Potty training can feel like an insurmountable challenge for many parents and families. Daytime accidents and bed-wetting can be an uncomfortable inconvenience for both children and their caregivers. A certain amount of urinary accidents can be normal in early childhood, but when children are repeatedly peeing in their clothing or bed on accident beyond the age of five, they may have enuresis.
What is Enuresis?
Enuresis is a toileting disorder that is often referred to simply as bedwetting, which can be misleading as it includes accidents in the daytime and in the nighttime. Kids need to be beyond the age of five to be diagnosed with enuresis, since early childhood accidents are fairly common. Typically, kids with enuresis do not wet themselves on purpose, but they experience true accidents. Some kids have a hard time building the awareness that they need to use the bathroom and might just not notice, others might know that they need to go to the bathroom but get distracted and forget. Kids who are heavy sleepers tend to wet the bed at night, since their body doesn’t wake them up in time to recognize the need to go. Research finds that boys are more likely to wet the bed at night, and girls are more likely to have daytime accidents.
A diagnosis of enuresis requires that a child is experiencing these challenges at least twice a week for a minimum of three months, or that the incidents are causing problems for the child in school or with peers. In addition, a doctor should confirm that the accidents are not a result of a medical issue, like a urinary tract infection or diabetes. Research finds that children may be more likely to have enuresis if one of their parents had it, if their environment is causing stress, or if they have experienced inconsistent toileting training.
How Can We Treat Enuresis?
Once medical issues are ruled out, enuresis is often most effectively treated with a behavioral therapy intervention. Mental health professionals who are trained to treat enuresis are equipped with tools and strategies for caregivers to use with their child to reduce the frequency of daytime and nighttime accidents. The specific approach may be different for each child, but there are some common strategies that they may work with families to implement. One strategy is to help reduce a child’s liquid intake prior to bedtime, to reduce the likeliness that they will need to urinate at night. Another could be implementing a structured reward system for proactively using the bathroom in order to prevent accidents. Further, you can introduce structured and more frequent opportunities for the child to use the bathroom throughout the day, reducing the chance that they forget their needs and get caught away from the toilet. This often takes the form of “planned sits,” where the caregiver prompts the child to sit on the toilet every 30 minutes, for at least 5 minutes, and provides a reward for any time the child successfully uses the potty. It is also important that when accidents occur, caregivers do not scold or shame children, as that can actually make achieving toileting skills more difficult and overwhelming. Simply saying, “that’s okay, it was an accident,” and even enlisting the child to help clean up are the best ways to respond when accidents inevitably occur. An additional option for bedtime toileting is to implement the use of a moisture alarm that wakes up a child when they begin to wet the bed. This method is often very effective, long-term but it requires consistent use and parental response, and can take several weeks to resolve the issue. Many professionals hold the opinion that the long-term benefits of using the moisture alarm make it worth the time and effort up front.
In cases where behavioral interventions aren’t enough, some doctors may be able to prescribe medication, but the caveat is that the symptoms will only reduce while the child is taking the medication. This makes it easy for symptoms to return with a lapse in medication.
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