Pediatrician Dr. B. Dreyer: Let’s move into the issues of bedwetting and going to camp. Usually kids are over six. Sometimes this is for the first time and scared as is and even kids who have “conquered” bedwetting suddenly start bedwetting again when they go to camp – secondary enuresis. So there are bedwetters who are going to camp and bedwetters who no longer wet but go to camp and begin because of the anxiety and scary nature of the place and start wetting the bed. Since you have the largest practice of it’s kind, why don’t you take over with the topic of bedwetting.
Dr. Danuloff: Our experience here at The Enuresis Treatment Center find those children who have not stop wetting the bed, or the youngster who begins again at camp are experiencing the same etiology, which is that deep sleep disorder that interferes with proper brain bladder connection.
Pediatrician: We were talking about this issue in the radio station before we began, the deep sleep issue and how it produces enuresis also called bed wetting. Tell us more about that.
Dr. Danuloff: What we discovered back in 1975 was the disorder is that bedwetting is almost always the result of a very very deep sleep disorder. For the youngster, teenager, or even an adult, the brain sleeps so deeply that it is unable to arouse itself to respond to the bladder signal and keeps the bladder muscle closed or wakes the bedwetter. Without that signal, the bladder empties. To simplify, the bladder muscle is either open or closed. Without the signal to stay closed, the bedwetter’s muscle opens and the bedwetting ensues.
Pediatrician: Right, so when your brain cycles at night and in a slightly lighter than deep sleep, you brain can respond to the signals.
Dr. Danuloff: Absolutely. Your brain is busy at night keeping you breathing and performing all kinds of functions – things you don’t need consciousness for. But in that deep sleep the arousal function does not do it’s job with bladder control. As you mentioned about kids who go to camp, the major experience for all kids is the fear of discovery – sleepovers, camp. Kids, who wet the bed, as I am sure you know in your own work, live in the fear that they will be discovered. They found out that other children could tease unmercifully. We know parents are worried about the bullying.
Pediatrician: So this is the situation where the kid will be discovered by kids who do not have adult supervision. Sleepover is one thing because you have the parents around. At camp you have counselors, but they are not usually around when the bedwetter is waking up in the morning trying to decide how to hide the problem.
Dr. Danuloff: The fear of exposure – fear of discovery is enormous. Those kids who go off to camp, if they decide to go, live in fear that when and if they wet the bed, someone is going to find out. As I am sure you know also, there are kids who go off to camp who have an even more severe problem than the bedwetting… they have daytime control problems. If suddenly one of the kids is on the baseball field and looks down and their pants are soaked with urine, again we have the fear of discovery and the intense feelings of shame that these kids are subject to. Advice to just wait to outgrow this does not help that child in the middle of a daytime wet and a fear of being discovered at night.
Pediatrician: So what advice can we give them? How do parents prepare for their kids going to camp? Or how should this be thought about even in the decision to go.
Dr. Danuloff: It is an excellent question because it is multi-leveled. You are hitting upon some very important issues.
#1 First of all, the child needs to know bedwetting is not his or her problem. We tell them this is not something you mean to do, nor that you are lazy or that you do not care. It is a problem that comes because you have a sleepy brain. It is not your fault.
#2 Kids really need to be able to air their anxieties to their parents. Ask questions. Tell me about what you are afraid of. Tell me what you think camp will be like.
As I have watched and consulted over the years, parents have to appreciate that a youngster may be so anxious that he or she will not enjoy the camp experience.
If a child does want to go to camp, then I think it is imperative for the parent to talk to camp personnel, the camp director about the problem and allow the camp director to tell the staff about the nighttime wetting problem.
# 3 Usually there is staff assigned to a child’s cabin throughout the stay. Develop a plan with the staff so that the bedwetting episode can be dealt with as soon as possible so that the possibility of discovery is diminished.
Pediatrician: I was a camp counselor and remember having a bedwetter. I probably did all the wrongs things! We do have a caller with a question. This is Kathleen from Ohio.
Caller: I have a ten-year-old son who is wetting the bed. I am a nurse and I have told him it is not his fault. He is a deep sleeper and I was wondering about the bedwetting drug called DDAVP and Tofranil mentioned by the pediatricians to give when they are spending the night or going to camp. What are the side effects? Is it something that you have to give them all the time? If you give it to them all the time will it go away?
Dr. Danuloff: This is a highly motivated mom who cares about her child and really glad she has let her son know it is not his fault.
#1 With regard to medications, our understanding is medication can work temporarily but you can’t rely on them to work over time. Medications do nothing to address the root cause of the bedwetting – the deep sleep disorder.
#2 Our experiences has been when you stop the medication, the bedwetting almost always returns. The medication cannot fix the problem.
#3 Children need to be well hydrated. There is a false assumption that the less urine production, the less bedwetting. This looks correct on the surface but really isn’t.
You cannot rely on medication.
Pediatrician: I agree with everything that has been said and would add the following. DDAVP makes you hold onto water. Not good to do all the time as it is interfering with normal body function. If it is going to be used for a sleepover that is a one or two nights is one thing, but t go away fro a month to summer camp and want to use the DDAVP for a month, I do not generally recommend to patients. I think it is a good short-term fix for a sleepover, but not a cure all.
Dr. Danuloff: I agree with what Dr. Dryer said. It is good for short-term management of bedwetting, but it is no fix.
Dr. Dreyer: None of the drugs prescribed for nighttime wetting the bed have been shown to cure enuresis and once you stop them, it comes right back.
Caller Kathleen: Would it make sense, if I were up at 1:00 to wake him up?
Dr. Danuloff: No, that is a common mistake parents make that if they can wake the child two hours after he or she goes to bed, they can catch the bed wetting. Bedwetting can occur anytime during the sleep pattern and it can happen day or night. It can occur during a long long nap at two in the afternoon. So trying to catch the child wetting the bed never works. Trying to stay up and get the child to the bathroom has really minimal effect, if any. If I may mom, you mentioned cutting back on fluids. Again, it is based upon the idea that less fluid in less fluid out. As Dr. Dryer will be glad to tell you, that is not how the bladder system and urinary system works. Urine is made all the time and cutting back on fluids is not a healthy thing to do for anybody.
Dr. Dreyer: What we usually recommend is no caffeine. Caffeine increases the amount of fluid abnormally bladder as I can attest on this two hour radio show when I am drinking diet coke. No caffeine in the evenings. Otherwise, if your child is thirsty, he should be able to drink.
Caller Kathleen: Yes, he wants to drink water with his snack.
Dr. Danuloff: What children will try to do, especially at camp, or anytime, is to manage their own bedwetting and they will stop drinking. They make the same assumption: if I don’t drink, I wont wet the bed. That can be very dangerous. Can you imagine a youngster at camp on a hot day, day after day, successful in not drinking AND hiding that from the staff. Dehydration can result and that is very dangerous.
Dr. Dreyer: That can be dangerous. Thank you Kathleen for calling. That was a great conversation. Lets return to the conversation about what a parent does with preparing for camp, telling staff about it.
Dr. Danuloff: What is important – parents have to listen very carefully to staff. The staff will say they know about bedwetting and how to handle that. Parents should not accept and be satisfied with that. Parents need to ask the staff exactly HOW they will handle it. Ask who will know, who will be responsible for helping our son or our daughter if the episode happens. Also, who will be responsible to be immediately available to our child if a daytime wetting accident happens? The KEY to a child’s reduced anxiety is knowing that the people who know will try their level best reduce the amount of time for discovery.
Dr. Dreyer: And to help them in the morning if they wet their bed. As a camp counselor, the mistake I made was getting them up at 11:00 to go pee in the bathroom. I was an innocent 18 year old. What did I know? I did what everyone said to do, get him or her up. That was my instruction, wrong instruction. I dragged them out of bed, turned on the faucet and let them hear the water and get them to pee. The thing that I did that was the most helpful was being there in the morning when he did wet his bed to help him clean up quickly and deal with the other kids who were actually pretty good about it.
Dr. Danuloff: If the youngster who you helped if he never said a word to you, I can tell you from our experience that a supportive adult is appreciated enormously.
Dr. Dreyer: We have three more callers that we are not going to be able to get to. I just want to tell everybody who we are – this is doctor Bernard Dryer on “Call For Kids” on the Doctor Radio, Sirius XM 81, and my guest is Lyle Danuloff, Ph.D. who is past president of the Michigan Psychological Association, and an expert as you can hear if you have been listening, on enuresis treatment- A bedwetting solution for all age groups. We have been having a fascinating discussion.
Now we are going to go to Vivian in Nebraska.
Vivian: Thank you for taking my call. My question is in regards to the age. I have a six year old who wakes up every morning with a pretty soaking pull up. I guess I attributed it to immaturity but after hearing you guys, I am wondering if there is a bigger issue.
Dr. Danuloff: Dr. Dryer, would you like to take this or would you like me to go first?
Dr. Dreyer: I am happy for you to go first. You are the guest
Dr. Danuloff: In our experience the youngster who by six years old has not attained night time dryness is probably not so much immaturity as it is the deep sleep disorder.
Dr. Dreyer: I would agree, that is what I would say.
Dr. Danuloff: We have a clinical rule that we follow which is that all deep sleepers are not bedwetters, but all bedwetters are deep sleepers. So my educated guess is that your six year old is a pretty deep sleeper. Either recently he has become that way or has always been that way. That is the problem. Generally The Enuresis Treatment Center in Farmington Hills, Michigan starts to treat youngsters as early as five. And we deal with youngsters as old a 45! Nighttime wetting from deep sleep can affect people of all ages. Obviously, primarily children, but we have teenagers, adolescents and adults.
Dr. Dryer: I think from what I read one percent of adults still wet their bed. eIs that the correct number?
Dr. Danuloff: Yes that is approximately the number. That is an interesting point. Bedwetting is wrapped in denial. Equally, when we do the initial assessment to explore all symptoms as it relates the brain, bladder and sleep, e ask how the child or teenagers is doing academically, the parent will frequently say we think he has attention deficit disorder – ADHD. And sometimes, when we have worked to end the chronic bedwetting, meaning when the sleep disorder has stabilized, many of the symptoms/features of the attention deficit disorder disappear. We know from four decades of proper treatment that the child is getting better sleep and frequently better academically.
Dr. Dryer: We should add there is a natural stop rate. Each year, without any intervention, children do stop wetting their bed. My experience is that those are children who do not wet their bed every night. Vivian, is your 12-year wetting the bed every night?
Caller Vivian: Oh yes, his Pull up is pretty full every morning, yes.
Dr. Dreyer: would be interested in Dr. Danuloff’s point of view, the kids who are going to outgrow it are gradually decreasing the nighttime bedwetting. They are on their way, not completely but on the way.
Dr. Danuloff: That does happen. We have experiences also where a child will spontaneously outgrow it and his or her last bedwetting event is on a Tuesday night and they never wet again. Enuresis sometimes spontaneously ends. The problem is when and how long will it take for that to happen. So the advice given to parents “Don’t worry they will outgrow it” is a mixed signal.
Dr. Danuloff: That methodology is what we have refined at The Enuresis Treatment Center. We have found that as long as the bed-wetting occurs, poorly functioning bladders occur. Low sensitivity and bladder strength become symptoms to understand and combine in our treatment process. As Dr. Dryer knows, the bladder grows by holding urine, the more that the bladder fails to hold the urine, the more, so to speak, the bladder stays small and weak. We look at many symptoms to properly end bedwetting.
Dr. Dreyer: Are those more important for the kids who wet during the day?
Dr. Danuloff: Absolutely. Children and adolescents who wet during the day are frequently told to stop waiting until the last minute. Don’t tell me at the last minute you have to go to the bathroom. The sadness is for these kids there is not any FIRST minute. By the time they feel the urge they are on their way to urinating.
Caller Vivian: Once in a while he will wet during the day. I guess we have attributed that to the fact that he would get busy wait until the very last minute.
Both Doctors at once: That is a common misconception.
Dr. Danuloff: That is a very common idea. It is not what causes bedwetting it at all. Youngsters who have daytime control problems either don’t have to go or they have to GO RIGHT NOW. There is nothing in between.
Dr. Dreyer: This has been a fascinating half hour and we need to invite you back for another half hour or maybe an hour or two hours.
Dr. Danuloff: I would be happy to do that. Can I do a shameless plug? The Enuresis Treatment Center can be found on www.nobedwetting.com We are a bed wetting treatment program that has been in business for forty years and we boast a 97% success rate.
Dr. Dreyer: That is a good point. I tell parents that this does not happen over night. People think that they can fix this with a bedwetting alarm and two weeks later it is all done. Not true. Parents, you now can do something about it. Right now to make a difference in your child’s life
Thank you Dr. Danuloff. Great show.
Sirius Doctor Radio Show Interview with an Expert from the Enuresis Treatment Center
Dr. Dreyer is Director of the Division of Developmental-Behavioral Pediatrics, the Director of Pediatrics at Bellevue Hospital Center, and a pediatric hospitalist at NYU Langone Medical Center and Bellevue Hospital. He also has a part-time practice in Developmental-Behavioral Pediatrics. He is Chair of the School of Medicine Curriculum Committee, and in 2010 he was named Master Educator and Mentor by the School of Medicine. He teaches and mentors medical students in the Practice of Medicine, the pediatric third year clerkship, and research projects. He also teaches and mentors pediatric residents and fellows in Developmental-Behavioral Pediatrics and Academic General Pediatrics.