A Bed-Wetting Plan of Attack

 

If I remember right, you blogged about your kids having issues with bed-wetting and letting them take some ownership with the clean-up? We are 2 weeks home with our 4-year-old adopted from China. In China, she had 1 accident per week. Since home, she has an accident every night. So we bought pull-ups. But sometimes she takes the pull-up off, and then there is a middle of the night bath, tears, load of laundry, etc. The bed-wetting is a physical thing. The taking the pajama pants and pull-up off is a choice. Any suggestions on how I can connect the two for her? Or what role a 4-year-old can play in the clean-up of wet bed mess?

First congratulations on your new daughter. Yes, you are right that I’ve had a lot of personal parenting experience with bed wetting. I also have done a fair amount of research on the subject and had an article on bed-wetting picked up by the Associated Press.  There was a time, when a Google search of my name returned only bed-wetting sites that had republished some of what I’ve written. Quite a claim to fame, eh???

Although I know it feels longer when you are up in the middle of the night for 2 weeks, you have really only just arrived home.  Your girl is adjusting to a complete and total change to everything she knows.  Regardless how she acts, she is likely reeling emotionally and barely hanging on.   Bed-wetting during this adjustment time is very, very common even with much older kids who had been totally dry pre-adoption.  Jet lag and poor sleep also contribute to bed-wetting.  I’ve read where it takes about a month to fully adjust to a new time zone when the difference between the time zones is as great as between China and the US.  Newly adopted kids often have erratic sleep patterns—not allowing themselves to fall into a deep sleep, frequent waking, etc.—all of which makes night wetting more common.

In your mind, pull-ups are the logical solution, but your daughter has likely never seen, nor worn them before.  They probably feel weird to her and are just another darn thing she has to adjust to.  There is nothing worse in my mind than having something weird touching me when I’m trying to go to sleep.  I think she sounds pretty resourceful.

However, I truly, truly know how exhausting it can be as the parent in this situation.  You too are getting over jet lag and are adjusting to a total change to your life.  A decent night’s sleep would really help right about now.  While I can’t promise you a totally uninterrupted night’s sleep for the near future, I do have a plan.

To put things in perspective, 40% of all children are still wetting the bed at age 4, and 20 percent at age 6.  By the age of 12, only three out of 100 are still wet at night. I don’t have any hard research, but from what I hear, I’d say that 80%+ of newly adopted 4 year olds wet the bed at night.

Three Types of Bed-wetters

At the risk of way over simplifying, there are three main types of bed-wetters: situational, developmental, and psychological.  Situational bedwetters wet the bed when they are sick, emotionally fried, or overly tired.   Developmental bedwetters simply have bodies that are not ready to stay dry at night until they are older—sometimes much older.  Research shows that enuresis (developmental bedwetting) is likely caused by a combination of genes, deep sleep, sluggish arousal mechanism, and smallish bladder.  And then there are the few who wet the bed (or during the day) as a way of controlling their world and parents.  These are pretty rare, and the key for parents is to avoid turning the situational and developmental bedwetter into the psychological bedwetter.

Your kiddo is clearly in the situational camp.  She doesn’t want to wet the bed any more than you want her to, regardless how she acts.  She might even be worried about it depending on how bedwetting was treated at the orphanage, and plenty of orphanages are pretty draconian about wetting the bed.  She will probably stay dry most nights pretty soon regardless what you do, but the message you need to send to her right now is that this is nothing to worry about, you will help her, and you understand her.  However, I also think it is really important that you minimize the hassle and fuss so that you both get as much sleep as possible.  I can help with my bed-wetting rules learned through years of soggy experience.

Bed-wetting Rules

The goal is to get your little one back to sleep with the minimal amount of fuss possible.  The more you do, the more awake you both become.  The added goal, especially with a developmental bedwetter, is to have them learn to get themselves back to sleep without involving you.   (This likely won’t happen with a situational bedwetter because they won’t wet the bed often enough to learn this skill.)

1.       Alter habits.  You are probably already doing this, but limit large amounts of fluids an hour or so before bedtime.  Have her go to the bathroom right before she goes to bed.  If you stay up for a couple of hours after that, it doesn’t hurt to take her to the potty before you go to bed.

2.       Simplify bedding. Put a good (read: not the cheapo brand) plastic cover over the mattress and pillow.  Use the minimal amount of bedding to keep the kid warm, but not exceed one washer load, keeping in mind that you’ll also be washing two pairs of pajamas.  We used a bottom sheet and one washable and quickly dryable warm blanket. For a while, we stopped using a fitted bottom sheet because it made remaking the bed more work.  We just threw the top sheet over the bed and didn’t even bother to tuck it in.  We didn’t use a bedspread or fluffy decorative pillows.  My kids that wet the bed weren’t big on sleeping with stuffed animals, and readily agreed to put their animals beside rather than on the bed, but you might have to play that one by ear.  If your child decides to sleep with a furry friend, just stick it in the washer and dryer with the rest of the bedding.

3.       Minimize middle of the night fuss.   First and foremost, there should be no bath until morning.   A little (or a lot) of pee will not cause a rash or harm her in any way.   If she (or you) strongly objects, let her use a few baby wipes to clean herself quickly.  She needs to change into dry PJs, and go back to sleep.

The big question is where.  I’m not a big believer in changing sheets in the middle of the night since the goal is to disrupt everyone’s sleep as little as possible.  For an occasional wet bed, I could be talked into it, but since your daughter is on a bed wetting roll, avoid the hassle of changing sheets in the middle of the night.  Here are a couple of options to consider.

a.       Have a plastic sheet spread out on the floor and a couple of blankets, so she can make a floor pallet to sleep on.  Most kids only wet once during the night, but if you have one that is the exception, then keep the floor bedding simple and easily washable as well.

b.      We brainstormed with one of ours, and he came up with this solution that worked really well.  He suggested that we keep a stack of pool towels by the bed.  If he wet the bed, he would simply lay a couple of towels on the bed then climb back in. I worried that he would still be damp and cold, but the bottom towel seemed to absorb the pee, and the top towel kept him dry.

c.       If there is another bed nearby that she could use, make sure it is ready.  I know plenty of kids who climb in bed with a sibling or parent, but you will want to make sure that bed is properly covered.

4.       Have dry jammies at the ready before they go to bed, and make sure the child knows where they are and can easily get into them on her own.  Also have a place to drop the wet pajamas.  We had an adjoining bathroom with a tiled floor, so we had them drop the wet pajamas on the floor to be picked up in the morning.  If we didn’t have that, I would put a piece of plastic (torn open garbage bag) on the floor and have them drop the soiled PJs on the plastic. You could just use a garbage bag, but getting wet pajamas into a garbage bag requires a certain amount of skill and requires being fairly awake for most little kids, so I prefer to create a situation that simply allows them to drop their clothes, but still protect the carpet from getting stinky.

5.       To use pull-ups or not—that is the BIG question.  There is a lot of debate amongst parents of developmental bedwetters and doctors about whether pull ups help or hurt the development of night time dryness.  The argument against using pull ups is that they are so absorbent that the child does not feel the first drops of urine, and therefore doesn’t rouse from her slumber enough to get to the bathroom or stop peeing.  There is some evidence that kids that use pull ups at night take longer to night time train.  The argument for pull ups is pretty obvious—ease of clean up.  In your case, your daughter objects to them, so I wouldn’t push it at all.  In my case, I was inconsistent.  In theory I agreed with the anti-pull up folks, so would go for periods of time without using them.  Then I would say “what the heck” and revert to using them again.  We always used them for travel and sleep overs.  Pull ups aren’t’ particularly useful for the situational bedwetter since you have to know in advance that the kids is going to wet the bed that night.

6.       Involve the child in the cleanup.  This rule is really more for the developmental bedwetter than the situational bedwetter.  If your kid occasionally wets the bed after skipping his nap or having a huge glass of water after dinner, it really doesn’t matter if he helps with the cleanup since it happens so infrequently.  If however it happens a lot, it is good for the child to take on some of the responsibility.  The key, and this is the most important part, is that this is in no way punitive.  You must NOT think of this as punishing your child by having her cleanup.  Your child is simply helping take care of herself.  We teach our children to button up their shirts by themselves and to take care of wet sheets for the same reason.  It builds confidence and, in the case of bedwetting, it restores dignity.  Bedwetting can make a kid feel inferior and immature, so everything we can do to build their competence is a good thing. Across the board, your attitude with bedwetting should be one of working together to solve the problem.

A four year old can help carry the pillow case and pajamas to the washer the next morning, while you carry the sheet and blanket.  Most four year olds would love to spray the mild cleaner on the plastic sheet cover and floor where the jammies sat while you wipe it down.  They will feel competent and proud to be able to help.   Make sure you notice how capable they are, and thank them as well.  They should also help make the bed up the following night.

Eventually and gradually, if your child does not develop night time dryness, she will grow into pulling the sheets off the bed in the morning and putting them in the washing machine.  Whoever is around when the washer stops should put them in the dryer.  My kids would usually empty the dryer and take the sheets up to their beds, but almost always I was around to help them remake the bed before bedtime.  We just incorporated this ritual into our bedtime routine.

7.       Reassure your child.  I have never heard of a child over the age of four or five who didn’t worry that something was wrong with them.  You are at a big disadvantage here since your daughter doesn’t have the language to understand reassuring words.  That is why your actions of treating this as just a normal part of adjustment is so crucial.  She will draw her reassurance from how you respond.  But for kids who do have language, they need to know that everyone occasionally wets the bed.  It helps for them to know that drinking that big drink right before bed or skipping that nap, make it more likely.

Developmental bed-wetters need to know that plenty of kids their age wet the bed.   Even though the cause of bed-wetting past the age of 4 or 5 is multifactorial, my kids latched on to the idea of small bladder size.  I used two different size balloons and showed them how the large balloon could hold so much more than the small balloon.  One time, one of my children had a friend sleep over.  I overheard him explain matter-of-factly to his friend that his bladder was still growing and wasn’t big enough yet to hold an evening’s worth of pee.  His friend responded, “Yeah, I understand. My nose is bigger than yours, so it I guess my bladder is too.”  Huh?!?  No need to correct faulty logic.  Bottom line is that my child accepted his bladder size, and his friend accepted his nose size.

My children gradually outgrew night time accidents when they were between 6 and 8.  There are medications and bed alarm systems, but we never needed to use them.  When I was writing the article on bedwetting, one of my former bedwetters was 12 years old.  When I told him in passing that I had been asked to write an article on bedwetting because of my “expertise”, he was genuinely confused about where I would get such expertise.  He had no memory of wetting the bed until I jogged his memory.  He was young when he stopped (6 ½  to 7) and he had not suffered from the sleep over or camp anxiety caused by bedwetting, but still his lack of memory surprised me.  Now mind you, this same kid can remember every time I have screwed up as a parent and unjustly accused him or lost my temper too quick, but couldn’t remember the times when I think I did something right, like how we handled bedwetting.  However, I suppose that is the goal—to treat bed-wetting as just a natural and normal part of life that it doesn’t warrant remembering 6 years later.

Image credit: SilviaVinas