Nighttime wetting the secret to staying dry

Nighttime Bed Wetting Maybe Beyond Child's Control.

ADH, the Unsung Hero for Nocturnal Eurisis or Bed Wetting:

First things first, let's unravel the mystery of ADH – Antidiuretic Hormone. Now, ADH might sound like a fancy term, but it's your kid's nighttime urine inhibitor. Picture ADH as the guardian at the gate, controlling the flow of water in the body. Produced by the brain, this hormone keeps a close watch on water balance, making sure the kidneys don't go into overdrive while your little one is catching those ZZZs.

ADH and the Nighttime Routine:

So, during the day, your kid's body is like a well-oiled machine, producing just the right amount of ADH to keep them dry. But when the sun sets, the body's ADH production kicks into high gear. This means that, ideally, your child should be able to snooze peacefully without needing a midnight bathroom break.

The Potty Training Connection:

Now, let's talk potty training. It's like introducing your child to the superhero squad of bodily functions. During the day, as your kiddo gets the hang of using the potty, they're also learning to listen to their body's signals. It's a whole team effort with you as the trusty sidekick!

But when it comes to nighttime, things get a bit trickier. Nighttime dryness depends not only on their potty training prowess but also on the superhero, ADH. Sometimes, ADH needs a bit more time to fully develop in your little one's body. It's like the hero getting ready for an epic battle – it takes time, training, and a bit of patience.

The Toddler's ADH Journey:

Research finds that most children are not developmentally capable of remaining dry at night until 4 or 5 years old. A large study found that about 30% of children experience bedwetting at 4.5 years and about 9.5% still experience it at 9.5 years. Research has also found that children attain nighttime dryness an average of 10 months after achieving daytime dryness,

Tips for helping children stay dry during nighttime

  • Hydrate Early: Encourage your little one to drink plenty of fluids during the day. This helps them get into the habit of hydrating when the sun is shining, giving ADH a better chance to do its superhero work at night.
  • Nighttime Bathroom Breaks: Before tucking in for the night, make a routine of a final bathroom break. It's like a superhero team meeting before bedtime, ensuring your kiddo has an empty bladder to conquer the night.
  • Superhero Sheets: Equip your child's bed with the ultimate weapon against nighttime accidents – waterproof sheets! This way, even if there's a little slip, cleanup is a breeze.
  • Praise and Encouragement: Celebrate every small victory in the potty training journey. Positive reinforcement is like superhero training fuel for your little one.

Bedwetting Alarms are an effective alternative

However, if your child continues to struggle with nighttime toilet training after the age of 5 years, you might want to try some strategies to help your child stay dry at night. The easiest strategies to try are waking up your child to use the bathroom before you go to bed yourself and limiting fluid intake before bedtime. If those strategies do not work, a great evidence-based strategy is an alarm that wakes your child up when they start urinating. One of the most common of these alarms is called TheraPee, which you can find on Amazon and other online retailers. Six randomized controlled trials (the “gold standard” of study designs) have found that bedwetting alarms are very effective in helping children to stay dry at night. Specifically, these studies have found that 77% of children using these alarms can stay dry for 14 nights in a row, while only 2% of children in the study without these alarms had 14 dry nights in a row. Children in these studies ranged in age from 8 to 10 years and the treatment lasted between 10 to 20 weeks.

Desmopressin is an effective treatment for nighttime wetting studies show.

hormone treatment referred to as desmopressin has also been found to be effective in reducing nighttime bedwetting. A review combining 47 randomized controlled trials found that desmopressin treatment results in 81% of children achieving 14 dry nights in a row (while only 2% of children without the treatment achieved this goal).

Studies show bedwetting alarms are as effective as desmopressin.

Studies find no difference in the effectiveness of bedwetting alarms versus desmopressin (research finds that both methods are very effective). However, the effectiveness of the alarm treatment may last longer, as more children were able to stay dry after treatment was completed with the alarm than with desmopressin. Additionally, desmopressin is associated with serious (but rare) side effects, while the alarm has no side effects (besides potentially disrupting your own sleep!).

When to Call in the Experts:

If your little one is consistently wetting the bed after the age of 7 or if nighttime accidents suddenly become a recurring theme, it's time to reach out to your friendly neighborhood pediatrician – that's me! We can rule out any supervillains causing trouble and discuss strategies to help your kiddo on their way to dry nights.

Remember, every kiddo is on their unique superhero journey. Some might zoom through potty training, while others take a more scenic route. Be patient, keep the positivity flowing, and celebrate the victories – big and small.

More on ADH Antidiuretic Hormone

ADH stands for Antidiuretic Hormone. It is a hormone produced by the hypothalamus and released by the pituitary gland, which is a small gland at the base of the brain. The primary function of ADH is to regulate the balance of water in the body.

Here's a breakdown of how ADH works and its main functions:

  • Water Balance: ADH plays a crucial role in maintaining the balance of water in the body. It does this by controlling the amount of water reabsorbed by the kidneys. When the body needs to conserve water, ADH signals the kidneys to reabsorb more water, leading to the production of concentrated urine. On the other hand, when the body has enough water, ADH levels decrease, and more water is excreted in the urine, resulting in dilute urine.
  • Thirst Regulation: ADH also influences the sensation of thirst. When the body is dehydrated, ADH release increases, causing the kidneys to conserve water. At the same time, an increased sensation of thirst encourages the person to drink more fluids, helping to restore the body's water balance.
  • Blood Pressure Regulation: In addition to its role in water balance, ADH can also have an impact on blood pressure. By regulating the amount of water in the blood, ADH indirectly affects blood pressure. When ADH levels are high, blood vessels may constrict, leading to an increase in blood pressure.
  • Stress Response: ADH release is also influenced by factors like stress, pain, and certain medications. In stressful situations, ADH levels may increase to help the body conserve water.
  • Diabetes Insipidus: Disorders affecting the production or response to ADH can lead to conditions such as diabetes insipidus. In diabetes insipidus, the body is unable to properly conserve water, resulting in the excretion of large amounts of dilute urine. This condition can be caused by a deficiency of ADH or by the kidneys not responding adequately to the hormone.

ADH is particularly relevant during nighttime when the body's production of this hormone is crucial in preventing excessive urine production and promoting dry nights. The maturation of the ADH system in children is a key factor in achieving nighttime dryness.

 

Cara Goodwin, Ph.D. Psychology Today. An Evidence-Based Approach to Potty Training 4 concerns for parents considering methods for toilet training. Posted May 22, 2022 

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