Dr Catherine
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4-7 years

Hi Catherine. My daughter has just turned 5, and while she has been night-time toilet trained for nearly 3yrs she has recently started wetting the bed. I have had her tested for a UTI, but it was negative, she hasn't had any changes in her life recently, we havent moved, no family disputes, she is excelling at school. The doctor believes she will just outgrow it. But its causing her a lot of distress :( And she doesnt want to wear a nappy/pullup/drynite to bed as she doesn't want t feel like a baby. She doesnt have liquids after 5pm, goes to the toilet at 7 just before bed, I am waking her at 10pm &amp; 2am to pee but she is still waking up wet at 7am. I just don't know what to do. I personally wake up several times a night to go to the bathroom, so I imagine she is just like me in this aspect, but until a month ago, she was getting up and going, now she isnt!

Dear Amanda, while it is not unusual for children to waiver between periods of dryness then return to bedwetting, it is always important to have any sudden return to nighttime wetting investigated. The type of bedwetting your daughter is experiencing is referred to as secondary bedwetting; this simply describes bedwetting that occurs among children who have been dry for a period of 6 months or more. Secondary bedwetting can be particularly frustrating for parents as just as you think you’ve left all this behind you, there it is again!! Secondary bedwetting appears to have two main causes: physical and psychological. Physical or medical causes can include such things as juvenile diabetes, urinary tract infections or chronic constipation. While physical causes of secondary bedwetting are rare, it is always important to rule these out first. The majority of secondary bedwetting results from emotional problems or psychological stress. All children react differently to stress. Signs of stress include physical symptoms such as ongoing headaches and stomach aches, vomiting as well as nighttime or daytime wetting. Common psychological stressors for younger children include the birth of a sibling, starting pre-school or school, hospitalization or moving house. Stress does not always result from a negative experience, with some children experiencing stress when they are overwhelmed or over-excited by new situations. Sometimes young children wet the bed out of fear; with fear of the dark being one of the most common fears of young children. It is probably worth checking if this is an issue, with a simple night light possibly making the difference. Typically the management of secondary nocturnal enuresis involves addressing the underlying cause. If there are no apparent ongoing psychological issues then the treatment options are the same as those recommend for children experiencing primary bedwetting. Avoid restricting fluids completely at night, as this can lead to dehydration and constipation (a known cause of bedwetting). Waking children is also not recommended, as it does not give the bladder opportunity to learn to store the amount of urine she is producing, nor does she learn to wake on her own. It also results in disrupted sleep patterns and can lead to over-tiredness, making it even more difficult for her to wake when her bladder does need emptying. Given her obvious distress and the fact that she really doesn’t want to wear DryNites, I would certainly look at introducing a conditioning alarm. You will need to support her with this initially as it is highly likely that she will not wake at first. In the meantime, reassure her that none of this is her fault and ensure that she feels loved and special. All the best! Regards, Dr Cathrine