Beware of the pediatrician who suggests your child just “isn't trying” without first doing a full medical exam (to rule out organic problems), a psychological exam (to rule out changes in the child's life that could cause increased exhaustion or stress), and a thorough family history (to investigate the possibility of an inherited problem). Since secondary enuresis is caused by stress and depression, and since punishing children causes them to feel stressed and become depressed, it is imperative that you react to bedwetting gently and with kindness. Otherwise, you'll make the situation worse rather than better.
If your child wets the bed because of a chronic inability to awaken, be careful of the many outrageously overpriced treatment programs from companies with questionable reputations that prey on desperate parents. One safe one is Try-for-Dry. It offers a free self-guided diagnosis and treatment program at
The common practice of restricting fluids in the evening is a controversial cure which probably won't help. Do eliminate liquids that irritate the bladder and increase the frequency of urination (such as caffeine), check for food allergies (see Chapter 9), and avoid lots of fluids late in the evening, but know that normal fluid intake does not cause bedwetting. Good hydration is necessary for your child's health. When children are dehydrated their urine is more concentrated, which increases urinary urgency. It's the inability to awaken that drives enuresis.
If the problem is your child's inability to awaken so he can use the potty, treatments aren't much help before age five or six. Some parents claim to have reset brain wave patterns during sleep by managing to bring their children to a state of complete wakefulness several times each night when they were very young.
Bedwetting specialists recommend that parents of toddlers try to determine the time at which the accidents typically occur by conducting frequent diaper checks or outfitting children with a moisture-sensitive unit that activates an alarm when urination begins. When the unit's electrical pad is moistened, a circuit closes and rings a bell or sounds a buzzer. In the past, these were very pricey items; now they are readily available through outlets that specialize in potty training products.
Don't try to cure your child's bedwetting by severely cutting back on fluids. Doing so makes the urine more concentrated, so your child's urge to urinate will be more intense. When she does have to go potty, she'll have a hard time getting there fast enough.
Keep track of wetting incidents for a week. Once you've established your child's patterns, awaken him ten to twenty minutes before he is likely to wet the bed and take him to the bathroom to see if he can use it. Even if he never fully awakens, you may be able to avoid some accidents. Moreover, if you can consistently head them off for several months, you may be able to cure the problem by conditioning him. Exactly how this conditioning works is not understood. Rather than learning to get up at night, most children who have been successfully conditioned simply sleep through the night and stay dry without ever using the potty. If wetting starts up again after they have been conditioned, parents may need to take them to the potty every night for a few days to provide their brain with a “tune-up.”
Some medications can be helpful to bedwetters, though they are not typically used with children younger than age five or six.
Imipramine (also known as Tofranil) is the most commonly prescribed medication for bedwetting. Although this tricyclic antidepressant can be helpful to older children, the many difficult side effects make its advisability questionable. They include mood changes, nightmares, constipation, dry mouth, cardiac arrhythmia, drowsiness, restless legs syndrome, hypotension, confusion, tremor, dizziness, jaw cramps, and more!
Oxybutynin chloride is a bladder antispasmodic which has proved helpful to many bedwetters. However, Stanford University researchers Barbara R. Sommer, William Kennedy, and Ruth O'Hara, Ph.D., note that adults who use this medication begin to show impaired memory and intellectual functioning. While the effects on children have not been studied and remain unknown, these doctors believe it is likely to have the same troubling effects. Known side effects include irritability, facial flushing, irritability, and heat exhaustion during hot months.
DDAVP or Desmopressin is the synthetic version of a hormone the body normally produces at night. It recycles water from urine and moves it back into the bloodstream, thereby decreasing the volume. That's why even though most people urinate every few hours during the day, they are able to sleep through the night without having to get up to use the bathroom. Although DDAVP is a common treatment for chronic bedwetting, it too has difficult side effects, including nosebleeds, flushing, hypertension, and hypotension. In addition, it can interact with a wide range of medications. Bedwetting typically resumes as soon as the medication is discontinued. Still, it is a boon to older children, who may be able to use it as needed so they can attend sleepovers and summer camp.