Tips to keep young children waking up to dry mornings.

During my 50 years as a doctor, I have helped many little bed wetters enjoy dry nights. It’s physiologically more accurate to call this nighttime nuisance “sleep wetting.” Commonly misunderstood as a psychological or discipline problem, bed-wetting is really more of a sleep quirk. Some kids, more commonly boys, sleep too soundly to respond to their bladder’s get-up-and-go signals. Just as there are normal late walkers and late talkers, there are normal late dry-nighters.

In my pediatric practice and in my own family, I have used five specific steps to conquer bed-wetting:

Draw a picture
I draw a picture of the brain with “wires” connected to the bladder, explaining to the child, “Your bladder is like a balloon the size of a baseball. Inside the balloon are tiny sensors that tell you when your bladder is full. The full bladder then sends messages to your brain, and the brain tells you to get up and go pee. Because you sleep so deeply, the brain says, ‘Don’t bother me. I don’t respond to text messages while I’m sleeping.’ But your bladder becomes so full it needs to empty, so you pee in your bed. We’re going to help your brain and your bladder listen to each other at night.”

Go before bed
You are your child’s bladder-training coach. Many bed wetters go to sleep with a half-full bladder because they are tired or in a hurry and only dribble a bit when they go to the bathroom before going to bed. Show and tell your child to “grunt it out” — squeeze all the pee out of your bladder and grunt, grunt, grunt three times so you go to bed with an empty bladder — as you use your hand to show him how the bladder squeezes all the urine out.

Enjoy a talk before bed
As your child is dozing off to sleep, repeat phrases to program his brain: “I will get up and go to the bathroom when I feel my bladder get big. I will splash water on my face to wake up and grunt three times.” This bedtime rehearsal imprints on your child’s brain and helps his bladder and brain cooperate at night. Alternately, since most children wet the bed within a few hours after retiring, set an alarm to go off a few hours later to prompt him to get up and go.

Wake and relieve
Before you go to bed, fully awaken your child, help him walk to the bathroom and prompt “grunt three times” to completely empty his bladder. Then escort the sleepy child back to bed.

Go high-tech
While the above measures usually work 90 percent of the time, if your child is becoming increasingly wet and bothered, try a pad-and-buzzer apparatus called a bladder-conditioning device (available online or in the of office of your health care provider). When a drop of urine strikes the moisture-sensitive pad, it sets off a buzzer that’s attached to the child’s T-shirt or pajama top. Explain this conditioned response to your child as the “beat the buzzer” game. Encourage him to get up and go to the bathroom before the buzzer sounds.

This technique can be effective 90 percent of the time if used correctly. For best results:
Have your child empty his bladder completely with the triple voiding technique just before going to bed.

Explain to him that the buzzer will help his bladder and brain listen to each other at night while he’s sleeping. Tell him what to expect: “Imagine waking up and taking a trip to the toilet. Pretend your bladder is full and starting to stretch and it’s time to get up.”

Practice: As he’s lying in bed, set off the alarm manually, and have your child hop out of bed as soon as he hears it. Then walk him to the bathroom, remind him how to wake himself up by splashing water on his face or holding a wet washcloth against it, and have him urinate. Explain that the aim of the game is to “beat the buzzer” and to sense when his bladder is full before the buzzer goes off. Run through the procedure several times until he’s used to the sound of the alarm and won’t be frightened by it in the night. Then hook up the device according to the manufacturer’s instructions. So you can hear the alarm, you may need to camp out in or near his bedroom or use an intercom.

It can take a lot of work, but when you and your child really want to end his bed-wetting, it will happen — and will be worth the effort. As one patient of mine said, “Being dry makes me feel so happy. Now I can stay overnight at my friend’s house without feeling embarrassed.”

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It can take a lot of work, but when you and your child really want to end his bed-wetting, it will happen – and will be worth the effort.

Bill Sears, M.D., is a father of eight and the author of 42 books on family health, including The Healthiest Kid in the Neighborhood. A practicing pediatrician for over 40 years, he is an Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr. Sears is a fellow of the American Academy of Pediatrics (AAP) and a fellow of the Royal College of Pediatricians (RCP).