Q Our 5-year-old still wets his bed. What can we do?
A Bed-wetting, especially in boys, is a common developmental quirk -- and it's not considered a real problem unless the child is 6 or older. However, kids may feel ashamed, so it's understandable that you want to help your child have drier nights. In my practice, I approach bed-wetting by first examining the child and doing a urinalysis to be sure there's not a kidney problem, which, though not common, can lead to bed-wetting.
I also consider the child's nighttime breathing pattern, since studies have shown a link between bed-wetting and sleep apnea. This partial airway obstruction, sometimes due to large tonsils, interferes with the sleep cycle and can trigger bed-wetting.
Once these potential triggers are ruled out, it's safe to assume that the bed-wetting is a normal, common (and often inherited) immaturity of the bladder-brain communication system. Explain to your child that he's not to blame, and then try these steps to help ease him out of this harmless phase:
* Before you tuck him in, tell him to go to the bathroom and grunt three times to push out all the pee.
* Since most kids wet their beds within a few hours of going to sleep, wake him up and lead him to the toilet just before you hit the hay.
* Don't let him consume more than 35 to 40 milligrams of caffeine (approximately a 16-ounce soda) during the day; it causes the body to process fluids faster. (However, don't limit his water intake.)
If your child hasn't outgrown his bed-wetting by the time he turns 6 and he's troubled by it, you can ask his doctor about a moisture-sensitive pad that fits in underwear and sounds an alarm at the first trickle of pee. She may also prescribe DDAVP, a tablet or nasal spray that slows the production of urine at night.