A popular technique to try to stop bedwetting is to wake your child up just before you go to bed so they can use the toilet.  Whilst this can be helpful for a few children when transitioning from nappies, it’s generally not useful for chronic bedwetters.  It may help some parents stay sane because their child is less likely to wee the bed that night, but often it doesn’t actually help the child learn how to stay dry for themselves in the long term.

When a child gets used to being woken up to go to the toilet, they don’t develop the bladder-brain communication that’s needed for them to be able to wake up dry every morning.  You have effectively taken control of the bladder away from your child.   

In addition, you might take your child to the toilet before the bladder is full, so he or she won’t learn to tune in to the sensations that the bladder needs emptying and learn get up to go at the right time.  

Of course, children also need to learn how to stay dry throughout the night without getting up to go.  The brain and bladder have no reason to communicate if you are going to do it for them, so it is possible that waking your child could actually prolong the bedwetting.

There are several practical steps you can take to minimise bedwetting.  Here are three important steps to start with:-

1)  Ensure your child goes to the toilet at least once before bed. 
2)  Make sure the child is well hydrated throughout the day but restrict fluid intake 2 hours before bedtime.
​3)  Ensure your child gets a regular amount of good quality sleep.

Whilst it is understandable that some parents choose to wake their child up to wee, it is important to know that in the long term, it doesn’t usually train the child to stay dry throughout the night and it might even prolong bedwetting.

Stay Dry at Night is a comprehensive bedwetting solution that helps your child learn how to be in control of their brain and bladder.  For more information on how to stop bedwetting go to   ​ http://www.staydryatnight.com/the-product.html
​

​People often ask what they can do to help their child to stop wetting the bed at night.  Here are 11 useful strategies that are fun and easy to put into practice.​

At around age nine or ten many children will get the opportunity to go on school camp for a few days.  Their excitement is palpable, it may be their first time away from home without a member of their family and they will enjoy the ‘grown up’ feeling that comes with this big adventure.  For some children, however, their excitement is accompanied by a terrible, often unspoken, dread:​

"What if I wet the bed on camp!"​

This can be an incredibly stressful time for your child.  They desperately want to go on camp, to have fun with their friends, but can they risk it?

Your child may feel unable to talk to anyone about the problem for fear of being ridiculed.  Their self-esteem can be affected as they start to wonder why they are different to everyone else.  Of course, they aren't different and there will be several other children in their school experiencing the same fears, but your child may feel lonely, alone and helpless.

Pressure for older children to stay dry can be counterproductive so it is important to treat the bedwetting as early as possible.  Early intervention gives your child time to get used to dry nights being the norm and, crucially, time to build their confidence in their ability to stay dry away from home.

So how can you help your child to stop wetting the bed?   There are some straightforward steps you can take right away:

1) First of all, take your child to the doctor and rule out any medical issues.

2) Start your child on an effective bedwetting program such as Stay Dry at Night.  

3) Discuss with your child, in a positive and encouraging way, what food and drink it might be best for them to avoid at camp.  It's prudent to stay clear of fizzy drinks, for example, and to avoid snacks for up to two hours before bed.  Stay Dry at Night provides information on best practices with food and drink as part of their program.

4) Always remain positive, supportive and compassionate.

If your child starts to worry as camp approaches, you can reassure them and boost their confidence by reminding them of any late nights, sleepovers, or times when they were sick and still remained dry.  So remember to take action early, so that your child has enough time to confidently know they will stay dry at night whilst enjoying school camp.
​

For further information, please visit www.staydryatnight.com

Parents’ beliefs about bedwetting are extremely important.  Their knowledge and understanding of bedwetting can shape the way they help their child.  For instance, a study carried out by the Urology Department, University of California found that 26% of parents thought their child wet the bed because they were lazy!   Because of this belief, these parents are more likely to become frustrated and angry with their child's behaviour, which can cause the child to feel a further sense of failure and shame.  

Children don't wet the bed on purpose.  All children hate wetting the bed.  It is embarrassing, it prevents sleepovers and disrupts sleep.  They have no idea why they do it or how to stop.  It is for this reason that sticker charts aren't particularly effective.  Children aren't lazy or doing it on purpose if they are wetting the bed when asleep, or, if they are unable to wake up sufficiently to go to the toilet.  

Parent embarrassment can also be significant, and this may prevent some families ever talking about it, going to the doctor, or looking into effective treatments.  Many parents believe their four, five or six year old should be dry by now (especially when the first day of school looms), and they can put a tremendous amount of pressure on their child to become dry.  This pressure can be counterproductive, especially if started at a very young age. 

In the aforementioned study, there was a lack of awareness of the causes of bedwettng and 72% of the parents didn't realise that there are products that can be very effective to help stop bedwetting.  Of course, some parents just hope their child will grow out of it, and some will, but others won't grow out of it for years.  Only 55% of these families reported they would seek medical help to investigate the bedwetting.  It is always important to go to your doctor to rule out any medical cause for the bedwetting.

As bedwetting is unconscious behaviour, it is very unlikely that any child routinely wets the bed out of laziness.  Understanding that bedwetting is something your child cannot help, and that there are viable products and techniques that can either reduce the bedwetting, or, stop it completely, can be very reassuring for the whole family.

References
Schlomer, Bruce et al.  Parental beliefs about nocturnal enuresis causes, treatments and the need to seek professional medical care, Journal of pediatric Urology (2013)  Dec;9(6 Pt B):1043-8. doi: 10.1016/j.jpurol.2013.02.013. Epub 2013 Apr 19, Accessed 2016 http://www.ncbi.nlm.nih.gov/pubmed/23608323
​

Bedwetting occurs at different times of the night for different children.   Some children will wet the bed early on in the night, whilst others may wet the bed early morning, and many chronic bedwetters wet the bed more than once a night.  

If your child is getting to bed at a regular time every night (including weekends) and getting sufficient sleep, then s/he will most likely have fairly regular sleep cycles.  Understanding these cycles can be very helpful for children and adults, because the nature of your sleep and ability to wake up from it, are different in each of the stages within a sleep cycle.

As you begin to fall asleep you start to enter stage one of sleep.  Your breathing slows down and you become lightly asleep.  This stage typically lasts for about one to seven minutes and you can easily be woken up from this sleep.1  In fact, if you were woken up, you may not think you had been asleep.2  It is at this stage of sleep when we sometimes experience the hypnagogic startle, a sudden jerk of your whole body that wakes you momentarily, and that is quite normal.  Of course, this doesn’t happen every time you go to sleep.
   
Then you enter stage two of sleep.  You are still in a ‘light sleep’ and it can be quite easy to wake you up depending on how far into stage two you are.   More time is spent in stage two of sleep throughout the night, than in any other single stage.3 

Finally, you go into REM (Rapid Eye Movement) sleep.  Your eyes move rapidly during this stage and most of your dreams occur in REM sleep.  Your breathing and heart rate become irregular.  Your muscles are relaxed and you don’t move your body, in fact, much of your body is effectively paralysed.6  You can wake up easily or with difficulty, and you can become alert quickly.  The first period of REM sleep may only last one to five minutes and typically gets longer throughout the night.7

​Then the cycle starts all over again.  Each cycle lasts approximately 90 minutes in adults and around 50 minutes in children.8  There is often a brief awakening at the start of the cycle, when you may become aware of your environment, adjust your position, you might check the time, reach for the blankets, or become consciously aware that you need to go to the toilet. 

When a child can understand that they naturally come out of their deep sleep at least a few times a night, it opens up the possibility that they can check in with their bladder at these times to see if they need to go, and getting out of bed will be easier at that stage in the sleep cycle.  Whilst this may not be a bed wetting solution on it's own, it can help build confidence that dry nights are possible.

1. Natural Patterns of Sleep, A resource from the Division of Sleep Medicine at 
Harvard Medical School, Accessed 2016,  http://healthysleep.med.harvard.edu/healthy/science/what/sleep-patterns-rem-nrem
2. Dr Richard Ferber, Solve Your Child’s Sleep Problems, Vermilion London, 2006
3. Health Boosters by Withings, Accessed 2016,  http://blog.withings.com/2015/03/17/the-4-different-stages-of-sleep/
4. National Sleep Foundation, Accessed 2016, https://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep
5. Dr Richard Ferber, op.cit
6. Dr Richard Ferber, op.cit.
7. Natural Patterns of Sleep, loc.cit.
8. Natural Patterns of Sleep, Accessed 2016, http://healthysleep.med.harvard.edu/healthy/science/variations/changes-in-sleep-with-age

Many parents who have a chronic bedwetter consider their children to be deep sleepers.  However, bed wetting doesn't appear to be related to any particular stage of sleep and significant sleep disorders are largely absent.  In addition, all deep sleepers aren't bedwetters.

A study carried out by Institute of Experimental Clinical Research, Denmark, shows that bedwetting children are 'normal sleepers'.1  Yet, why does it appear that most parents of bedwetting children feel their child sleeps deeply?  Senior lecturer Tryggve Neveus at Uppsala Uiversity in Sweden suggests it is because these children can be so difficult to wake.  Their sleep is 'normal' but their ability to arouse from the sleep is more problematic.2  

It is therefore important to ensure that children who wet the bed aren't overtired and get good quality, sufficient sleep.   Here is some information on how to get a better sleep and therefore wake up more easily.

• Limit eating two hours before bed.  Digestion hinders sleeping as it requires a great deal of energy.3 Cutting back on food consumption before bed also stops the bowel from pressing against the bladder and reducing bladder capacity.4
• Sugar, soft drinks and caffeine before bed also hinder good quality sleep and can increase bedwetting.
• Milk can also increase the tendency for some children to wet the bed.
• Limit computer use before bed.  The light from the screen, especially from tablets, has been found to significantly reduce levels of the hormone melatonin, which regulates our internal clocks and plays a role in the sleep cycle.5
• Set a regular time for bed and to wake up in the morning.  Melatonin levels begin to increase approximately two hours before bedtime, so keeping a regular sleep schedule will aid the sleep cycle.5
• Set a regular and calm routine at bedtime so your child's body knows what activities lead to sleep.
• Ensure your child is getting enough sleep.  Although children vary in the amount of sleep they need, parents often underestimate how much they should be getting for their age.  
•  According to the Sleep Health Foundation it is recommended  that a child between the age of six and thirteen years has nine to eleven hours sleep.6  Lifestyle is also important to take into consideration.  If your child  has started school, is undertaking tests, has various activities during the week or is close to the end of term, he or she may need more sleep.  If your child wakes up tired most mornings, this can also indicate insufficient sleep.​
• Ideally the bedroom should be dark (and your child has no light coming in from the windows). A bright night light can hinder going to sleep and also affect quality of sleep. 

​
Improving  the amount and quality of sleep can lead to more dry nights.  Another way to help children wake up to go to the toilet, is to increase their level of awareness at certain times in the night.  This will be covered in the next blog.

References
1. Jens Peter Nørgaard, Jens Christian Djurhuus “The Pathophysiology of Enuresis in Children and Young Adults”  Clin Pediatr (Phila). July 1993 vol. 32 no. 1 suppl 5-9
2. Nevéus T., Enuretic sleep: deep, disturbed or just wet? Pediatr Nephrol. 2008 Aug;23(8):1201-2. doi: 10.1007/s00467-008-0859-1. Epub 2008 May 15.
3. Crystal Saltrelli "Whats the Connection Between  Sleep and Digestion,  Blog, MARCH 11, 2010, accessesd 30 June 2006  http://livingwithgastroparesis.com/gastroparesis-sleep/
4.  Mike Klawitter, School of Medicine and Public Health, Published 02/20/2009, accessed 30 June 2016 http://www.med.wisc.edu/news-events/wetting-the-bed-could-be-all-in-the-head/332
5. 10 Things You Didn't Know About The Sleep Hormone: Melatonin, Accessed 30 June 2016  http://blog.withings.com/2014/08/26/10-things-you-didnt-know-about-the-sleep-hormone-melatonin/ 
6. National Sleep Foundation.  https://sleepfoundation.org/sleep-topics/children-and-sleep/page/0/2, Accessed 30 June 2016

How parents deal with their child wetting the bed will influence their ability to overcome bedwetting and their self-worth.  No child wants to wet the bed and for the vast majority it is a behaviour that is not in their conscious control.  They wet the bed when they are fast asleep.

Bed wetting in older children is such a hidden problem that it is rarely discussed for fear of bullying or embarrassment.  Yet the impact of bedwetting for children and their families can be significant and can increase as the child gets older.  It can affect children’s level of self-esteem, and they often quietly feel a huge amount of shame.   The frustration for a parent can increase with interrupted sleep and constant washing.  So what are the dos and don’ts of how to deal with your child wetting the bed?

Studies have shown that punishing bedwetting leads to depression and a reduced quality of life. It is similar to punishing someone for grinding their teeth when sleeping. The vast majority of children will be totally and utterly oblivious to it. Some children may wake up mid-flow and still be unaware in time or they may find it difficult to wake up enough to get out of bed.  Other children will dream they are going to the toilet and so wet the bed.  Punishing them for something they have no control of, or shaming them in the hope it will change their behaviour can actually be damaging to the child and to the parent-child relationship.

Putting pressure on the child to stop bedwetting can also be harmful.  It is, in effect, setting your child up for failure as they don’t know how to stop wetting the bed.  If the child constantly fails their parent’s expectations to stay dry, this feeling of failure can also affect their self-esteem and spread into other aspects of their lives. 

So what should you do?  Should you ignore it?  If the child is under the age of five or six it is sensible to treat the bedwetting as normal.  Children learn to do different things at different times and the less parents make an issue of it, the easier it will be for the child to stop.  It is useful however to read up on how to help your child to stay dry at night.  For instance certain drinks such as milk can increase bedwetting, and overtired children often wet the bed too.

If your child is still in nappies, stop using them for a week or so, and see if there are any signs of your child becoming dry.  It can make life easier for everyone if you use an over the sheet mattress protector because when the mattress protector gets wet you can simply take it off the bed and the sheet will still be dry underneath.  If there are any dry nights, use lots of praise and see what happens.  If there are no signs of staying dry or the process is frustrating everyone, then stop and try again later.  The more positive you keep the experience the easier it will be next time you try.

If your child is around seven or older and still not showing any signs of stopping bedwetting then it is useful to take action.  It is possible he or she could still grow out of it, however it could continue for some years.  Firstly it is best to get your child checked out by a doctor to ensure there is no medical reason for the bedwetting.  It is also helpful to tell your child that thousands of children still wet the bed at their age and reassure them that they will become dry.  You can talk to them about their achievements encourage them to have self-compassion.  If there is no medical reason for the bed wetting, it is then useful to look at some bedwetting solutions.  Options include the bedwetting alarm and the Stay Dry at Night Bedwetting Program.

The bedwetting alarm is a devise that when wet, sets off a loud alarm to awaken the child.  Although it can work well, it is also a great sleep disturber for the whole family.  The bell only sounds after the person has started to urinate which is why it may not work for some children.

Stay Dry at Night is a gentle and effective bedwetting solution.  Key to the program is a recording customised for your child to help build the communication between the brain and bladder, to increase awareness of the sensations of the bladder becoming full at night and help them to get out of bed to go to the toilet.  It encourages the child to remember some things he or she has achieved and builds confidence that they can learn to do things automatically.  It is set to beautiful music and is a very calming solution.  Children listen to it in bed as they drift off to sleep.  Read about this natural bedwetting solution here www.staydryatnight.com.

Although bedwetting is hugely disruptive for everyone, it is useful to understand it, learn how you can help your child to stop wetting and try to stay positive.  Be as kind, supportive and caring as you can.   You aren’t on your own, so when you are changing the sheets again in the middle of the night, think of the thousands of other parents doing the same thing.  Remember that children don’t wet the bed on purpose.    

As bedwetting is such a hidden issue, it would be helpful to other parents if you can share your stories or leave a comment below.

References:-
Austin. TA. 2006: Resolving Adult Enuresis
Faten Nabeel Al-Zaben, Mohammad Gamal Sehlo. May 2015: Punishment for bedwetting is associated with child depression and reduced quality of life.  Child Abuse & Neglect, Volume 43, Pages 22 - 29