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The Blame Game

The official name for bedwetting is enuresis, and it is divided into two categories: primary nocturnal enuresis, which is when a child never really stops wetting the bed, and secondary nocturnal enuresis, where a child who learned to be dry at night, suddenly begins wetting the bed at age 5 or older.

According to Renee Mercer, founder of Enuresis Associates in Maryland, primary nocturnal enuresis affects an estimated five to seven million children in the United States, and it is a medical disorder with a physiological cause.

Children who wet the bed do not do it on purpose as some parents are led to believe. Common misconceptions include: children do it to get attention, because they're lazy, because they want to somehow "control" their parents or because they have a bad attitude.

Shelly Morris, director of the Enuresis Treatment Center in Michigan, has had too much personal experience with bedwetting to ever think a child would continue to wet the bed unless they were completely helpless to stop. "The majority of our counseling is done over the phone and via the Internet simply because it's such a huge self-esteem issue for the child that they would never want to be seen coming in here," says Morris, who wet the bed herself until the age of 19. "You can't tell me that it is a stubbornness or behavioral problem. Believe me, they want to stop."

Similarly, it's not an issue of poor parenting when a child wets the bed, and there's no reason for a parent to feel at fault or to try to change their parenting style.

What Causes Bedwetting

Although experts now realize behavioral problems don't cause bedwetting, they don't know what does cause it.

There is, however, overwhelming evidence that primary nocturnal enuresis is both genetic and hereditary. There is even a growing body of research into the possibility that it's part of an underlying sleep disorder. Other possibilities include the fact that a child may have a small bladder, may just manufacture more urine than their bladder can hold or their urinary system is simply not developed enough to control urination.

Other factors that may contribute include sleep arousal problems or other disorders, but there is no general agreement on one single cause.

Secondary enuresis can be caused by a stressful situation, such as a death in the family, divorce or a move. It can also be caused by the onset of a medical problem. Much more rarely, it can be a symptom of some sort of abuse.

Nevertheless, the first step in determining the "reason" for a child's bedwetting is a complete medical examination to rule out any underlying physical factors such as kidney or bladder problems.

Recognizing the Problem

Some parents point to the notion that "it isn't a problem at all" is a major misconception. Many doctors may have the attitude that it's not a big deal, but to the children and parents who are dealing with it, it is a big deal, especially when it comes to social events like sleepovers and camp.

*Allison of Pittsburgh, Pa. felt that her pediatrician was entirely too casual about her daughter, *Caitlyn, who was still wetting the bed at age 8.

"She was starting to be invited to slumber parties, plus our Brownie troop was planning a couple of sleepovers, and she was so upset because she didn't want to be left out, but she was terrified she'd have an accident," Allison says. "We went to our pediatrician who told us not to worry, that she'd grow out of it. When I asked her what should I do about my miserable, embarrassed daughter, she just shrugged and said ‘Keep her at home.' I changed doctors."

The cure for Bedwetting

Many misconceptions revolve around the idea that there is or is not a cure for bedwetting. The fact is that different things work for different children and no matter what, most children will outgrow it eventually. It's also important to remember there are no miracle cures or overnight successes.

If there is no physical cause for bedwetting, physicians may suggest waking the child at night to use the bathroom. The idea is to train the child's unconscious mind to recognize the feeling of "having to go" and use that recognition to clamp down on the sphincter muscle.

Mercer and Morris both point out that if a child is sleeping too deeply to wake to go to the bathroom, the parent will need to wake the child up.

In the meantime, the parent may choose to use disposable absorbent underpants to cut down on laundry and ruined mattresses. GoodNites® Underpants also can save embarrassment and allow kids to attend sleepovers and camping trips. Some physicians also may recommend restricting fluids before bedtime (though never withhold fluids) and waking the child one or more times a night to go to the bathroom.

The time to treat bedwetting is when it first becomes obvious that it is a problem – at about age 5 or so. Mercer points out that at that age children have few social obligations, parents have a lot of control over their bedtime habits and children tend to be very amenable to taking directions. This is important because the biggest factor in the successful treatment of bedwetting is a high level of parental involvement.

When you're dealing with a problem like bedwetting with both physical and social consequences, it's important to get all your facts straight so you can give your child the best possible help to get through this stage of his life. Remember, if you're ever in doubt, consult your doctor for the right information.

* Names changed for privacy purposes.