Toddler Q&A

Q:

My toddler has been fully potty trained for six months now, but he recently started wetting the bed again. He doesn’t seem to have any nightmares, and I’m reluctant to put him back in night-time nappies. What could be causing this? How can I help him stop?

A:

CLAIRE ANSWERS: Bedwetting is not unusual in children under the age of five, but it is unusual for a child to start bedwetting after having been dry for a period of time.

When a child has been dry for a period of six months, reverting to bedwetting (known as secondary nocturnal enuresis) can be attributed to a number of factors, both physiological and psychological.

Being a heavy sleeper, having a family history of bedwetting, a bladder infection or another medical condition such as diabetes are all possible physiological causes. Some children also have what is known as a smaller functional bladder, that sends a message that the bladder is full while the child is asleep. Additionally, psychological upsets such as a death in the family, bullying, moving house, parental conflict, or the birth of a sibling, among others, can lead to secondary nocturnal enuresis. Irrespective of the cause, there are a number of strategies that may prove to work:

✓ Reduce fluids before going to bed – avoid caffeine. That means chocolate should be avoided too.

✓ Make bedtime preparations happy – spend time brushing teeth, going to the toilet, bathing etc. Don’t rush him.

✓ Make sure your child goes to the toilet before he goes to sleep. Try and work out at what time he usually wets the bed, and wake him up just before. He might get into the habit of taking himself to the toilet.

✓ If your child is a heavy sleeper, try using a night light to help avoid him sleeping too deeply.

✓ Keep a little potty next to the bed. ✓ Use star charts to work on selfesteem and positive reinforcement when he wakes up dry. Don’t take any rewards away for wet nights. Children are thought to outgrow bedwetting, and many doctors recommend that treatment in the form of medication should be delayed until the child is about six or seven years old. However, if the aforementioned psychological and physiological causes are absent and bedwetting persists, it may be necessary to visit a doctor or a psychologist in order to deal with the probable causes. Remember to reassure your son that bedwetting is quite normal in children. These behaviours are usually made worse if a child feels ashamed or in trouble, so don’t reprimand him for it. Remember to react patiently and supportively, even if it does become frustrating having to wake up in the middle of the night to frequently change sheets and pyjamas.

A: DR SINCLAIR RESPONDS: Secondary enuresis refers to wetting (the bed or oneself) after a minimum of three months of being persistently dry. The common physical causes of this regressive behaviour can include:

• Constipation, where stool is occupying the pelvis and so diminishes the potential bladder volume.

• Urinary tract infection. Though this is far more common in girls than in boys, a urine test should always be done to exclude it as a possible cause.

• Worms, and most notably the pinworm, can disturb bowel and bladder function, particularly at night.

• Fluid intake, because as kids get older and more independent, they increase their pre-bed intake of fluid.

• An upper airway obstruction and/ or allergic rhinitis with deeper restless sleep patterns.

Chat to your child’s doctor about this bedwetting to exclude any of these causes. You can also help your child by:

• Ensuring he poos regularly.

• Deworming him, the rest of the family and the family’s pets regularly.

• Regulating your child’s fluid intake prior to bed.

• Starting a star chart for dry nights with small rewards.

• Waking your child once during the night to wee.