My Doctor Online The Permanente Medical Group

Causes

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Children learn how to fully control their bladders at different ages. It is fairly normal for a child under the age of 7 to occasionally wet the bed or their underpants. Children up through the age of 10 may have an occasional urinary accident. By the time a child reaches 15, most can control their bladder, but a few continue to have the occasional urinary accident, usually at night. Bedwetting tends to run in families.

In some children, the bladder becomes overly full of urine at night while they are asleep. Their brain hasn't learned to respond to the signal that their bladder is full, so they don't wake up to go to the bathroom.

If your child is toilet-trained and has consistently stayed dry for 6 months and then suddenly begins wetting the bed or clothing, it may be a symptom of another condition. For instance, children with a urinary tract infection may lose control of their bladder. Other more serious conditions, such as diabetes, can also cause enuresis.

Sometimes toddlers or preschoolers who were previously dry can begin bedwetting when a new sibling arrives. This setback is usually temporary.

Enuresis can also be associated with a psychological condition, such as conduct disorder. Also, children who have disabilities, such as cerebral palsy or Down syndrome, may be at higher risk.

If you are concerned that your child's incontinence may be due to a more serious condition, please discuss it with us.

Symptoms

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A child with enuresis involuntarily wets their bed or underpants several times per month after the age of 5 or 6 years old.

Older children with enuresis may have 1 urinary accident or more per month.

Diagnosis

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We diagnose enuresis (typically bedwetting) by performing a physical examination and by listening to your child's symptoms.

We will ask you about how often your child wets their bed or underpants. It may help if you keep a diary to identify the following:

• When your child urinates in the toilet
  
• When your child has a urinary accident
  
• Your child's food and fluid intake (noting the times they eat and drink)
  
• The hours when your child sleeps

We may test your child's urine to rule out another condition, such as a urinary tract infection. Rarely, we may request abdominal X-rays to rule out other conditions.

Prevention

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It may help for your child to get plenty of sleep and use the toilet regularly throughout the day and right before bedtime. You may also wish to waken your child once during the night to use the toilet.

If bedwetting is a problem, avoid giving your child fluids an hour or 2 before bedtime; however, don't overly restrict fluids because your child needs fluids to stay healthy. Some parents find that not giving their children drinks that contain caffeine also helps.

Treatments

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Most children grow out of urinary accidents so no treatment is needed. However, there are some things you can do at home to help your child remain dry.

Scheduled routine

Make sure your child uses the bathroom at regular times throughout the day. Have them sit on the toilet for 5 to 10 minutes shortly after meals and after drinking fluids, even if they do not feel the urge to urinate. Talk to older children about not holding their urine and going to the toilet as soon as they feel an urge to urinate. You may also wish to waken your child once during the night to use the toilet.

Bedwetting alarm

If your child has a bedwetting problem, an alarm (such as Sleep Dry, Wet-stop, or Enuretone) might help. You can buy a bedwetting alarm at many stores without a prescription. The small alarm goes off when the child begins to urinate in their bed. The alarm awakens you or your child so that the child can get up and urinate in the toilet. It can take several months for your child to awaken with the bedwetting alarm. When used consistently, these alarms are successful at stopping bedwetting.

Encouragement

Reward younger children (ages 5 to 8) for staying dry at night and urinating frequently throughout the day. For instance, the child can place a sticker on a calendar each time they use the toilet and have a dry night. Have your child actively help remove wet clothing or bedding. Older children can place their wet clothing or sheets in the washing machine or bundle them for the laundromat. 

Never punish or humiliate your child for having enuresis, no matter how old they are. All children, but especially older children, suffer from discomfort, embarrassment, and shame surrounding this condition. Reassure your child that bedwetting is a common problem that can be helped. 

Medications

If your child has issues with bedwetting, we may prescribe a medication called DDAVP (desmopressin). It decreases the amount of urine output at night. Your child may want to use this medication if they have a sleepover so they don't have a urinary accident in front of friends. It can also be used over a long period of time to stop bedwetting incidents, but it can lead to dependence and electrolyte imbalances. We may ask you to stop using the medicine periodically to see if the bedwetting problem has gone away.

When to Call Us

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Please call the Appointment and Advice line for help if your child is

Ages 2 through 5 and toilet-trained and has not had a urinary accident for at least 6 months, but suddenly begins wetting their underpants or bed.

Ages 5 through 10 and consistently wets their bed or underpants at least 2 times a week.

Ages 10 and up and continues to have urinary accidents at least once a month. Treatment is available, and your child does not need to continue to suffer the embarrassment of urinary accidents.

Also, please call us if your child of any age is:

• Drinking large amounts of fluid 
• Complaining that it hurts or burns when urinating
• Having swelling in feet or ankles
• Misbehaving in strange, new ways

In some instances, your child may have an underlying condition that we should evaluate.

Your Child's Care with Me

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If you are concerned about your child’s symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child’s symptoms and medical history and your preferences, the nurse may:

• Provide advice about how to care for your child at home.
• Send me a message so I can follow up with you directly.
• Offer you a telephone appointment with me or a trusted colleague.
• Make an appointment for your child to be seen in person.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).