A child wakes in the middle of the night, removes her sheets from the bed and places them in the laundry, then returns to sleep on the floor to avoid embarrassment, ridicule or humiliation. This child also avoids attending sleepovers with her friends and does not invite others to spend the night at her home. Although for most children it is not an every night problem, the unpredictability of bedwetting can be enough to affect self-image and esteem, confidence and social interaction. But what can be done?

What is Bedwetting?
Nocturnal enuresis – the medical term for bedwetting – is the "involuntary discharge of urine after an age by which bladder control should have been established, which in children is normally presented by the age of 5," according to Taber's Medical Dictionary. Most commonly, the involuntary discharge of urine occurs at night, while the child is sleeping, causing them to wake.

According to the National Kidney Foundation, bedwetting affects approximately 7 million children in the U.S alone. The condition is more common in boys than in girls, and tends to occur more frequently in first-born children than in younger siblings. A distinct family connection or inheritance tendency is also present.

Causes of Bedwetting
Bedwetting may be caused by one or more factors. These factors include poor bladder control, spastic bladder conditions, stress, trauma, urinary infection, increased fluid intake, diabetes mellitus or, in a small percentage of cases, a serious disease or illness involving the spinal cord or muscles of the pelvis. The most common cause of bedwetting, however, may typically be due to a child’s bladder not growing as fast as the rest of his body. "…the most common causes of bedwetting continue to be issues involving bladder control, infection, fluid intake, stress and trauma," says Dr. Stephen Sheldon, director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago, Ill, noting that more serious causes include diabetes.

In addition to these factors, the role of family inheritance also can play a part in the presence of bedwetting. According to Dr. Sheldon, the reason for the family trait of bedwetting is not clear, although the passing of the condition from parent to child is. "If one or both parents wet the bed when they were younger, then it is more then likely that their child will wet the bed as well," he says. "There are lots of conditions or diseases that also run in families that could be a contributing factor of bedwetting, which is one of the reasons why it is so difficult to say 'why' it runs it families but we know that it does."

"My son is 10 and he has always wet the bed," says Denise, a mom from Mays Landing, N.J. "His father and several of his aunts wet the bed until they were in their teens. We feel it's hereditary. We've always treated it as no big deal and we've let him know that it's quite common. If he starts to become really bothered by it and asks for help, we'll tell him about alternatives … and see if he wants to try any of it. It'll be his choice."

Effects of Bedwetting on Children
Children who wet the bed are often overcome by feelings of embarrassment and humiliation. These children know that they are old enough that they should be able to sleep through the night without wetting the bed and may feel out of control when an "accident" occurs. In addition, a child may feel ashamed as a result of the bedwetting episode. Any or all of the feelings related to bedwetting can cause a child to see himself as a failure, affecting his self-esteem and self-image.

According to Dr. Sheldon, the feelings that stem from episodes of bedwetting can carry over into other parts of a child's life. "A child that wets the bed may feel all kinds of emotion," he says. "Whether embarrassment, fear of someone finding out, or failure, these feelings do not stay confined to the bedroom. A child who wets the bed may feel they are a failure or that they cannot control their own body and this can inhibit participation in other areas such as sports, friends or outings. Bedwetting – and especially the feelings a child may have accompanying an episode – can affect more then a child's sleep."

"My daughter is 5 years old now and will often have bedwetting incidents when upset or stressed," says Crystel, a mom from Clemson, S.C. "The stress and feelings she feels when she wets the bed are obvious in other areas of her life as well. We are just patient. She is a sensitive child and we have to keep that in mind when dealing with her in any aspect of her life. All we do is dry the bed and put on clean sheets. It'll all come out in the wash and a hug and kiss will help with the rest."

Reacting to the Bedwetting Episodes
One of the most important aspects of dealing with bedwetting episodes is the way a parent or caretaker reacts. According to Dr. Paul Coleman, author of How to Say It to Your Kids, reacting harshly can often cause the problem to worsen. "It is important to teach a child about the problem without causing any more humiliation then is already there," says Coleman. "As a child may be feeling stress already – and the stress may be the cause for the bedwetting incident – adding more stress will only make it worse, getting both the parent and the child into a vicious cycle with no end in sight."

So how should a parent react to their child's bedwetting? Coleman suggests reacting with reassurance. "Empathy is crucial," says Coleman. "Let the child know that you understand that he/she is upset and help them to understand that they are not alone in having this problem. Reassure him or her that they are just as normal as other kids and that with help, they will overcome this problem, too. Offer to help. After the bed is wet say, 'OK, you pull off the sheets and I'll get a fresh set.' It is fine if the child prefers to make the bed alone – they may be embarrassed. It is also fine if the parent tells the child that he/she is to make it by him/herself if they are tired or very busy. However, making the bed should not be viewed as a punishment. The tone should not be scolding. Having to make a bed will not motivate a child to overcome enuresis."

Bedwetting Help
Bedwetting is a different problem for different kids. For some, it is simply a phase they will outgrow. For others, professional help may be needed to overcome it. There are several things a parent can do at home in an attempt to work through bedwetting.

Dr. Sheldon states that one of the first steps in helping a child combat bedwetting is the limiting of fluids two hours before bedtime. As fluids build up as urine during the night, limiting the amount of fluids a child consumes before going to bed can often limit the number of "accidents" that occur. "Children who do not suffer from any conditions such as diabetes, a blood disorder or are prone to dehydration, limiting the amount of fluids consumed before bed will often decrease the occurrence of bedwetting," he says.

Making it routine that a child use the bathroom immediately before going to bed is another intervention parents can do at home. According to Dr. Sheldon, by emptying the bladder before going to bed, children may reduce the incidence of bedwetting by one night a week. In addition, parents can awaken their child once each night – approximately four hours after bedtime – to take their child to the bathroom. This technique often may result in a habit the child continues on his own, lessening the occurrence of bedwetting.

Using disposable absorbent underpants is another strategy. Waking up dry may have positive effects on the child’s self-esteem, ease stress and allow parents and children to cope during the bedwetting period. Additionally, using disposable underpants may allow the child to attend sleepovers or host them at his own house, without fear of embarrassment.

"Parents should attempt to do what they can for their child at home with simple interventions," says Dr. Sheldon. "Oftentimes little things work wonders in decreasing the frequency of bedwetting. But, if the parental intervention doesn't work, don't be afraid to ask for help."

Should your child need more assistance to overcome bedwetting, consult your doctor. Treatment can range from bladder training to administering medication before bed. Depending upon the frequency and consistency of the bedwetting, a treatment plan is individualized for each child.