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How should parents deal with frequent bed-wetting? 

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Accidents happen, as parents of toilet-trained kids well know. But when the occasional wet blanket becomes a regular occurrence, it can create anxiety and stress for the entire family.

This month, Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, reminds parents to just relax; don't take it personally. Most bed-wetting is benign and goes away over time. While you wait, Dr. First offers a few tips for keeping kids dry.KIDS VT: When is the right time to toilet train a child?

LEWIS FIRST: There is no exact age. I recommend going by the following four questions: Does your child have a good understanding of the words for defecation and urination? Is there a regular time they tend to urinate or defecate? Are they interested in other people using the bathroom? Finally, are they uncomfortable with something in their diaper? If they couldn't care less what's in their diaper, they're not ready. Successful toilet training typically occurs between ages 2 and 3, and boys tend to lag slightly behind girls. If a child hasn't begun to develop an interest in the potty by age 3, it's worth talking to your doctor.

KVT: How common is bed-wetting?

LF: Bed-wetting is much more common than most parents think. Fifteen to 20 percent of 6-year-olds will continue to wet the bed, and about 1 percent of otherwise healthy teenagers wet their beds.

KVT: What are the most common causes?

LF: Oftentimes we don't know, or the causes are multifactorial. A child can have a very small bladder and/or be a very sound sleeper. It may even be genetic. If one parent has a history of bed-wetting, there's about a 50 percent chance that the child will, too. And if both parents do, there's a 75 percent chance. Also, when kids are constipated, the full large intestine may push into the bladder, making the bladder smaller. Bed-wetting may also flare up during times of stress or anxiety. But most of the time, it's unusual to find a medical cause, and the problem typically goes away on its own.

KVT: When should parents seek medical advice?

LF: Bed-wetting becomes a problem when a child has been toilet trained for months or years and then begins having nighttime accidents, or regular accidents by day, too. Then we start asking, is it diabetes? A urinary tract infection? Emotional trauma? These are much rarer causes.

KVT: Are there popular misconceptions around bed-wetting?

LF: Yes: The notion that parents shouldn't give their children something to drink before they go to sleep. Kids with this problem will still wet the bed. Obviously, if they really tank up on fluids before bedtime, the odds of an accident increase. But there is no proof that depriving a child of fluids before bedtime will result in a dry bed.

KVT: Anything else?

LF: The most important thing to remember is that it's not your child's fault. This is not something they have direct control over. Parents often assume the child is trying to frustrate them. All that does is make it more difficult for the child to gain control over this problem for fear they will disappoint and anger their parents. Rather than saying, "How could you have another accident?" parents should realize that one in five kids in kindergarten does this. They will likely outgrow it over time.

KVT: Do pull-ups or diapers worn at night enable bed-wetting?

LF: No, but for frequent bed-wetting, it's better to use these products with alarms, such as Wet-Stop. It's a monitor with a sensor pad that sits inside the diaper or pull-up and sounds a buzzer whenever it senses a drop of moisture. Eventually, it trains the child to wake up before he or she needs to use the toilet rather than letting the alarm go off. It's also a good idea for parents to take their child to the toilet right before he or she goes to bed. If the child tends to have accidents at a certain time, parents can set an alarm for themselves and take their child to the bathroom before it happens — although this may not teach the same bladder self-control that a sensor system can.

KVT: What if the problem persists?

LF: Your child's doctor can prescribe medications — not as a cure but as a temporizer — to allow your child to hold onto fluid longer. When is this useful? At a sleepover. Many kids are embarrassed about going on a sleepover because of the fact that they can't hold their urine. The medication will get them through the night, but it's still a good idea to come with a change of pajamas, just in case. Even alerting the friend's family helps demystify the stigma around bed-wetting. If the child is still wetting the bed after age 6, it makes sense to seek medical attention just to make sure there's no underlying medical condition.

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