Archive for the ‘Medications’ Category

Summer Camp and Bedwetting

Friday, June 18th, 2010

My 10 year old is leaving in a month for a week of summer camp. He really wants to go but I am worried because he wets 2 or 3 times a week. What should we do?

This is a common question this time of year. I am re-posting some suggestions that I wrote last year about this time. Parents wonder what to do??

First, if your child is currently using an alarm, we would not expect him or her to take it to camp with them. They can interrupt usage and restart when they come home.

Secondly, a back up plan should be in place, even for kids who wet intermittently. There are a few choices:

• Wear disposable pants, with a plan for putting them on discreetly and disposal in the morning. Disposables come in all sizes, even small through extra large adult sizes. If your child has outgrown traditional children’s pull-ups, there are still many options. Disposable male guards or women’s incontinence pads can be secured to regular underwear to catch a small amount of urine. Disposable underpads that lie on a sheet or in a sleeping bag have tape strips to hold them in place.

• Use washable bedtime pants to preserve dignity. These can be a nice back-up for kids who are dry most nights but want to make sure there is no leakage onto bedding.

• Waterproof sleeping bag liners fit into a regular sleeping bag. They provide a comfortable, waterproof surface for sleeping without raising questions from other campers.

• Mattress overlays can be used on top of a sheet or used inside a sleeping bag. The overlays can be discreetly pulled into place when your child is ready to go to sleep. The new blue cloud overlays are colorful and look like a regular piece of bedding.

• Make arrangements with the camp counselor to have toileting twice before bedtime and to continue a lifting routine if this is used successfully at home. (Lifting is when a caregiver walks the child to the bathroom at a designated time.)

• Medication, such as desmopressin, can be used temporarily to decrease the amount of urine produced that night. The correct dosage should be determined a week or two before camp begins. Only a small amount of liquid (2-4 ounces) should be ingested once this medication is used. It is best dosed shortly before actually going to sleep.

Lastly, make sure that your child knows that they are not alone and most camps are very helpful in discreetly handling any wetting episodes. Fluid of choice after dinner is water. Double voiding before going to sleep is helpful. Staying well hydrated during the day is helpful so the kids are not so thirsty later in the day.

Allergies and Bedwetting

Tuesday, April 6th, 2010

My 8 year old son has springtime allergies. It seems that he always wets his bed more during this time. Is there any connection?

Although I have not seen research that directly connects seasonal allergies to an increase in bedwetting, there are some factors that may coincide to increase your son’s wetting episodes. First, does he take any medications during this time? Antihistamines, even non-sedating ones, may change his sleep patterns. You could experiment with dosing times to see if the time of day the medication is given makes a difference. Some allergy medications increase thirst so your son could be drinking more than usual. Increasing fluids during the day so he isn’t so thirsty in the evening is important.

With spring, more outdoor play and sports activities are also common. A later bedtime and going to bed exhausted can contribute to bedwetting. Trying to maintain a schedule where he gets an adequate amount of sleep each night can be helpful.

Other than seasonal allergies, some children’s bladders may be “allergic” to certain foods. Some foods have been reported to make the bladder more irritable (contracts more easily) or increase the production of urine. These foods include citrus (lemonade or orange juice), artificial food colors, carbonation, foods with added Vit C ( or megadoses of Vit C), candy and foods with high sugar content. Milk and milk products produce some natural sedative effects so in some cases cause the kids to sleep more soundly. Having milk products earlier in the day is best. Experimenting with eliminating most of these things allows you to see the impact, if any, on the wetting episodes. Then gradually restart and keep tract of your son’s response. If you do the elimination diet while he is using a bedwetting alarm, it is very easy to know when and how often the wetting occurs. You can see for yourselves if allergy medication, diet, milk, fatigue, or any other springtime event makes a difference.

Sleep Research and Bedwetting

Tuesday, March 16th, 2010

I read with interest an article that was published on-line on 3/10/10 in Acta Pediatrica.
“Effects of desmopressin on the sleep of children suffering from enuresis”
This article presented research on that done in Germany last year. The aim was to evaluate the effect of DDAVP (desmopressin) on the sleep architecture and arousal reactions in children with bedwetting. The method of the study was a prospective, placebo-controlled, randomized, cross-over study that was performed over a 7-day period of time. Placebo and DDAVP were given for 7 days each after which an unattended home polysomnography was recorded. 20 bedwetting children, aged 6-15 years, were enrolled.

Results: The number of wet nights decreased with DDAVP treatment. Delta power, distribution of sleep stages, number of arousals, arousal index and the effect of arousals on sleep stages did not differ significantly between the two groups. Bed-wetting occurred within each sleep stage and did not follow any particular pattern. In most cases, it was preceded by an arousal reaction, but no awakening occurred.

Conclusion: DDAVP has no effect on the sleep architecture of children with bedwetting.

This study concluded that DDAVP did not affect the sleep patterns of children who take it. Since its mechanism of action is to work locally on the kidneys to produce more concentrated urine, the results are exactly what I expected.

The reason that this study was so interesting to me; however, was that these sleep studies indicated that bedwetting occurs during every sleep stage and does not follow a particular pattern. This is exactly what I see clinically in the families that I work with each day. There are some organizations that talk about bedwetting as a sleep disorder and how bedwetting children stay in the deep sleep phase longer and wet during this phase. This is based on research that was done in Canada in 1968. In the more recent research report that I just read, bedwetting did not occur only in the deep sleep stage but throughout the entire sleep cycle, with no pattern. Families report that the bedwetting alarm goes off at different times each night, anywhere from 30 minutes after bedtime to 30 minutes before wakening in the morning. The child cannot be in deep sleep all of these times.

Anyway, it would have been nice to have a larger sample size but this is good information.

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