What should I know about children daytime wetting?

[mme_highlight] Daytime wetting is generally self-limited and in most cases benign. It should be considered a problem in a child who is over the age of 4 years. One of the main reasons to treat daytime wetting is to help minimize children’s embarrassment and parents’ frustration. [/mme_highlight]

Daytime wetting is also named daytime urinary incontinence. The medical definition for daytime wetting is, as listed in Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), an involuntary voiding of urine during the day, with a severity of at least twice a week, in children >5 years of age in the absence of congenital or acquired defects of the central nervous system.
This situation is generally self-limited and in most cases benign (not related to any medical condition).

How common is daytime wetting?

The prevalence of daytime wetting varies with age and sex. Generally speaking, it has been estimated to be approximately 3% to 4% of children between the ages of 4 and 12 years, affecting more girls than boys – oppositely to nocturnal enuresis, which is more prevalent among boys. More detailed statistical data is listed below.

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Prevalence of Daytime Wetting

Study Population: 1192 people from 1.5 to 27 years of age

– Overall prevalence: 10%

– ≤2 years old: 64%

– 2 -3 years old: 29%

– 3 -4 years old: 13%

– 4 -5 years old: 7%

– 5 -6 years old: 10

OR – Odds Ratio; CI – Confidence Interval
Prevalence – The total number of cases of a disease in a given population at a specific time.
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Prevalence comparison between girls and boys regarding Daytime Wetting

1) Study Population: 5386 children – 6 year old (Scotland)

– Prevalence among girls: 4.1%

– Prevalence among boys: 1.8%

2) Study Population: 3556 children – 7 year old (Sweden)

– Prevalence among girls: 6%

– Prevalence among boys: 3.8%

OR – Odds Ratio; CI – Confidence Interval
Prevalence – The total number of cases of a disease in a given population at a specific time.
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Is daytime wetting normal?

Yes, it can be normal. Generally, by 4 years of age, children are able to control their bladder and stay dry during the day. Children between 2 and 5 years old can generally stay dry during the day, although at this stage wetting accidents may happen and are not considered a problem.

What are the causes of daytime wetting?

If children are very active, they can try to hold urine too much time and wait too long before going to the toilet. Constipation may also be a cause of incontinence for children. Urinary tract infections cause incontinence and sometimes pain when urinating. Nervous system conditions are rarer causes.

What can be the impact of daytime wetting for children?

Especially when children enroll in school, daytime wetting can be a source of embarrassment leading to ridicule by peers. In fact, it was rated as the third out of 20 most stressful life events for children at school age.
Some studies have suggested an association between daytime wetting and psychological problems. A study reported a higher rate of attention-deficit/hyperactivity disorder in children with daytime wetting.

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Psychological Problems in children with daytime wetting

(8000 children, only statistical significantly results shown)

– Separation Anxiety: 1.77 times more risk in those with daytime wetting (OR 1.77 [95% CI, 1.36–2.30])

– Attention problems: 2.06 times more risk in those with daytime wetting (OR 2.06 [95% CI, 1.70–2.50])

– Oppositional Behavior: 1.98 times more risk in those with daytime wetting (OR 1.98 [95% CI, 1.52–2.59])

– Conduct problems: 2.02 times more risk in those with daytime wetting (OR 2.02 [95% CI, 1.56–2.62])

OR – Odds Ratio; CI – Confidence Interval
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How can I help my child?

Put your child to urinate every 2 to 3 hours.
Give a positive reinforcement when children stay dry during the day; on the other hand, do not punish your child if she/he wets the pants.
Explain your child she/he should not hold urine too much time.
Be careful with the use soap in the genital area, as it can be irritating.
Remember that the cause for daytime wetting can be constipation.

What treatments are available?

The general measures stated above are successful and sufficient in most cases. If the cause is a urinary tract infection, an antibiotic may be prescribed. Children with constipation may need a high-fiber diet, enema or laxative to help evacuate.

When should I be worried?

Daytime wetting should be considered a problem in a child after the age of 4 years. However, regardless of the child’s age, your concern is reason enough to seek for medical help. It is always an alarm sign in a child who was previously continent.

Summary and Recommendations

Daytime wetting is an involuntary voiding of urine during the day in children >5 years of age.
It is a common problem, but generally benign and self-limited.
Common causes are behavioral, constipation and urinary tract infections.
Daytime wetting is a source of embarrassment for children and frustration for parents, which is the main cause to treat it.
In most cases general measures to help toilet training of the child are sufficient.
If a child who was previously continent is wetting during the day, seek medical help.

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References

1. Robson WL, Leung AK, Bloom DA. Daytime wetting in childhood. Clin Pediatr (Phila). 1996 Feb;35(2):91-8.
2. Joinson C, Heron J, von Gontard A. Psychological problems in children with daytime wetting. Pediatrics. 2006 Nov;118(5):1985-93.
3. Hellström AL, Hanson E, Hansson S, Hjälmås K, Jodal U. Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. 1990 Mar;149(6):434-7.
4. Ollendick TH, King NJ, Frary RB. Fears in children and adolescents: reliability and generalizability across gender, age and nationality. Behav Res Ther. 1989;27:19–26.
5. Kodman-Jones C, Hawkins L, Schulman SL. Behavioral characteristics of children with daytime wetting. J Urol. 2001 Dec;166(6):2392-5.

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