Text: Mandy Collins. Article from the March 2015 issue of Living and Loving Magazine.

If your child is under the age of five and still wetting the bed, there’s only one thing to do: don’t worry – it’s perfectly normal. That’s the message from Johannesburg incontinence specialist, Dr Margaret Fockema.

From a physiological point of view, there’s no specific age at which children have to be dry,” she says. “Generally speaking, girls are dry sooner than boys, and most children will be dry in the daytime before they are dry at night, but we wouldn’t start worrying about a child who’s wetting the bed until they’re five years old.”

Dr Fockema adds that she would only actively investigate a child under five who is wetting the bed if it’s a problem for the child, or if the parents are very concerned about it. “For example, some four-year-olds are distraught if they wet their bed,” she says.

“Generally, I look at infection, urgency and frequency. If there’s no bladder infection, or in girls, no vaginal discharge or itchiness, then we do an ultrasound of the bladder, and a uroflow test, which measures their urine flow rate. If all of this is normal, and they’re eating and drinking normally, then don’t worry – they’ll sort themselves out.” She says it’s also helpful to compare your child’s urination habits with other children. If your child is going to the bathroom roughly as often as his or her peers, then there’s nothing to worry about: increased frequency and urgency to urinate are the main signs that there may be a problem.

Johannesburg electrophysiologist, Dr Lizelle Grindell, adds that often parents arrive at her rooms because their children are starting preschool, and the school has stipulated that all children must be toilet-trained by the time they start.

“Parents come to us in December or at the beginning of the school year, because the child is still wet at night, and they then try to force their kids to be dry 24 hours a day. Actually, it really doesn’t matter to the school if kids still wear nappies at night – they just want the kids dry when they’re at school!

Remember that breast milk is very different to cow’s milk, which is aligned for calves, not humans. Water is a great choice for kids, or even rooibos tea.

“It’s really important not to force things. Remember that children only really gain control of the requisite nerves between the ages of four and five. It creates so much pressure on everyone, especially the kids, and it can make the problem worse, or cause the very thing you’re trying to stop.”

For example, Dr Fockema says, it’s not a good idea to wake children up at night to take them to the toilet. “They need a normal sleep cycle because certain hormones are produced that concentrate our urine at night, and our bladders should be big enough to cope,” she says. “If you wake them up for a wee, you teach them that it’s normal to wee at night, and that just prolongs the problem. If they’re not dry at night, put them in a nappy.”

Stressing about it or making a big deal out of it will cause more problems, because many kids are only dry at age three or four. “And if you’re picking them up to go to the toilet at night,” says Dr Fockema with a smile, “you’re not training the child. The only person who is being trained is the parent.”

That’s not to say you shouldn’t be sensible: give them something to drink at suppertime, but don’t give them a lot to drink just before they go to bed. They should be drinking throughout the day, and have their drinks spaced out.

“It’s important that kids drink a sensible amount – too little is as bad for them as too much,” comments Dr Grindell. “I tell parents that there are seven ‘events’ during the day when children should drink: when they wake up, and at breakfast, teatime, lunch, afternoon tea, ‘sundowners’, and dinner. Maybe a small drink after that, but that should be enough.”

The best way to gauge whether your child is drinking the right quantities is to check their urine: it should be a pale straw colour, says Dr Fockema. Only the first wee of the day should be concentrated, dark and strong- smelling. So if it’s dark yellow or orange after that, then they’re not drinking enough. If their wee looks like water, they’re drinking too much.

Drinking enough is also important for their bowel movements – too little fluid can leave them constipated. Normal poos should look like a sausage, not like little pellets, or clusters of pellets.

“It’s helpful if kids can poo in the morning before they go to school, because if their colon is empty, they’ll have fewer accidents,” says Dr Grindell.

“Your digestive system works like this: when you eat, it stimulates enzymes in the stomach that send a message to the brain, which sends a message to the colon. That gets peristalsis going, which gives you the urge to poo.

“So it’s a good strategy to let them eat breakfast in the morning, then let them play for 10 minutes or so, and then put them on the toilet for 10 minutes before you leave for school. This will usually do the trick. What children drink is also important, because there are food substances that are bladder irritants, such as dairy, fizzy drinks, tea and coffee. “No small child should be drinking tea or coffee,” says Dr Fockema. “And many children have chocolaty drinks before bed, so they’re drinking dairy plus chocolate, which is a stimulant! Remember that breast milk is very different to cow’s milk, which is designed for calves, not humans.” Water is a great choice for kids, or even rooibos tea, as they won’t irritate the bladder.

Dr Fockema adds that during the day, parents should let children urinate when their bladders tell them it’s time to use the toilet, instead of making them wee ‘just in case’, but it’s okay to let them have a last wee just before bed. “So often I see parents who give kids a huge drink at bedtime and don’t let them have a last wee, and then wonder why the child can’t make it through the night without needing the loo.” Then, it’s also important to help them to sit correctly in public toilets. The way you sit on the toilet has an impact on how effectively you urinate. Many parents hold their children over the toilet seat instead of allowing them to sit down properly. That means that they’re not in the correct anatomical position to urinate, which means they usually don’t empty their bladders properly.

“Don’t hold them hovering over the toilet,” says Dr Grindell. “If you’re really worried about germs, put some toilet paper on the seat, or buy some disposable seat covers, but they need to sit down or they’ll clench all the wrong muscles. Support them so that they don’t fall into the toilet.

Both experts say that toilets are cleaner than the things we touch with our hands every day: the credit card machine, door handles and balustrades, for example. “Carry some alcohol spray with you,” says Dr Grindell, “but let your children sit properly on the toilet. If you don’t, you may be setting them up for problems later in life.”