May 15, 2009


Après moi, le déluge

When Ted Sr. and Tammy were dating, he didn't mention that he wet the bed until he was 11. Here's a secret that men know: discussing your bedwetting history is not the surest way to score with chicks. Luckily, at a family Christmas dinner shortly after their engagement, Ted's mother discussed this history openly for the benefit of everyone present, including the inlaws he just met.

But this is an unusual circumstance. Usually, when a child is brought to me because of bedwetting, the mom doesn't know the 'family' history--which usually means the dad's history. It's not unusual for boys to be older than girls when they finally stay dry at night. And there's often a family history when the problem is lasting well into elementary school.

So Tammy knew this history when she brought me Teddy Jr., who's unusually bright and articulate, and 7. He was keenly embarrassed by his need for a pull-up at night. He couldn't go on sleep-overs, and was afraid to go to summer camp. Mostly, he felt bad in the morning when he had an accident. He was open about feeling like this was his fault, and hopeless because nothing his parents tried really helped. At first they didn't let him drink at bedtime, then an hour before, then nothing after dinner. They tried waking him up when they went to sleep. They tried waking up in the middle of the night and dragging him to the bathroom then. But it was either too early or too late.

Bedwetting is usually not a problem with kidneys, bladder, metabolism, or how much a kid drinks. (Though I check all of these out just to be sure.) It's about sleep. When we're asleep and our bladders get full, a signal is sent to the brain. The signal wakes us up, and though we try to stay in bed, we reluctantly drag ourselves up long enough to do what we have to do. Kids often sleep so deeply that they sleep through this alarm. As they get older, the sleep cycles of children change enough to let them hear that alarm, so they can wake up and stub their toes like the rest of us.

So perhaps it comes as no surprise that one of the most successful interventions is a bedwetting alarm. It's a simple device that sounds a loud alarm when it senses moisture. The first few times it goes off are obviously after the accident happens. But just like an adult who wakes up just before the alarm goes off, the child's brain reprograms the sleep cycle to a shallower level when the alarm is anticipated. This allows them to hear the signal from the bladder. I advised them that in order to be effective, the alarm has to be loud enough to wake up a kid who has this problem because he sleeps so deeply. So it's going to wake up everyone in the house. Some alarms have a vibrate feature, so they don't awaken everyone. These never work, because they don't wake up the bedwetter either. And some kids just aren't ready. If it doesn't work in a couple of weeks, put it away and try again in a few months. I explained this concept to the parents and to Ted Jr., who got it right away and wanted to try it. After I told him why it was happening, he looked really happy. He believed it wasn't his fault.

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Please let me know what you think. Do you know a child or situation like this?