Bedwetting Webinar by Dr. John DeGarmo

Hello there and welcome to this Foster Care Institute online training webinar: Bedwetting, understanding the condition and how to best address it. I’m your host Dr John Digarmo, the founder and director of the Foster Care Institute. I am also an author of several best-selling foster care books, an international speaker and trainer on child welfare issues, and a parent myself. Indeed, through the years my wife and I have had over 60 children join our home through the years. As foster and adoptive and biological parents, we’ve had as many as 11 children in our house at the same time. So you can be rest assured that we have had our fair share of bed wetting experiences, sometimes with more than one children at the house at the same time.

Our goal during this Foster Care Institute training webinar is to increase the awareness of the causes of bedwetting and examine possible solutions to help these children. Our key objectives are to increase your awareness of what may lead to bedwetting in children in foster care, and children in general as well as gain an understanding of how to develop and implement strategies designed to help the children who experience bedwetting.

Now let’s briefly examine what bedwetting is and this is from the Mayo Clinic. According to the Mayo Clinic, they say bed wetting, also called nightmare incontinence or nocturnal enuresis, is an involuntary urination while asleep after the age of which staying dry at night can be reasonably expected. And again thank you to the Mayo Clinic for this explanation. Some brief statistics surrounding bedwetting: 40 percent of all children are still wetting the bed at age four. Recently I had somebody speak to me online, messaged me online, they said Dr. John, we have a child in their home who’s two years of age and our child is bedwetting, what can we do about it? Well as we see right here, that’s to be expected. And by age four. forty percent of children are still bed wetting. By age six, twenty percent of children are bedwetting. By age eight – between six to eight percent are bedwetting. Indeed, going further without treatment of some kind about two percent of children still wet the bed by 15 years of age. So, if your children are falling between those ages of maybe one to four, one to five, you can see that bedwetting truly is not an unusual experience.

Digging deeper into some of these statistics, only about one percent of children are affected by medical conditions. For example, a urinary tract infection that may possibly contribute to bedwetting. Now, in situations like this perhaps in medical conditions of some kind, it is necessary to work with your foster child’s caseworker as well at the same time a primary care physician. When you do this, when you work alongside your child’s case worker and their physician, this will help you to discover some possible solutions to help this child to give the child the help that he needs. Now you may be asking yourself what might be some of the causes of bedwetting? Well let’s take a few moments to examine some of these causes.

For some children, perhaps they may have some hormonal problems or they may be lacking an hormone or ADH that slows the urine production during nighttime during those hours when a child is sleeping. To be sure, genetics can be a cause for bed wetting as well because it can run in the family. As you may have guessed, a small bladder can be a cause of a bedwetting experience. Spasms in a child’s bladder may also be a cause for bedwetting. Going on to other causes, urinary tract infections, anatomical abnormalities, medical conditions including diabetes and constipation – these can also be causes for child to have a bed wetting experience or to bed wet in general. Further causes may include abnormalities in the spinal cord. Perhaps a child has a slow development in their central nervous system. And as you may have expected,for many children who have been placed in foster care, for those children who have experienced traumatic events in their life or who are suffering from some type of anxiety, yes, psychological problems can also cause bed wetting.

Now, there are different types of bedwetters. Bedwetters do not fall under one general category. Indeed, they’re separated into separate types, separate categories if you will. First we have the situational bedwetter. A situational bedwetter are those children that wet the bed when they are exhausted, they are emotionally exhausted and they are worn out or work out if you will. They have worked so hard or they may have just been emotionally exhausted that they worn out. Those children who are feeling sick, that can be a situational experience. Those children who are overly tired, this may cause a situational experience. Situational type of bedwetting. Next we have the developmental type of bed wetting. These children who fall under this category, their bodies simply are not ready to go through the night, daily night through night without using the bathroom and remain dry throughout the evening. This could be caused for a few different reasons. Developmental reasons may include deep sleep. Perhaps the child is in such a deep sleep that they are unable to get up and use a bathroom and remain dry in the night. Again, we go back to earlier where we said genes do play a part of it. Well family genes might be a reason why they fall under the developmental category. Maybe they have a sluggish arousal mechanism, they just really struggle waking up in the night. Their body is just in such a deep sleep and it’s difficult for the child to arouse themselves, to wake up. And again another type of developmental category is the smallish bladder which we looked at earlie. A third type is a psychological type of bedwetter. Now these bedwetters wet their beds as a means of control. Now to clarify, this this is not a common type of bedwetter. The psychological one is not a common type of bedwetting. Are there other reasons? Oh indeed there are. It may be possible the child is wetting his bed as a defense against some sort of sexual abuse they’ve experienced. Perhaps before moving into your home as a child and foster, before being placed into your home as a foster family. And as you can imagine, many children in foster care might fall under this type of reasoning if you will. Now if we know this to be to be true, and we’ve examined this on several foster care institute training openers as well as several books, it is a very stressful time for children when they’re placed into foster care. Perhaps you’ve heard what I’ve heard over and over again. Oh they must be lucky, Dr. John. They must feel so happy to be placed in your home. They must be so happy to be living with your family. We know that to be the opposite when a child is placed into foster care. It is a very stressful time. Indeed, it is a time of great anxiety. Again we’ve covered this in several other webinars but let’s take a moment to just look at it here.

When a child is placed in foster, when they are taken from their family, sometimes late at night without any explanation, their mother, their father may be even split up from their siblings, taken from their home their bedroom, their house, their home, their stuffed animals, their toys, their pets, their neighbors – taken from their schooling, taken from everything that is familiar to them and placed into a house that they are strangers. To a family that they are completely strange, unknown to them. A house of strangers. Your home, a house, they are completely unfamiliar with strange rules, strange parental figures, strange siblings if you will. A foster home like mine, like yours. This is a time of tremendous uncertainty. They are scared. They may be asking questions like, why am I here? When do I go home? When do I see my mommy next? Is it my fault? I’m in foster care, did I do something wrong? This leads to tremendous anxiety. And this may trigger bed wetting experiences for some children. They feel guilty for being placed in foster care because they believe they did something themselves. And for some children, they are simply unable to express themselves. Again, we go into this in a much detail, much greater detail in several of our training webinars here at the Foster Care Institute, including placement, including trauma, and more.Check those out while you’re here.

Make no mistake it is a time of tremendous confusion. Children in foster care simply may not understand why they’ve been placed into your home. They may not see it as an illogical or irrational move. They may blame themselves. They may feel they’re no longer loved. They may feel abandoned. And this can lead to bedwetting, and as we’ve seen here in several Foster Care Institute training webinars, we also know that many children in foster care do suffer from post-traumatic stress disorder, an anxiety disorder occurring after someone has experienced or witnessed an extreme traumatic event. The child feels overwhelmed. The child feels filled with fear. They feel hopeless and helpless. Again, this can trigger bedwetting. Some of the traumatic experiences they may be filled with prolonged separation from the family. Maybe a death of a family member. Maybe their family members have experienced various forms of abuse in their home, they’ve experienced themselves maybe they’ve witnessed abuse of somebody else. Maybe they’ve been homeless. Maybe they’ve been drugs and alcohol in the family. Perhaps they’ve been neglected. Maybe they’ve been abandoned. Perhaps they’ve experienced the imprisonment of a family member. These are all feelings of trauma that can trigger bedwetting. So it’s quite clear to see here, very simply here. If you’ve been a foster parent of some sort over the years, a kinship parent, adopt a parent, a caseworker – you can quite easily see why a child might be experiencing bedwetting at night due to the trauma that is encompassing their body. Due to the anxiety that’s surfacing their body and they do not know how to process. They are overwhelmed by their trauma. They are overwhelmed by the anxiety they feel.

In addition to that there is also something known as separation anxiety. The more childless move from home to home and from school to school, from one foster home to the next or even from their biological family members to your home and to another foster care home and to another and so on and so forth… the more they move from home to home and school to school, the more their anxiety will increase. When they’re separated from their friends, when they’re separated from their family members, when they’re separated from those they’ve made some sort of attachment to, perhaps your foster home, separated from people they trust – this creates anxiety. This may lead to bedwetting. For those children who have undergone multiple displacements, which is going from home to home to home, this makes it very difficult for a child to form any type of relationship and they may place walls to separate themselves from the pain.

Primary nocturnal enuresis. Seven million american children under the age of six have a condition known as PNE or primary nocturnal enuresis, more commonly known as bedwetting. Again, would you please look at that first line. Five to seven million children in the United States over the age of six experience something known as PNE. Known as bedwetting. This is defined as the condition of the child over the age of six who has never achieved dryness at night. And then there is secondary enuresis, a condition that occurs in a child to stay dry for at least six months or maybe even several years, if you will, suddenly begins to wet the bed again. Perhaps a child was living in their home and they were months or years without wetting the bed, and then suddenly without any explanation whatsoever to them, to their mind, their placed into a strange home. A foster care home. And then they begin to wet the bed months later after they stopped it years later. They stopped it. Secondary Enuresis. This is thought to be associated with either the medical condition of the time or the time of increased distress in one’s life. So you can quite easily see, while child and foster care place in your home, with this added stress in their life, the increased stress in their life, begins to wet the bed. It’s really quite common. In fact for children foster care to wet the bed, do to that last line there, a time of increased stress in one’s life. And we know this to be true. When a child is placed in foster care, it is without a shadow of a doubt – make no mistake – it increases stress in the child’s life. So why would they not wet their bed? Why would they not? Dr. Brian F, Greer, the director of the center for preventive psychiatry, says this. It is wrong to assume that every foster child who wets the bed does so because of the trauma he or she has suffered. Perhaps the first assumption should be that this is happening because a child is adjusting to the placement. If the bedwetting continues for more than three weeks, this child should be evaluated. First for medical for physical causes and then emotional. And we thank Dr. Greer for this statement.

For so many children, perhaps for children in your home, for children in my home – it is a time of humiliation and shame. Bedwetting is a time of tremendous embarrassment. For many children, they are embarrassed, they are humiliated, they have a sense of shame as they watch you, their foster parent, change their sheets morning after morning after morning. Quite clearly, the child is simply trying to hang on. They did not asked to be placed into foster care. They did not be asked to be placed in your home. They did not ask for the anxiety they’re feeling. They did not ask for the trauma that they’ve experienced. They asked for none of this. When they’re placed in your home, they’re barely hanging on. And yes, for many of them they will begin to wet their bed. They need your help. So how do we help these children to wake up like this dry in the middle in the middle of the night or in the morning, ready to jump out of bed and tackle the day? How do we help these children?

To begin with, we have to be realistic with our expectations. We have to be reasonable with our expectations. Don’t expect that simply loving the child is going to be a quick fix to bedwetting. The child is scared. They are scared to be in my home ,they are scared to be in your home, because we are strangers. It may take some time for them to adjust. tTe fact that they’re living with a strange family ,to begin to trust you, to form some sort of attachment, to realize that they’re not going to be hurt in your home, to realize they’re not going to be abused in their home, to realize you’re not going to abandon them – it’s going to take some time. They need from you permission quite simply. The child placed in your home may be afraid to use your bathroom at night. Perhaps there were some particular circumstances in their own home with their family that prevented them from using the bathroom you and I may never know what those circumstances might be so they need permission. Reassure them that they have the permission to use the bathroom any time day and night. Just let them know, sweetheart, in the middle of night, if you need to go to the bathroom, you’re welcome to do it. This is your bathroom too. Allow the child to become comfortable in your home, to comfortably adjust to his new home, his foster home, the new family – a foster family. It’s going to take time.

Now maybe the worst thing you could ever do is to be critical of this child when they wet the bed, or for the other children in the home – maybe other foster siblings or maybe even your own children, to mock them or make fun of them in some fashion. This is absolutely critical. Do not be critical of them. No shaming whatsoever. Instead show empathy to that child. He’s going to feel bad enough about wetting their bed. Remember, he’s in a strange home. He doesn’t want to make a bad impression on his new family if you will. He doesn’t want to wet the bed. He’s going to feel embarrassed about it. So, show empathy towards him and use phrases like “Sweetheart it’s okay it’s all right. Accidents happen,it’s nothing to worry about. It’s okay, let’s work on this together.” They need to hear that from you when they wet the bed. Not criticism or shaming or mocking or making fun of. One of the first things we do to childs placed in our home is we show them where the bathroom is and we keep a nightlight on for them in the bathroom for a number of reasons. Bedwetting is one of those reasons. Why? Children in foster care need a night light on in the bathroom because they need to know where the bathroom is in a strange home. Remember when that little girl, that little four-year-old girl or six-year-old boy is placed in your home, that very first night or those first few nights? They don’t know the layout of your house. They don’t know where the bathroom is and they don’t know if they have permission to use the bathroom in the night. They’re not sure they can leave the bedroom at night. So again, give them permission. Show them where the bathroom is and keep a night light on in the room ,the bathroom, for them. It makes it a little less scary for them. If you will remember, it’s a strange home.

Now, there are those studies that indicate, that suggests that a night light should be red as it does not suppress melatonin production, which can help a child go back to sleep quicker. Now we do we discuss melatonin in our foster care institute training webinar on sleep anxieties and I would encourage you to check out that webinar at some point. Now this might seem very, very simple and logical, but it’s important to remember, okay? Remember, everybody does not know this. Remember to limit the number of drinks before bedtime. All right? Have a child drink more liquids during the day time so she is not thirsty at nighttime. We had a child in our home who would wet the bed on a regular basis. The child was 10 years of age. The child of course felt embarrassed. One of the things that we did, and we’re a family that encourages drinking water, my wife is a doctor of nutrition naturopathic medicines and and she is a strong believer that water is one of the best things you can place in your body. So we drink a lot of water throughout the day. The 10 year old would go to bed on school evenings about 8-8:30 so we would stop drinking liquids in the home after dinner about 5:30. So the last three hours, there was no engagement of any liquids with this. In regards to this child, we just stopped the number of drinks before that time, about three hours before. Now, to be sure, we would drink a lot of water throughout the day. Now absolutely no caffeine drinks at least four hours before bedtime as caffeine helps to stimulate the bladder. Remind the child to use a bathroom right before bedtime, even if he says he doesn’t need to. Even if he says I can’t go. Say “sweetheart just try to use it anyways.” You know, right before you turn the light off maybe the child goes upstairs and has 30 minutes of reading in their room at night. Remind them that right before they turn the lights off, try to use the bathroom, you know?

When a child comes into foster care, many times they’ve never had a sense of routine in their life. Routine is essential for so many different reasons. Child sleep patterns. One way you can help a child find a good night’s sleep is by providing a consistent sense of routine each evening before bedtime. Now this nightly routine can include what time the child has a bath, brushing the teeth, maybe even a story time. For example, in our house we have dinner and then we will bathe and then we may have a short play time for a while and then we may snuggle up for a bit of a story time and then we’ll brush your teeth, go to the bathroom and go to bed. In nightly routines, the child knows what to expect. So it’s not strange and unknown. Story time each evening helps a child to relax and establishes some quiet time before bedtime. Now again, for much more on this part in regards to sleep anxieties, check out the foster carers training webinar.

A mattress liner is a great way to help a child and your family to be sure for those children who are wetting their beds. Waterproof mattress liners make cleaning up any accent the child might have- much easier, much quicker if you will. And mattress liners can be bought at many many stores. You can buy them online and they’re generally inexpensiv. Make sure clean sheets are readily available for a quick and easy transition when the child wets a bed. Rip those sheets off real quick, wipe down the mattress liner, dry it off and then put on some fresh sheets. Now you might want to consider having a heavy towel underneath the sheets and above the mattress liner, in between if you will, to help absorb any wetness a child might experience throughout the evening. As we did say earlier, reading time does help. Story time in the evening has many benefits, among them it helps a child to feel safe, relaxed comfortable – secure in your home. Remember they’re in a strange home. A home where they’re not familiar with and that might lead to bedwetting as we’ve seen here. So one way you can help them to relax and to feel comfortable and safe, is by sitting down with them and reading a story to them. This can help a child have a better night’s sleep. At the same time it’s also teaching them as well. You might consider a reward system of some kind. Perhaps a reward chart where the child can track their dry nights and work towards a goal of some sort. You know, perhaps you might say you know if you have three dry nights in a row, maybe we can cook up your favorite cake flavor. If you have five nights in a row, maybe it’s cake and ice cream. Seven nights in a row, maybe you can stay up a little bit later and watch a movie on the weekends. Now you can consider your own rewards.

If you will extra extra protection, there are those disposable absorbent underpants that can help. You can purchase those at normal grocery stores or in a variety of stores. It can help these children who are older with bedwetting problems and there are a number of varieties when you go down to the grocery store, any type of store like that, or a big a big chain store, if you will. And you’re going down the aisle the diaper aisle you will see some absorbent underpants for children who are generally older. You might want to consider an alarm clock of some kind. Waking a child the night with an alarm clock can be helpful. This will help the child to get in the routine and when you know how important routine is in regards to children in foster care an alarm clock waking them up will help them to get in the routine of using the bathroom in the middle of the night each evening. There are also special alarm clocks, bed wetting alarms, sometimes known as moisture alarms. You can do a quick search online for these. They’re small devices that are often attached to the child’s diaper or even their clothing, and maybe even sometimes to the mattress itself. These moisture alarms or bedwetting alarms detect small levels of moisture, and when they do, they sound an alarm of sorts and the child can quickly wake up and then head off towards your bathroom that is well lit with your nightlight, your red light light. Don’t forget there are those forms of medication out there prescription medication like DDAVP helps to reduce urine production in the evenings. And in the nighttime, there are other medications available as well.

Now I have to heavily stress this – I encourage you to ensure that you consult with your child’s doctor first before you give any sort of medication and then let your caseworker know again. Make sure you consult with the child’s doctor before you prescribe any type of medication or give any medication to the child for bedwetting and let your caseworker know and then document all medications used in the intake. So you document every evening you give the child in your documentation folder. And we have a whole webinar here on the importance of documentation here at the foster care institute. And if you’ve not watched that webinar, I strongly encourage you to do that because you’ll see the importance of documentation in all aspects of foster parenting.

But how about those children who wet during the daytime? Indeed, some children may experience wetting during the daytime such as at school. So how do you help this job? Well, to begin with, you can have a child practice at home on how to hold her bladder or bladder training, if you will. And the child might practice holding her bladder for longer and longer periods each time throughout the day. So when the child returns home from school, or maybe on saturdays and sundays, ask the child if they can go 30 minutes holding their bladder, 45 minutes holding their bladde, an hour holding their bladder. Again, have them practice holding the bladder longer and longer. If a child is wetting at school, talk to their teacher. Ask the teacher to help the child with keeping the wetting discreet, keeping it quiet. A little secret between the child and the student of you I’m sorry between the student and the teacher if you will ask the teacher if this child can have free access to the restroom throughout the school day. Now I must tell you for a long time I was a teacher and I recognized the anxiety levels of children in foster care were higher than many of my children coming from traditional homes. So with that in mind, if you let your teacher know that “hey I’ve got a child placed in my home. This child is placed in foster care. This child has suffered a number of traumas and it would be so helpful if you could help us help this child by allowing the child to go to the restroom throughout the day. If you could please do that, that would help this child who suffered so much – help his child tremendously.” And most likely that teacher is going to say “absolutely I want to help that child.” They need to know. Pack some extra clothing and underwear for any daytime accidents ,in the child’s school bag. Maybe include an extra set of clothing at school as well. Put an extra set of clothing in a large ziploc bag. If the wetting should happen at school, the child can quickly change if needed and put the wet clothes in the ziploc bag and take them back home.

Now, if the bedwetting should continue, you’ve tried all these things and the bedwetting continues… let’s say it’s been a couple months. You may want to consider professional help. I’ve talked a lot about professional here at the foster care institute and I’ll say one more time, I’ve been a foster myself to 60 plus children. I recognize that I am not a pro at everything, when my car does break down – I’m taking it to a mechanic. And when my refrigerator does break down ,I’m calling a refrigerator repairman. Wen I have a tooth that hurts I’m going to the dentist, and that’s okay. The bedwetting continues in your home after you’ve tried everything after prolonged period of time, you might want to consider professional help such as a trained therapist or counselor. This does not mean you are a failure as a foster parent. Does not mean your failure as a parent. It just means that you are seeking out some help in areas that you’re not an expert in because these trained professionals can help you determine what the root cause, the child’s problem, might be and help you – help the child. They can deliver professional help so you can help the child at home.

Now, let’s be clear one more time. When a child is placed in your home, it is a time of great uncertainty of great emotion of great fear of great anxiety. They’re going to be scared. They’re scared coming to my home, they’re scared to come into your home. It’s a scary time, being placed in foster care, and that can lead very likely to bedwetting. So when we try we understand why the child might be wetting the bed, we understand what type of child the bedwetting experience is, and we try various forms of of helping the child. After a while, you’re gonna find a good night’s sleep – not just for the child itself, but for you and the rest of your family. And goodness knows as foster parents we need a good night’s sleep, right! Because during the daytime, it can be full on exhausting. It’s not just exhausting for the child being in your home, it’s exhausting for us as foster parents as well. And we all need a good night’s sleep. And that can be hard as fast parents to be sure.

Hey, I understand. I really appreciate all that you do as a foster parent. If you want more information, check out the foster carers dude dr john degeneres fostercare.Com we have a number of resources videos of course our online training about ours here at the foster care institute and so much more. Follow me on facebook on twitter as well. Email me. Consider picking up this book here. I recently asked foster parents across the country what did they want in a book and they told me they wanted a daily little book of foster parenting. This is the book that you asked for, The Little Book of Foster Care Wisdom: 365 days of inspiration encouragement for foster care families. I know you’re going to love it. And we have many other best-selling books at the foster care institute. Finding a good night’s sleep for not only the child but for you as a foster parent can be a challenge. Foster parenting to me has been the most challenging thing I’ve ever done it has been the most rewarding thing I’ve ever done at the same time, but I understand how difficult and how stressful it can be as a false parent and why a good night’s sleep is important for everybody in the home. So my hope and my thought, my prayer is that you’re able to find a good night’s sleep soon.

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