A CONVERSATION WITH JODIE THOMPSON, PART 2
Jodie Thompson is a Paediatric Nursing Consultant, and she has 26 years of experience working as a caring paediatric nurse. I asked Jodie a few questions about children and bedwetting and hopefully this will help you better understand the problem at hand and how to best deal with it.
WHY DO SOME CHILDREN WET THE BED?
Children wet the bed for a variety of reasons which can include the following:
- The size of their bladder is not being large enough to store the amount of urine they are producing overnight. The filling capacity of the bladder may be further impacted upon if the child experiences constipation whereby the colon (large bowel) compresses the bladder. This can lead to reduced filling capacity and increased irritability of the bladder therefore increasing the chance of night time accidents.
- The child’s levels of anti-diuretic hormone produced in their brain isn’t at a peak level as yet which reduces the amount of urine produced by the kidneys overnight, therefore allowing the bladder to store this reduced amount of urine.
- The child is not waking overnight to the feeling of a full bladder in order to get up and go to the toilet to empty their bladder. This may be due to a reduced sense of body awareness of the sensations of a full bladder, or can be related to a sleep issue which should be investigated if they snore or breathe with an open mouth.
- Some children continue to wet the bed if they have experienced some emotional trauma, increase in stress, or disruptions to their normal routines.
- Structural abnormalities or conditions should be ruled out with your child’s GP or Paediatrician, related to changes in their organs, muscles, or nerves, supplying their bladder. Some children may have very small bladders that don’t store much urine, or become irritable when only half full of urine. Other medical conditions should also be investigated such as the possibility of a urinary tract infection or diabetes.
WHAT CAN BE DONE TO HELP BEDWETTING?
There are several things that can be done to assist with bed wetting.
- Start by treating any constipation that your child may be experiencing. This may be related to their diet, or the amount of water they consume during their day. Increasing their fibre and water intake may help, or they may need the assistance of medications that help to soften and hydrate the stools so that they can be more easily passed.
- Establish good bowel routines whereby your child aims to open their bowels well each day. Time their sitting on the toilet around 20 minutes following a main meal, this often open their bowels, and helps to utilizes the gastro-colic reflex which is the reflex that helps to increase the peristaltic waves through the bowel to move food along following a larger meal i.e. breakfast, lunch or dinner. Encourage them to sit on the toilet for up to 10 minutes to ensure they fully empty their bowels. This helps to reduce any impact that having large stools sitting in the bowel that press on the bladder therefore affecting its storage capacity. Having a stool underneath their feet and a supportive toilet seat that allows them to be positioned with their knees higher than their hips is the most ideal position for ease of passing stools.
- Ensure your child is drinking plenty of water during the first half of the day to prevent afternoon thirst, tapering any fluids off into the evening and before bed. Never deny children sips of water as their body is reliant on this to remain healthy. You just want to ensure they are not consuming large amounts of fluid prior to bed as their body won’t have time to process their fluid prior to bed, and it will fill up their bladder overnight which they won’t be able to hold in. Limit the amount of any fizzy drinks or brown drinks e.g. cola, chocolate, tea or coffee that they may consume as these contain caffeine and can lead to increased bladder irritability. Our aim is to have their urine nice and dilute and not a concentrated yellow colour as concentrated urine also irritates bladders.
- Encourage your child to empty their bladder regularly during the day – on waking, before school, at recess, lunchtime, after school, after dinner and before bed. Bladders are a muscle and need a regular workout of filling up and expanding and then shrinking again to fully empty all the urine out. This keeps the bladder nice and stretchy and able to store the maximum amount of urine overnight.
- If you child has a bedtime routine whereby they lay down for half an hour before bed, perhaps reading a book, encourage them to empty their bladder prior to laying down and then again just before they are going to sleep. They won’t feel like they need to go to the toilet, but encourage them anyway as this small amount of urine can make the difference between having a dry night or a wet night.
WHEN TO SEEK PROFESSIONAL HELP?
Children can often become dry overnight between the ages of 3-5 years, however many children still experience bedwetting much later than this which can be for a variety of reasons. Children who still experience bedwetting who are under 7 years old are considered within the normal range, and often interventions are not sought until after the child turns 7.
Talk with your doctor about your child’s bedwetting if they are still wetting the bed from the age of 5 and over so they are aware of this in case they feel that further testing is required. Children who experience bedwetting over the age of 7 should have their sleep quality investigated in case of sleep apnoea, often caused by enlarged tonsils or adenoids, or in the case they may have an underlying condition such as diabetes, or other structural abnormalities such as small capacity bladder or an over-active bladder that can’t store a lot of urine.
If your child has a developmental delay then they often will experience bedwetting for a longer period of time in which case a consultation with a Continence Nurse Specialist may be helpful. If your child is receiving NDIS funding and has issues with daytime or night time incontinence then they should receive a Continence Assessment from age 5 to advise the NDIS of their continence needs and what products will be needed to support these needs to assist them on their continence journey.
Families can contact the Continence Foundation of Australia if they would like further information about managing bedwetting or to receive a name of a local Continence Nurse Specialist who can provide an assessment and assist in provide recommendations based on your child’s particular needs to assist with their incontinence.
WHAT BEDWETTING TREATMENT OPTIONS ARE AVAILABLE?
There are several treatment options available to assist children with bedwetting.
- Bed Wetting Alarms / Pad and Bell – these alarms are used to assist with waking the child at the first sign of any urine that makes its way to the pad, or onto a special sensor that can be placed into the child’s pullup or underwear. These can potentially work for children who are able to be woken overnight and can act upon this alarm by getting up and going to the toilet. They don’t work well for children who are very deep sleepers and are unable to be woken, or for those children who have sensory sensitivities, or who may have Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder as these alarms can induce high levels of anxiety and can cause disrupted sleep which then leads to challenging daytime behaviours.
- Some children may be suitable for a trial of Minirin (Desmopressin) which is a medication taken just before bed which helps to slow down the production of urine overnight so that the amount of urine produced can be held in the bladder without wetting. This is done under prescription and guidance from your child’s GP or Paediatrician. It is done with caution as parents need to ensure that their child does not have drinks of fluids after they have had their Minirin as they can experience complications in their body due to fluid overload.
- There are children who may have small bladders that are not able to store much urine and need the assistance of medications to help relax their bladder so they can increase their storage capacity. Ditropan is one medication that may be prescribed by your child’s doctor to help with this, but this is only offered in a small amount of cases.
It is important to acknowledge that children who experience bedwetting do so for a variety of reasons, and often investigating the root of the problem and addressing the problem often leads to the child becoming dry in their own time. Ensuring that children are supported through encouragement, use of products such as pullups or Pjama Pants to contain their urine as well as bed protection helps to maintain their confidence. If they feel comfortable and not worried about their bedwetting then they are more likely to become dry having stress removed as a potential factor for their bedwetting.
KIDS COLLABORATIVE: WE’RE HERE TO HELP
Kids Collaborative is a paediatric nursing service, lead by Paediatric Nursing Consultant, Jodie Thompson, an experienced and caring paediatric nurse of 26 years.
Kids Collaborative aims to make a positive difference in the lives of children with complex medical needs or disabilities and their families by offering care and education services that are often difficult to find in the community, but play a very important part in supporting families.
Services include Paediatric Continence Assessments, Independent Nursing Assessments, Education for Common Healthcare Procedures, the development of Healthcare Folders and School Healthcare Plans for children with complex needs to support carers, other family members and school support staff as well as Occasional Care for children living within the Hills District and surrounds with complex needs.