Bed-wetting! One of the concerns often brought to the Paediatricians by mothers!
It seems next to the issue of teething and poor eating, concerns about bed-wetting ranks as the third most common questions mothers ask the Paediatricians.
Dr Adaobi Solarin, Consultant Paediatric Nephrologist addresses the issue of bed-wetting in children in a recent Group Discussion on Ask The Paediatricians Group recently. The essential highlights of that discourse are summarised in this article.
Bladder only does two things. It likes to fill up with pee and store it for you until you are ready to go to the toilet. This is what the bladder should do most of the time. The Bladder fills first with urine and when the bladder is half full, there is a first desire to pass urine (micturate) but most people will through the brain inhibits the process until they are at the right place and time to pass urine. There is a sphincter or tap that control the release of urine when the person is ready by relaxing so the urine can flow out. When the person is ready, the bladder will empty. The tap at the bottom has to open nicely and the muscle in the bladder squeezes all the pee out so none is left behind.
Bedwetting is also called ENURESIS when it happens at night. Enuresis means recurrent, spontaneous urination during sleep in children aged at least 5 yrs. of age. By age 5 yrs. a child is normally able to avoid at will and to postpone voiding in a socially acceptable manner.
It is a common disorder that affects 15 – 20% of 5 yr old kids and 5 – 10% of 7yr olds. There is a higher prevalence in boys than in girls by a ratio of 2:1. It is a hereditary disorder that runs in some families with an autosomal dominant pattern of inheritance. If either parent had enuresis the relative risk for the child to have enuresis is 7.8; if both parents had enuresis the relative risk is 16. Children with developmental delay, mental retardation, Attention deficit hyperactivity disorder (ADHD) and minor neurological dysfunction have a higher prevalence of bed-wetting compared to other children.
Apart from hereditary, it can occur as a result of three major mechanisms:
- Nocturnal Polyuria (too much urine in the bladder at night)
- Detrusor overactivity (the bladder muscle working too much)
- Increased arousal thresholds ( a problem at the brain that does not make the child wake up on time) Common disturbance at brainstem level.
Enuresis or Bed-wetting can be classified in many ways.
Primary Enuresis: no specific cause in a child who has not been dry for less than 6 months
Secondary Enuresis: due to other diseases in a child who has been previously dry for at least 6 months.
Monosymptomatic Enuresis: Enuresis without any other Lower Urinary Tract symptoms (LUT)
Non-monosymptomatic Enuresis: Enuresis with other LUT symptoms, e.g. daytime incontinence, urgency, frequency, weak stream, straining
The secondary Causes of Enuresis include Urinary tract infection, Constipation, Pinworm infection, Diabetes Mellitus, Diabetes Insipidus, Psychological stress and Chronic Renal failure.
HOW DO DOCTORS HANDLE CHILDREN WHO HAVE ENURESIS (BED-WETTING)
In managing a child with enuresis, the first thing doctors do is to ask questions. Some of these questions that are important you will be asked include the family history of bedwetting; has the child always bed-wet or there is a preceding dry period; nocturia – every night or occasionally, the child’s drinking habits and sleeping patterns.
After the questions, the child will be examined physically. This includes the Ear, Nose and Throat (ENT) examination for adenotonsillar hypertrophy; Abdominal palpation for renal masses and faecal mass; the external genitalia (phimosis, hypospadias); the spine for deformation, pigmentation, hair growth and neurological examination. Finally, Urine is tested with a dipstick for the presence of sugar, protein and white blood cells that may help rule out Diabetes mellitus, renal disease and urinary tract infection.
TREATMENT OF ENURESIS
• Primary mono-symptomatic enuresis resolves with time.
• Medication is rarely indicated in children younger than 6 yrs of age.
• The first step is to educate the child and family.
• Before primary nocturnal enuresis is treated, daytime symptoms must be actively identified and managed.
• Secondary causes like urinary tract infection must be investigated and managed appropriately.
GENERAL MEASURES (for Parents)
- Bladder retraining
- Regular fluid intake: 30ml of water/kg each day, mostly at school
- Minimise evening fluid and solute intake
- Timed regular voiding: voiding regularly, At least two or three times during school hours
- Correct toilet position: Relax the pelvic floor muscles
- Treat constipation: Fluids, higher fibre intake
- Encourage physical activities
TREATMENT
When general measures do not lead to resolution of symptoms, then the child should be seen by the Paediatric Nephrologist, the Paediatrician with expertise in managing kidney and urinary problems in children.
Some of the modes of treatment used by the Nephrologists include the use of alarms and medications such as Desmopressin and imipramine. These medications must be prescribed by your doctors and you must be conversant with their potential side effects.
All children with daytime wetting (not the wets during an afternoon nap but otherwise dry) MUST see their paediatrician for appropriate evaluation and referral to the nephrologist.
In conclusion, most bed-wetting with no cause will resolve with general measures. Bed-wetting that are due to other causes will resolve with treatment of the underlying causes. If there is no improvement with simple and general measures, it is important to see a Paediatric nephrologist for further evaluation and treatment.
Thanks for all this information many of us have got help through this post. May God continue to bless u all. Pls my 2years baby her weight is 12.17kg this month but she is OK growing only in her height. Her bath weight was 3 .8 kg .
That is a perfectly normal weight for a 2 year old. She is doing very well…well done Mummy. Thank you for your kind words
Wat is the cause of ”ntaa”as locally called it makes baby thin and so skinny no matter how much food he or she eats
Kindly read the post on “Oka” here
From the discription of “oka” here, it’s not same with”nta”(igbo). Nta does not affect the baby’s head rather it eats the baby from inside, making the baby look abnormally small in size and unconfortable When some native medication is applied on the baby’s skin, things like fur comes out through the skin. What is possibily the cause and how to remedy it medically? God bless you ma.
Adaeze Nta sounds like what we refer to as severe malnutrition and nothing to do with the scalp or fontanelle. Kindly take such children to the Children’s emergency room of the closest Teaching hospitals for treatment.
Thank you ma for the good work. I want to wean my 15month old baby but am scared of the night cries, how do I go about it? God bless the labour of your hands.
Kindly read the article here Simple tips for weaning There is no need to worry!
Greater you I pray ma. My 2years and 7months son breads with his month and gives different kinds of sound. We did x-ray, nothing was discovered but I’m not pleased with his condition. I noticed he reacts to cold easily, so we make sure this is avoided….
He makes the sound while sleeping not during the day. Thanks ms
Pls ma. I will like to know about navel. My baby is a month old i was told i need to keep using hot water on her navel till she is 3months. Is it right medically. Thanks
No!!! That is unnecessary and one of the popular myths. Just leave the navel only once the cord has dropped and healed completely. The appropriate cord care is use of chlorhexidine gel once daily for 7 days. If you do not have the chlorhexidine gel, kindly use methylated spirit with cotton wool to clean the cord until it dropped and all the raw area have healed. Please do not use hot water to massage or the lattern.
Highly educative. Thank you for the good work Doc. May God bless you and your team.
Thank you Mojisola
Please ma, I have a 10yrs old girl that still bedwet , if I don’t wake her she will urinate on d bed, and she sleeps so deep at first stage of sleeping. If i wake her up without accompany her to the restroom she will start misbehaving. But this girl is very intelligent
Kindly see a Paediatric Nephrologist if you have practiced what the article recommends and still no improvement….ensure you read the article first.
Good Afternoon ma,
I have a similar case of my almost 10yr old girl who still bed wets, although,the frequency is a bit reduced now .
Could you kindly recommend a paediatric Nephrologist in Lagos ma?.
Thank you.
Most Teaching Hospitals have Paediatric Nephrologists. You can go to LUTH or LASUTH to see any of their Paediatric Nephrologists
Thanks so much, but what can be done or given to a baby that throw up part of what she takes after 5-10min of breast feeding. I notice it on Saturday and she did same on Sunday. Thanks
That sounds like gastroesophageal reflux which is quite common in babies. What to do is to keep the baby upright longer for 15 – 30 minutes after breastfeeding before making the baby to lie flat. However, some babies can have a more severe type which will require seeing a Paediatrician for more interventions like breast milk thickeners and so on.
Thanks ma for your good work Pls my two weeks baby has an inflammation on his gum at birth does it mean anything?
I am not sure what you meant by inflammation of the gum of a baby at birth. You may want to see a Paediatrician first. Who told you the baby has inflammation of the gums or what symptoms made you think so?
My baby is 18month and still uses diaper. Pls, how will I start potty training n when is d right age to stop using diaper?
Hi Linda! Different kids are ready at different times for potty training but you can start now. Start by putting her to the potty every 2 – 3 hours. You may need to block out 2 -3 weeks to do this. If the child can also say wee-wee , that will be helpful. Once the child can goo to potty on their own or communicate their toilet needs, you can stop the diaper.
wow! doc you really done a good job here. weldone ma’am.
Thanks Victory
Thanks so much Doctor , you are a gift to this generation. May God bless you real good. Pls Ma my 1yr and 7months child has not started walking but can walk round the house holding something. What do I do
Thank you Joyce!
A 19 month old should be walking independently except he or she was born preterm. Kindly see a Paediatric Neurologist or Developmental Paediatrician at the closest Teaching Hospital for proper evaluation and management.
Thank u Dr, this really helped for my 3 year old daughter.
Please, may ask if using diaper at night encourages bedwetting in toddlers. Note, she doesn’t use it during the dau
Not at all! Though we usually don’t worry call it bed-wetting (enuresis) till age 5 years! In other words, it is not unusual for 3 year olds to still wet their beds at night though dry and off diaper during the day. It has to do with ability to maintain bladder control and wake up to go to the bathroom when necessary
God bless u ma for d good work,
My kids of 4yrs (twins)are yet to pronounced some words clearly
Please ma is it normal for d age.
Are they talking and able to sustain conversation? You may want to see a Paediatrician or speech therapist for further evaluation and management.
It depends on what they can not pronounce well….You may want to see a Paediatrician or Speech therapist first for further evaluation so one can know whether is normal or abnormal
Thank you very much. It was really educating.
I wish to find out what scale of growth is my daughter. She is 9 months, she weighs a little over 9kg based on measurement with the bathroom scale. Her height is 27.5 inches or 71cm and head circumference is 46cm. She takes homemade pap from guinea-corn with nan. She doesnt really accept complementary foods apart from beans.
I shall be waiting for your advise and response To my question.
Thank you.
Her weight, height and Head circumference are fine. Gradually introduce the other foods….You have to be patient and persistent. Read more here healthy eating
Thanks alot doctor. I have a 3 year old who bed wets even if you take her to pee up to 3 times at night.
During the day she keeps her hand alot on her vagina. I had taken it to be a bad habit like thumb suckling, but after reading this article I am not sure anymore.
I also I have checked her vagina for any irritation or redness numerous times and seen nothing. Also there is no visible discharge. Which tests do you think we should go for? I many thanks.
We do not worry about bedwetting in a 3 year old…the article says 5 years so I think it is too early to worry. The hands thing on the private part may just be an habit especially if she is not scratching. However if in doubt you may still want to see a Paediatrician first for further evaluation. Please be sure she is also not a victim of child sexual abuse.
Doctor’s in the house i appreciate your kind advise on this platform. Pls advise, my 14yrs old daughter still bedwet . I hv taken her to UTCH for series of test but all to no avail. Pls Dr, what adivise can u add up? Will appreciate ur swift response.
Regards.
Did you see a Paediatric Nephrologist? You need to see one and they are the one that can say what the underlying cause is and the way forward.
Welldone ma, please my 2yr plus baby has wound all over her mouth please what can I do
Please take the child to see a doctor first for proper evaluation to know the cause of the wounds in the mouth and appropriate treatment will be recommended.
Well done ma, please my niece of 4yrs can’t not speak clearly and can’t hear clearly too.But respond to only school rhyme’s and not clearly as well.please what can be done to this?
Kindly see a Paediatrician preferably a Paediatric Neurologist immediately!
Pls ma ,can u treat the convulsion that occur without high fever
Yes they can be treated very well. Kindly read more about it here and here. Please see a Paediatric neurologist for further evaluation and proper treatment.
hello doctor
my baby of 18months always have mouth odour when he wakes up in the morning. what can I use to stop the odour
You should see a dentist or Paediatrician so the child can be examined to know the cause of the mouth odour. It may be due to poor oral hygiene or diseases within the mouth or throat. The solution lies in dealing with the root cause of the mouth odour itself and the odour will go away.
good day doc,i have a 6year old son who urinates very frequently,sometimes as often as 15minuted interval when he takes tea,juice etc.
He most times pees on himself until i presuade him to use the toilet.
Can u advice on specific tests to run?
Hi Akintonmide…you can not go around doing tests without seeing a doctor first who will then review the results of those tests with you. Kindly see a Paediatrician as soon as possible for proper evaluation and management.
I have a girl of 14 years plus that is still bed wetting, please ma which hospital can i visit, i stays in idoani in ondo state.
You can go to the Federal Medical Centre Owo or any other teaching hospital close to you to see a Paediatric Nephrologist for further management