Enuresis is the lack of urinary continence beyond age four for daytime, and beyond age six for nighttime, or the loss of continence after at least three months of dryness. There is a genetic predisposition to this problem.

Enuresis can indicate a serious anatomic illness or physiologic abnormality, but most often it is caused by the immaturity of control mechanisms. For example, 90% of four-year olds are continent during the day, but only 75% of them are continent at night. Nighttime continence improves in time. By age eight, at least 90% of children have no problems, and 98% of children 12 to 14 years of age are problem free. Treatment options may include observation, medications (DDAVP), counseling, or bed alarms. Bladder stretching exercises or limiting fluid intake at bedtime have very limited effects.

Medications are quite hard to discontinue, as the problem tends to come back. At this point, bed alarms are the best treatment, and patience is required, because it may take a few weeks or months to see a result. In any case, it is important for your child to understand that he or she is not to blame for the problem, and that together you will work to improve the situation. Emotional support is one of the most important parts of successful treatment for enuresis.

For additional healthy kids tips, log onto baymed.org, scroll over "Health Checks & You" and join our "E-List." For more information about childhood diseases or development, contact Inez Balinska, MD or Darek Balinski, MD, Bay Regional Pediatrics, Medical Mall, 1456 W. Center Road, Essexville. (989) 895-4840.