Children over 3 years of age generally do not pee in bed anymore, but it is normal for the child to still pee in bed on some nights until around age 5. From there the child should be able to identify the urge to go in the bathroom day and night and not wet the bed any more.
From 4 years of age, parents should be aware if the child is able to hold the pee during the day and also at night, making sure she does not pee in bed whenever she wakes up in the morning.
When to worry
It may be cause for concern if the child is over 4.5 years old and safely takes pee during the day but still pees in bed every night or more than 2 times a week. In this case, the pediatrician should be warned because these various causes for this to happen.
A common cause is for the child to take lots of fluids from 6 pm and not to pee before going to bed, another common cause is the child being anxious, afraid and not wanting to get out of bed to go to the bathroom, but sometimes, bed wetting can be caused by a situation called nocturnal enuresis, a type of childhood urinary incontinence.
The child should not be blamed for bed wetting, but bedwetting needs specific treatment, which may include urine training, use of special pajamas, or even use of medications indicated by the pediatrician.
Main causes of enuresis
Any child up to age 8 can pee in bed at night if drinking lots of water after dinner or not going to the bathroom before bed, however this situation should be rare and have to be associated with these factors.
If the child often pees in bed, the causes may be related to:
- Delayed growth - children who start walking after 18 months, who do not control stool or have difficulty speaking, are more likely to not control urine before age 5;
- Mental problems - children with psychiatric illnesses such as schizophrenia or problems such as hyperactivity or attention deficit, are less able to control urine at night;
- Stress - situations such as separation from parents, fights, birth of sibling can make it difficult to control urine at night;
- Diabetes - The difficulty of controlling urine can be associated with too much thirst and hunger, weight loss and altered vision, which are some of the symptoms of diabetes.
There are 2 different types of the disease: primary enuresis occurs when the child has always needed diapers not to pee in bed, and secondary enuresis occurs when for some reason, after the child is able to control pee well at night, to pee in bed.
How to identify enuresis
Parents may be wary when the child is 5 years old and still pees in bed or when he or she returns to bed wetting after spending more than 6 months of urine control. But for the diagnosis of enuresis it is necessary to go to the doctor to do some exams, such as urinalysis, ultrasound in the bladder and, in some cases, perform a urodynamic examination to study the storage, transport and emptying of urine.
6 steps to help the child not to pee in bed
The treatment of nocturnal enuresis is very important and should be started as soon as possible, especially between 6 and 8 years of age, to avoid problems such as social isolation, conflicts with parents, situations of bullying and decreased self-esteem, for example. So, some techniques that can help heal enuresis include:
1. Maintain Positive Reinforcement
The child should be rewarded on dry nights, which are those in which he is able to not pee in bed, receiving hugs, kisses or stars, for example.
2. Train urine control
This training should be done once a week to train the ability to identify full bladder sensation. For this the child should take at least 3 glasses of water and control the urge to urinate for at least 3 minutes. If she does, next week she'll have to take 6 minutes and the next week, 9 minutes. The goal is for her to be able to go without peeing for 45 minutes.
3. Wake up at night to pee
Waking the child at least 2 times a night to pee is a good strategy for her to learn how to hold the pee well. It may be helpful to pee before going to bed and set an alarm to wake up 3 hours after bedtime. When you wake up, you should go immediately to pee. If your child sleeps more than 6 hours, set the alarm for every 3 hours.
4. Taking medicines indicated by your pediatrician
The pediatrician may recommend the use of medications, such as Desmopressin, to reduce urine output at night or taking antidepressants like Imipramine, especially in case of hyperactivity or attention deficit or anticholinergics, such as oxybutynin, if needed.
5. Use sensor in pajamas
Alarm can be applied to the pajamas, which emit a sound when the child pees in his pajamas, which causes the child to wake up because the sensor detects the presence of pee in his pajamas.
6. Conduct motivational therapy
Motivational therapy should be indicated by the psychologist and one of the techniques is to ask the child to change and wash their pajamas and bedding whenever they pee in bed to increase their responsibility.
Usually the treatment lasts between 1 and 3 months and requires the use of several techniques at the same time, being very important the collaboration of the parents so that the child learns not to pee in bed.
