Once you have found a team you trust, however, it is just as important that you work effectively with them.  This means following instructions to the letter (asking for clarification when needed) and being very frank about other treatments you are using and about which treatments seem to be working and which do not.

• Teachers: You do not need to tell your teachers about your child’s bedwetting, but you should be in contact with your child’s instructors to make sure that your child’s grades or social development is not suffering. An alert teacher can also often be your first alert of bullying or teasing that is taking place.

• Pediatrician: Your child’s doctor should be one of your first stops when bedwetting becomes a problem, as your child’s pediatrician can run tests to determine whether there are any physical or underlying causes behind the bedwetting.

• Therapists/Child Psychologists: If your child’s grades, self-esteem, or social skills are affected by bedwetting, you may need to help your child develop a team of emotional support.  Therapists and others can discuss your child’s feelings with him or her and can help your child develop coping strategies for teasing and other problems.

• Pediatric nephrologist or urologist (kidney or urinary system specialist): In some children, a medical problem such as a badly working urinary sphincter can cause bedwetting.  Kidney specialists and urologists can tell you whether your child’s urinary system is fine or whether there is some underlying medical problem or physical problem behind the bedwetting.

If bedwetting persists very late (such as into adolescence) or is a nightly problem even by age eight or so, medical or physical reasons should be explored very carefully as they are a likely culprit.

Many parents are reluctant to seek a second opinion, even though they are not satisfied with a child’s care.  Many doctors are reluctant to recommend a child see an urologist or other professional because bedwetting is a problem.

However, you are the parent and you should take responsibility for your child’s health.  If your instinct tells you that something is wrong, seek a second opinion.  Consider the following problems that can easily be mis-diagnosed or overlooked:

• bladder reflux – This illness can contribute to bedwetting and can require surgery to correct

• constipation – If your child does not empty his or her bowels regularly or completely, remaining waste can press down on the bladder and cause bedwetting.

• Malfunctioning of the urinary sphincter – The sphincter muscle is responsible for controlling urine flow.  In those people who do not have a functioning sphincter, bedwetting is chronic and will not go away by itself.

• Kidney diseases – Some kidney diseases cause bedwetting as well as other symptoms.  Without resolving the kidney problem, there is not much chance in successfully beating the bedwetting problem.

• Undiagnosed underlying problems – Some children may wet the bed due some serious problem such as abuse, diabetes, epilepsy, OSA, or other problems. If medical avenues are not carefully explored, these conditions will remain undetected and untreated, putting the child at risk.

If your child’s self-esteem, grades, or social development is affected by bedwetting, you need to let your doctor know because at that point bedwetting has moved from a non-threatening problem to a problem that is affecting your child’s development.  Discuss with your doctor the steps that must be taken to stop bedwetting or at least cope with the problems your child has developed as a result of it.

Tip #43: Did your child’s bedwetting develop at the same time as other symptoms?

If your child has developed bedwetting and snoring or extreme fatigue at the same time, you should mention this to your pediatrician.

In rare cases, something called Obstructive Sleep Apnea (OSA) may contribute to bedwetting. OSA means that some blockage – such as enlarged lymph glands called adenoids – block flow of air to the lungs.

In some cases, this problem causes snoring while for some children OSA causes brief periods where breathing is entirely interrupted.  OSA is thought to cause enough to seriously interfere with breathing. The most common cause of OSA is restless sleep, early morning headaches, and fatigue.

Some researchers have also linked this condition to bedwetting. Bedwetting caused by OSA is very rare, but can be treated, usually by removing the tonsils or adenoids.  Your doctor can run a special test to determine whether your child’s bedwetting is related to OSA.

- When your child wets the bed (dates and times, if possible)

- Any family history of bedwetting

- Any results of bedwetting (crying, problems at school, teasing)

- Any medications your child is on or any medical problems your child has had or is having
- Any questions you have about bedwetting

- Any questions or comments your child makes about bedwetting

- Any comments that your child makes before bedtime that may indicate a problem (aches before bed, emotional upsets during the day)

- Any bedwetting products (disposable liners, moisture detectors) your child is using and how effective they seem to be

- Any other symptoms your child seems to be experiencing

- Notes on any resources or information about bedwetting that you encounter that seems helpful

Health care professionals are busier than ever today and keeping such a diary can be a big help to a busy physician.  Go over the notebook with your doctor and together look for patters, and possible causes. Get answers to the questions you have written down.

Keeping a diary can also be useful for you and for your child.  If your child shows improvement (wetting every few days rather than once a night) you can show your child this improvement.  If you yourself have any questions, you can easily refer to the resources and information you have collected in your notebook for more information.

Your pediatrician will be an important part of dealing with bedwetting. However, since medical health professionals are so busy today, you will want to make sure that you approach your child’s physician in a way that ensures maximum cooperation.  Here are some tips that can help you communicate with your child’s pediatrician in a way that will ensure better treatment options for your child.

These drugs, unlike many medications used to treat bedwetting, are effective for children with bladder capacity who have trouble controlling their bladders during the daytime as well as at night.

These drugs are usually used with DDAVP for children who wet the bed but may be used alone if a child wets the bed due to general bladder control problems that are present during the day as well. These drugs are taken once or twice a day, often at bedtime. They are not intended for children under twelve years old. Anticholinergic drugs do have a number of side effects, including flushing and dry mouth syndrome.

Some doctors are also quite cautious with this medication because researchers have not been able to completely define how it works to prevent bedwetting.

Imipramine, like most drugs used to treat bedwetting, works best for older children who have normal bladder capacity.  Like most other drugs used to treat the problem, it also only affects symptoms, meaning that those who stop taking Imipramine will frequently resume bedwetting.

This drug is usually taken an hour or two before bedtime.  Doses vary based on the patient.  Side effects with this medication are rare, but may include irritability, sleeping disruptions, fatigue or drowsiness, changes in appetite, mood swings, and personality changes. It is also possible to die from this drug if an overdose occurs.

Children with low levels of this hormone produce more urine nightly. DDAVP corrects this problem by supplying a substance that works in the body just as the hormone does (to reduce urine) and is also though to help children wake more easily.

It is important to note that Desmopressin Acetate treats the symptoms of bedwetting.  This means that while your child is on this medication, they will urinate less during the night.  However, the condition of bedwetting per se will not be cured.  In many cases, when children stop taking drugs such as DDAVP, bedwetting returns.  The hope is that by the time they stop the medication, bedwetting will have passed on its own.  This is not always the case.

DDAVP is more likely to work with older children who have normal bladder capacity.  Younger children with small bladders are less likely to be helped by the drug.
DDAVP can be taken as a pill or nasal spray.  The nasal spray is usually given to younger patients who may have a hard time with the pill form.

However, the spray may be affected by colds or stuffy noses.  The pills have also been found to be slightly more effective in some studies.

DDAVP needs to be taken at night but does not need to be taken daily to be effective. This drug also has some side effects, including stomach upset and headache.  These symptoms are more common in patients who take the nasal form of the drug.  Patients taking the nasal spray may also experience nosebleeds and sinus or nasal pain.  More seriously, children who take DDAVP are at risk of seizures caused by water intoxication.

This medical emergency usually has symptoms such as nausea, vomiting and headache.  If your child is taking DDAVP and experiences these symptoms, seek medical help right away.

Water intoxication and the risk of seizure can be prevented if children taking DDAVP avoid drinking water the evenings that they are taking the drug.  In general, no fluids should be taken in the two hours before retiring and only small amounts in the late afternoon and evening leading up to bedtime.

There are a number of alarms on the market that your child can wear.  These emit a noise when moisture is detected.  They will wake your child up, allowing him or her to go to the bathroom.  Even if your child is a very heavy sleeper and will not wake up, the alarm can wake up the rest of the household, so that you can wake your child up.  The idea behind this device is that the child will eventually learn to wake him or herself after being woken up by the alarm several times. Some improvement will usually be seen in about two weeks.