Pediatricians are often asked to check a child who
is either urinating frequently or wetting themselves in school. These youngsters do not
complain of pain when voiding and usually have no problem with bladder control when
sleeping. A check of the urine reveals no signs of infection or diabetes. The problem is
mostly an inconvenience for the child. However, for the parents the problem can be
infuriating, especially when the child must frequently visit the bathroom during meals or
while driving in the car.
The most common reason for daytime wetting,
particularly in boys, is holding their urine to the last possible minute. Children
commonly become so engrossed in play activities that they ignore the bladder’s signal
to urinate. These children often fidget, press their legs together, squirm while sitting,
or adopt other postures that suppress the need to void. After several signals are ignored,
however, the bladder no longer can be suppressed and an incontinent episode results.
Recently toilet trained children frequently begin
wetting during the day after they lose the motivation to remain dry. During the toilet
training process, youngsters are often rewarded with smiles and stickers for going to the
bathroom. They enjoy the attention received from their parents. Soon, dry pants become
expected by the parents and the child receives less attention for staying dry and forgets
to go to the bathroom.
Some elementary school children with daytime
wetting prefer not to use the bathroom at school, especially if a school bully is lurking
about. Occasionally the school bus leaves before the child has had a chance to use the
toilet or the trip home is too long.
Emotional stress is a frequent cause of daytime
wetting. The incontinence may begin after a known stress, such as starting kindergarten or
a new school, the death of a relative, or a family illness. Most of the time, however,
incontinence due to stress has no readily identifiable cause. The common age-range for
this reaction to stress is from ages four to twelve. If the cause of her stress is
identified and eliminated, the problem usually disappears within weeks. If not, the
frequency may persist for two to three months.
If the child is a girl, using bubble bath or
heavily scented toilet paper can cause an inflammation of the urethra and produce daytime
wetting and urinary frequency.
Constipation can also be associated with daytime
wetting. It is thought that the pressure of the stool in the large intestines triggers a
reflex in the bladder, causing the child suddenly to void during the day.
Occasionally, a child with urinary frequency will
be found to drink a large number of drinks containing caffeine, which can cause this
symptom. Certain soft drinks, such as Mountain Dew®, Dr. Pepper® and Sprite® are often
associated with urinary frequency. Reducing the child's caffeine intake usually stops the
Ninety-five percent of voiding problems in
children are functional. Having your child checked by their pediatrician and performing a
urinalysis will usually identify the five percent that have a medical cause.
Treatment consists of reducing the
youngster’s embarrassment and reducing the parent’s frustration. Parents often
assume that their child’s daytime wetting and urinary frequency is due to laziness or
silliness. Criticism and punishment will only prolong the problem. It will be important to
reassure the child that there is nothing wrong with their body, and that they will
gradually return to a normal pattern.
In a study of over 20,000 schoolchildren living in
four continents, "wetting pants in class" was the third most stressful event
mentioned, ranking only behind "losing a parent" and "going blind."
Teachers can encourage the child to go to the bathroom at recess or between classes and
will help to avoid the embarrassment of incontinence. Children should have a change of
clothes at school and a plastic bag in which to store their wet clothes. Youngsters who
hold their urine to the last minute should be encouraged to go to the bathroom immediately
once they get the urge to urinate. Although the child might deny the need to void, parents
should make it a rule that the child tries before going outside to play or leaving in the
With patience and positive reinforcement, the problem of daytime
wetting will resolve over time. Parents should ignore the wetting and urinary frequency,
they should not keep a record, and should stop talking about it. Understanding parents
should do whatever they can to help their child relax until the problem resolves on its