By the age of three, 60% of children are dry through the night. Most of the remaining 40% are boys, and the majority of them will be dry by age 6. The remaining children may have occasional dry nights but some will continue to wet even into early adolescence. Rarely can these facts be explained by emotional causes although a great upset will sometimes result in a few nights of wetting in a previously dry child. For a long time children have been blamed and shamed for bedwetting and only recently have scientists understood what is really behind this phenomenon.

The brain produces many hormones, one of which is called ADH, anti-diuretic hormone, or vasopressin, and this hormone is responsible in part for allowing us to remain dry throughout the night. Infants do not produce much ADH and certainly not in the cycles of day/night that adults produce. The eventual "kick-in" for ADH cyclic production is unknown but sometime in the second and third year of life the secretion pattern of this hormone begins to resemble the adult version. But only in 60% of children! The rest wait for this to happen gradually and meanwhile have variable success at night dryness.

Understanding the physiological reasons for bedwetting should help parents to avoid feelings of failure and hopefully will relieve children of the burden of guilt that has been traditionally aimed at them. The key to management for families with this issue is to determine when special measures like medication or behavior modification needs to be started. In most cases, time and patience puts an end to this issue.

Older children who still wet the bed and are becoming self-conscious about sleep overs and out of town visits can be approached in several ways. When possible parents should discretely alert the host family of the situation and if simple measures such as limiting intake of fluids after dinner and being led to the bathroom around midnight usually result in dry success they may be willing to help your child with these methods. Often children are so keyed up about wetting when they are sleeping at a friend's home that they are dry in the morning simply on the basis of having never really allowed themselves to fall completely asleep all night. This method obviously can't work for long.

In the case of the older child who will want to go to summer sleep away camp or for extended visits out of town, the kindest and simplest approach is the use of a replacement hormone, which, prior to this spring, was available only as a nasal spray. Now, the medication is also available in a small tablet. Known by the brand name, DDAVP, you can find out more information about it and other treatment options for bedwetting on a web site developed by the manufacturer of the product. The address is http://www.drynights.com (also found in our "Links" section, under "New Links"). DDAVP Tablets are a very safe medication, and the only side effect seen in a very few patients is headache. Also, nighttime fluids should be restricted when taking DDAVP. In the very few cases that patients don't respond to DDAVP there are other oral medications such as Ditropan which by different means, can keep your child dry. Bed wetting alarms have long been the popular method of treatment however success is limited to a few children and requires months of use in order to reinforce the method. It works best in children who sleep very deeply and its effect is dependent on the child's desire to get up at the first sense of wet - hopefully the child learns to wake at the first feeling of urgency but this training has no impact on the hormonal release which will still have to develop in time. Other medications used in the past such as Tofranil, are no longer recommended for this condition.

Using "pull-ups" for the child who wets sends a negative message. It infantilizes the child who is seeking to achieve a more "big kid" status and it also implies that wetting isn't so bad since the diaper will catch it anyway. It even allows parents to become indifferent to the issue although as an alternative to a parent being overwhelmed and angry I suppose it is a better choice. Instead I suggest parents make the bed in layers; plastic,sheet, plastic, sheet, plastic, sheet; this way the wet child can be taught to simply remove the top layer of plastic and sheet and toss that into the tub and go back to sleep on "dry ground". The advantage for the parents is less work in the night, for the child there is the independence and reduction of shame felt when it is no longer necessary to wake a parent to help them. One of the common results of bedwetting is a child sleeping with his parents which is not helpful in their efforts to grow up independent and usually results in parental resentment and more lack of sleep. With this method, the bedwetting becomes little more than a laundry issue.

If your child has previously achieved dry nights for more than a few months and has then begun to wet the bed it is important to check with your pediatrician who will want a urine sample before deciding to direct you in one or another of these suggestions. In rare cases there is a physical cause for bed wetting and this needs to be ruled out in such situations.