, M.D., assistant clinical professor of pediatrics at Duke University Medical Center in Durham, North Carolina. ''The child can set the alarm clock to wake him up 20 minutes to half an hour before he usually wets the bed so he can get up and go to the bathroom,'' she explains.

Encourage a dry run. This is a ''dress-rehearsal'' technique your schoolage child can do during the day. ''I have the child lie in bed, close his eyes, pretend it's the middle of the night and give himself a little pep talk,'' says Dr. Schmitt. ''It goes something like, 'I'm in a deep, deep sleep, my bladder is full, my bladder is starting to feel pressure and is trying to wake me up. It's saying get up before it's too late.' ''

The child should then practice getting up, walking to the bathroom and going to the toilet. ''I have them actually walk from bedroom to bathroom, so they know exactly how many paces it is,'' says Dr. Schmitt.

Avoid caffeine. Caffeine is a diuretic, a substance that encourages urination, explains Dr. Howard. It's in many sodas and in chocolate as well as in coffee and tea. Avoiding these foods and drinks may help your child avoid wetting, she says.

Encourage bladder-control practice. Explain to your child that she can help ''train'' her bladder by practicing during the day. Have your child drink a lot, and then wait as long as she can to go to the bathroom. ''Have her try to wait a little bit longer each time,'' says Dr. Piazza. '' You want to train a child to associate the feeling of having a full bladder with having to go to the bathroom.''

Stream-interruption exercises can also help, says Dr. Schmitt. Have the child begin to urinate and then stop briefly before starting up again. She should try to do this several times each time she urinates. ''Those exercises build up the bladder sphincter,'' says Dr. Schmitt.

Buy a bed alarm. Most experts agree that moisture-activated bed alarms are the most effective treatment for bed-wetting. '' When moisture hits the pad, an alarm goes off and wakes the child,'' explains Dr. Sterne. ''It conditions the child to recognize the sensation and wake up before they have to urinate.'' Alarms are battery-operated, cost around $40 and are available from several companies without a prescription. Ask your pediatrician to recommend a brand or type. Use the alarm until your child is dry every night for one month. In most alarms, wetting triggers a loud sound that awakens the child. A silent, vibrating alarm is also available for children who don't respond to sound.

Dr. Schmitt recommends portable, transistorized alarms that are worn on the body rather than the bell and pad devices. And he says parents shouldn't insist on using the alarm if the child is opposed to it.

Stick with it. Be understanding and patient with your child, and stick with

your efforts to stop the bed-wetting. ''Conditioning requires time,'' says Dr. Bartholomew. He compares it to piano lessons: ''Children might not get any results in the first month or two, but if they continue to practice, they'll be able to improve.''