Q. My 10-year-old daughter still wets the bed at night. Should I be concerned? What can we do to help her? She has become very self-conscious.
Most children develop daytime bladder control between 2 to 4 years old; however, staying dry at night often occurs much later. According to the American Academy of Pediatrics, 15 to 30 percent of 6-year olds and 4 percent of 12-year olds are still wetting the bed some of the time.
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There are several reasons that children will wet the bed at night. Some of these include:
-- Sleeping too soundly to recognize the sensation of a full bladder
-- Small bladder capacity
-- Increased urine production
-- Family history of bedwetting
When evaluating a child for bedwetting, or “nocturnal enuresis,” the first question to ask is whether she has ever developed nighttime bladder control. If a child has been dry at night for at least a six-month period in the past, then there may be an underlying medical reason for this sudden change. If a child has never fully developed nighttime bladder control, this is called primary nocturnal enuresis.
Treatment for primary nocturnal enuresis involves decreasing a child’s overnight urine production and training a child to rouse in response to the sensation of a full bladder. Some simple initial measures include limiting her intake of liquids prior to bed, avoiding caffeinated and carbonated beverages and waking her to urinate about an hour or two after she has fallen asleep.
If a child is still wetting the bed, a bed-wetting alarm is the next step. A bed-wetting alarm signals in response to urine, prompting the child to wake and go the bathroom. Bed-wetting alarms have a relatively high success rate when used for children who are at least 7 years old and have begun having occasional dry nights.
A medication called DDAVP is used in some cases for bedwetting. DDAVP works by decreasing urine production overnight. It does not cure bed-wetting. Because of potential side effects, its use is typically reserved for specific social situations such as summer camp or sleepovers.
Nocturnal enuresis can sometimes be a sign of an underlying medical problem. If your child is experiencing any pain with urination, lower extremity weakness, blood in her urine, daytime accidents, increased thirst or fever, she should be seen by her physician. More information about bedwetting is available at www.aap.org.
Vaseline and nosebleeds
Several readers last week raised questions about my advice to use Vaseline to stop a nose bleed, fearing the thick jelly could inhibit breathing, especially in small children, or lead to pneumonia.
If a small amount of a petroleum-based product such as Vaseline is applied just inside the nares for a short period of time, there should be no lasting or harmful effects.
However, for more long-term or chronic use, a water-based product is a safer alternative.
Mentholatum, Vick’s vapo-rub, is not recommended to use in the nose.
Learn more in this MayoClinic article mayoclinic.com/health/petroleum-jelly/AN00947