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What to Do When Kids Wet the Bed

For at least five million children in the United States, bed-wetting is a fact of life. It creates more of a problem than the need to wash a load of sheets before rushing off to work  -- it can disrupt the whole family. Fortunately, thanks to new insights regarding nighttime accidents, and approaches to preventing them, most kids can be spared the embarrassment (and their parents the inconvenience) of wet nights.

Bed-wetting, or "enuresis," is rarely an emotional or psychological problem. It doesn't mean that your child is too lazy to get up or is trying to control you, or that she's stubborn or immature. Usually bed-wetting is simply a developmental lag  -- and one that you may have experienced yourself: If both her parents were bed-wetters after the age of 6, a child has about an 80 percent chance of being one; if only one parent was wet at night, the child has a 40 percent chance of having accidents. There are late walkers, late talkers  -- and late dry-nighters. In addition, some children have small bladders that are more easily overfilled, and some studies suggest others don't produce enough antidiuretic hormone (ADH), which is released by the pituitary gland during sleep and causes the kidneys to manufacture less urine so that the bladder doesn't fill beyond capacity. In any case, it's unreasonable to expect a child under the age of 4 or 5 to always wake up dry.

In fact, a child who wets the bed usually can't control it any more than one with asthma can help wheezing. So take heart knowing that most bed-wetters outgrow the problem without treatment; if your youngster isn't bothered by it there's no reason to intervene  -- but if she is, there are effective tactics to try.

Why Kids Wet the Bed

It helps to understand how children achieve bladder control. Infants urinate in response to the bladder-emptying reflex: When the bladder has stretched to a certain point, it automatically releases the urine. Sometime between 2 and 3 years of age, most children become aware of bladder fullness, and learn that they can consciously inhibit the bladder-emptying reflex and hold in their urine. At this point they achieve daytime bladder control.

Nighttime control occurs when a child can unconsciously inhibit the bladder-emptying reflex. So think of bed-wetting as a communication problem: The bladder and the brain don't "speak" during sleep. The child who urinates in his sleep literally sleeps through his bladder's signals and fails to wake up to go to the bathroom.