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Le Bonheur Pediatric Nurse Practitioners Chrisla Key and Jill Travis participated in a Facebook Live Q&A session to answer viewer questions about bedwetting and other related urological problems. They discussed symptoms, causes, when to seek medical attention and the latest devices, training and techniques that can help. Here are their answers to five very common questions.

Q: What causes bedwetting?

A: This is an awesome question; it’s one we get in our clinical practice every day, and the answer is, there is not one thing that causes bedwetting. A variety of things cause bedwetting. Most of the children that we see for bedwetting are heavy sleepers. We all have that cue that our brain gives us to wake up while we’re sleeping if our bladder is full. Heavy sleepers tend to sleep through that cue. That’s the primary issue we see every day, but there are other causes, such as things that can cause your bladder to squeeze too much or to become overactive. That could come from bladder irritants – some of the things we eat and drink, such as caffeine from soda and citric acid from fruits.

Q: Is there any age where bedwetting is normal?

A: Everybody starts off in diapers, so yes babies and toddlers, they are going to wet the bed more often. Then as they get older, they start outgrowing it, some earlier than others. I would say about 20 percent of 5-year-olds are still wetting the bed. So when you think about that, they are starting Kindergarten, making friends, wanting to be more independent and you will have many that are dealing with bedwetting problems. Every year after that, it decreases by about 1 percent. We start getting really serious about treatment, other than just behavior modifications, at around the age of 8, when it starts becoming more of a social issue.

Q: Is bedwetting genetic, and is there anything we can do to prevent it?

A: Genetic is different than familial. There are things that run in families that there may not have been an actual gene identified for, but it’s definitely something that runs in families. If you have a heavy sleeper in the family, you might have multiple heavy sleepers. Often when we talk to families, we find a history and many times it’s even around the same age. Sometimes, it’s nice to hear you aren’t the only one suffering with this problem, especially the older, school-age kids. Just because it runs in the family doesn’t mean you shouldn’t come see us, though.

Q: What is the right age to start potty training?

A: There’s no right age. You listen to your child. When they start showing interest, you encourage that interest. Of course, if a kiddo is not potty-trained by school age, that raises eyebrows, and you would definitely consider coming to us. But that’s not so much a potty-training issue, that’s more about us determining that there’s not an anatomic, physical problem going on. We treat many children with developmental delays, and that will also cause delays to potty training. If a 10-year-old child functions cognitively as a 3-year-old, his or her potty training will be delayed as well. We also see many patients with ADD or ADHD, who are more likely to have these issues.

Q: Do I need a referral for my child to see a urologist? What is an appointment like? What tests do you run?

A: It depends on your insurance, really, if you need a referral. With this kind of problem, especially because it’s been going on for a while and it’s been mentioned to your pediatrician at regular checkups and different visits – if they’re knowledgeable about what’s going on then they’re happy for you to move on and see us, and they’ll be happy to get you the referral if you need it. Otherwise you can just call and make an appointment, and we’ll be happy to see your child.

Be prepared. The first visit is lengthier than an average 15-minute visit. It’ll take us about 40-45 minutes for the initial visit. We’ll talk with the child, with the parents, to get the details that may be making the bedwetting last longer, and also to explain to kids why we may be taking away some of the things they love, like hot cocoa. We want to help them understand the “why’s” behind the “do’s.” After that initial visit, as long as they’re staying on the plan, the subsequent visits are a lot shorter.

The tests that we run depend on the child’s complaints. If there are daytime issues, or if they’ve had urinary tract infections, that will require us checking at least urine samples or possibly getting an ultrasound. If any of these urinary tract infections involved fever, that requires additional tests. We have the ability to check on how well your child is emptying his or her bladder, but all of those things we sort through on an individual basis.  It’s always nice to tell your child we’re not going to do anything scary -- no shots, there’s no bloodwork -- even though it is a full exam.

To learn even more, check out the full discussion below.

About the experts:

Chrisla Key, DNP, FNP, NP-C, has been in pediatric urology for 14 years and a nurse practitioner for 10 years. She has more than 10 years of experience managing patients with dysfunctional voiding syndrome.

Jill Travis, FNP, NP-C, has been in pediatric nursing for 10 years and a nurse practitioner in pediatric urology for the past six years.