DESPERATELY
SEEKING DRYNESS
Families struggling with bedwetting are not alone
BY COURTNEY MCGEE
edwett ing is an issue many parents
deal with, yet few discuss. They
may fear violating their child’s privacy
or feel that others will criticize their
parenting; or maybe they wrestle with
their own feelings of concern and
frustration. It can be isolating.

The American Academy of Pediatrics
says that 5 million children older than
6 continue to cope with nocturnal
enuresis, or bedwett ing. About two
out of three of these are boys, and
most have a parent who struggled
with bedwett ing as a child. The AAP
also says that enuresis can often go
away on its own in a certain number of
aff ected children each year. But what
is a parent to do when a child doesn’t
“grow out of it?”
Marlo Eldridge, a nurse practitioner,
is director of the Pediatric Voiding
Improvement Program at Johns
Hopkins Hospital’s Brady Urological
Institute. Eldridge understands the
strain that bedwett ing can put on family
14 December 2018
washingtonFAMILY.com functioning, and she helped shed light
on this nightt ime challenge.

Involuntary Action
Let’s start with a key fact: “There is
nothing tied between intelligence and
continence,” Eldridge says with great
emphasis. Primary nocturnal enuresis
is involuntary urination during sleep,
after an age when bladder control
generally occurs. The Type A parent in
all of us may fi nd it hard to ignore the
parents who boast about litt le Jane who
pott y trained at age 1 and kept dry all
night at 2. Stop comparing.

Ordinary Development
Bedwett ing often resolves by about
age 4 but is still not uncommon even
between ages 8 and 10, according to
Eldridge. Most often, development
will resolve the issue over time. By age
10, about 95 percent of children are
dry at night. But as many as 2 percent
still present at age 18—mostly due
to unresolved or missed diagnostic
opportunities. “It is not considered
out of the ordinary until the seventh
birthday,” Eldridge says. “When it
persists beyond age 7, there are factors
to investigate.”
Tank Size
I wondered if continence was more
a factor of age or body size. Eldridge
reminded me that it varies by child, as
she’s seen some bedwett ing 9-year-olds
weighing 50 pounds and others 100
pounds, so there’s no magic number.

“Instead, think about tank size,” she says,
“and what could be limiting capacity.”
An undersized bladder, or incomplete
emptying of the bladder, may be a
root cause. Find baselines of functional
bladder capacity by measuring urine
output. “A 7-year-old’s max urine output
is about 270 cc (cubic centimeters),”
Eldridge relates for perspective. “If he or
she is only voiding 120 cc, think about
that. That’s four ounces (about a juice
box). Some kids may need to urinate
after only 60 cc. What is limiting that tank
capacity?” Talk to your pediatric primary-
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