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My eight-year-old daughter still wets the bed

Question: My eight-year-old daughter still wets the bed. What should we do?

Answer: Close to 5 per cent of children wet their bed at this age. About twice as many boys than girls wet have this problem. The longer this situation continues the more likely it is that the child may be bothered by low self esteem.

Bedwetting, known medically as nocturnal enuresis, is frequently associated with the child being a deep sleeper. A family history of this condition is also common.

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In addition, constipation and a small bladder volume may predispose the child to enuresis. A normal bladder volume for an eight-year-old is close to 10 ounces (300 millilitres) One can roughly calculate a bladder volume by adding two to the child's age. (In this case, eight years plus two gives 10.)

I suggest you start a diary to record when your daughter wets her bed (early or later during the night), the frequency of enuresis, if there is an association between the bedwetting and constipation, how hard it is to wake her up and if there are any urinary tract concerns.

This approach may help identify factors that contribute to bet wetting. Adding fibre to the diet, for instance, may reduce constipation. Or, limiting fluids after a certain time of night could be helpful.

If there is a medical abnormality, such as an infection of the urinary tract or blood in the urine, then further testing is required. But the vast majority of patients with bedwetting have no related medical condition such as urinary tract abnormalities or diabetes.

Treatment options include a device which sets off an alarm when the child voids. The device is strapped to the child's arm at night and is connected to a pad that is placed in the underwear; this pad picks up the urine flow and starts the alarm. The aim is to condition the brain not to sleep so deeply. Hopefully, over time, the child becomes a lighter sleeper and wakes when there's an urge to urinate.

There are also several medications that doctors sometimes prescribe for bedwetting, including DDAVP tablets (desmopressin acetate), which act like a hormone to reduced urine production, and Ditropan (oxybutynin) which relaxes the bladder wall.

More and more parents are interested in solving this issue naturally, without resorting to medications. If that's your inclination, you may want to check out a recent book "Stop Washing The Sheets" by Calgary pediatrician, Lane Robson, one of Canada's foremost experts on bedwetting. It's an extremely comprehensive and easy-to-use book for parents. (Visit

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Most pediatricians tend to reassure families that the majority of children will outgrow bedwetting. Dr. Robson, who is sometimes referred to as "the professor of pee," goes a step further by offering useful ideas that will help both parents and children deal with enuresis.

Send pediatrician Peter Nieman your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Peter Nieman.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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