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hen Chloe Stevenson (not her real name) was almost eight, she was still wearing a pull-up diaper to bed. Unperturbed by the fact that she wet the bed at night, Chloe turned wearing a diaper at night into a fashion statement. In fact, when her girlfriends came for a sleepover, they all insisted on wearing "pull-ups" to bed, too -- just like Chloe.

"I wish every child with a bedwetting problem had this kind of attitude," says Dr. Fabian Gorodzinksy, author of the Canadian Paediatric Society statement on bedwetting. "Basically, bedwetting is not a condition that needs to be treated unless it becomes a problem for the child," he explains. "This is the most important thing that parents need to know."

Unfortunately for boys, who tend to have bedwetting problems more than twice as often as girls, wearing a diaper to bed can be a major embarrassment socially. And while involuntarily urinating during the night after the age of five or six is something that all children grow out of, for some, this rite of passage can be a painful process.

"Bedwetting is a common condition that can get kids very upset and affect self-esteem," says Dr. Gorodzinsky, who is associate professor of pediatrics at the University of Western Ontario in London, Ontario. "The child may become withdrawn because he feels he has a secret that he doesn't want anyone else to find out about." The worst case scenario, adds Dr. Gorodzinsky, is when a brother or sister "spills the beans" to other children.

			When bedwetting is caused by troubled emotions
			While most bedwetting is the result of an immature neurological system, not emotional problems, there are some situations in which troubled feelings can lead a young child to wet the bed after several months or even years of dryness at night. These situations may include any changes which make the child feel insecure, such as: moving to a new neighbourhood or school losing a family member or loved one the arrival of a new baby or child in the home. Similarly, bedwetting can occur when toilet training took place too early and caused undue stress for the child. Speak to your paediatrician or family doctor.

At the age of five years, approximately 15% of children wet the bed, studies show. At the age of 10, 5% continue to wet the bed and by the age of 15, 1% wet the bed.

Also known as "nocturnal enuresis," bedwetting falls into two categories:

1. The most common is called "primary nocturnal enuresis" and it is characterized by delayed maturation of the nervous system in which messages sent by the bladder are not recognized by the sleeping brain. In primary nocturnal enuresis, the child has never been "dry" at night.
   
   
2. In the second type of bedwetting, known as "secondary nocturnal enuresis," bedwetting occurs after being dry for at least six months and is the result of a urinary tract infection or a metabolic disorder such as diabetes. Approximately 1% of bedwetting falls into this latter category.

Bedwetting does appear to run in families, research shows, because of a gene that has been identified that is responsible for enuresis. In children who wet the bed, not enough of this anti-diuretic gene is secreted during the night. "There have been very good studies to show that there's a genetic component to bedwetting," says Dr. Gorodzinsky. When a child has one parent who used to wet the bed, the chance of doing the same is 25% ; when the child is the product of two former bed-wetters, the chances of doing the same are 65%.

			How parents can help
			Remember that bedwetting is not something your child does on purpose and which usually causes feelings of shame; Offer encouragement and show faith that your child will eventually be able to stay dry at night. Limit liquids before bedtime and make sure your child urinates before bed. Wake your child during the night to go to the toilet. Praise your child on dry mornings and never, ever punish for wetting the bed.

Most children who wet the bed do not have emotional problems, says doctors. What's more, all bedwetting problems -- whatever the cause -- are manageable . If parents are concerned but the child doesn't appear to be worried, simple reassurance is the best medicine, says Dr. Gorodzinsky. "Normally, children outgrow the problem if you do nothing," he explains. "I just tell the parents to come back when their child is motivated."

On the other hand, any child who is troubled by wetting the bed should be seen by the paediatrician or family physician as treatment will improve self-esteem. A complete medical history and full physical examination, including urinalysis, will determine whether or not the kidneys are functioning properly, as urine volume is controlled by the kidneys.

In the vast majority of cases, however, there are three "not very serious" reasons why a child will continue to wet the bed:

1. He may be a particularly sound sleeper and not respond to sensations of bladder fullness during the night
2. His kidneys may be producing a large volume of urine at night because his levels of a naturally-occurring anti-diuretic hormone are low
3. He may have a small bladder.

In some children, points out Dr. Gorodzinsky, bedwetting may be caused by a combination of these factors.

There are many ways that parents can help a child who wets the bed. Speak to your paediatrician or family doctor about the best treatment for your child and beware of advertisements for expensive bedwetting "cures."