Bedwetting during the COVID-19 pandemic

Doctors at Yale New Haven Children's Hospital have seen a spike in day and nighttime wetting since the start of the COVID-19 outbreak. It may be due to an increase in anxiety and depression among children.

The portion of the brain associated with attention deficit disorders and anxiety are the frontal lobes, also known as the executive functioning areas. Israel Franco, MD, director of the Yale New Haven Children’s Bladder and Continence Program, said that the same areas of the brain that control executive function also control urination. Uncertainty over the pandemic may be causing children to have new onset of day and nighttime wetting.

 “The change in school, the change in how they’re being taught, the stresses of being at home and not being able to go out, have potentially had an impact, especially on the children who have some type of developmental problems, it’s had a significant impact,” Dr. Franco said.

Increased wetting could also be caused by constipation, stemming from a sudden reduction in physical activity and dietary changes. Kids who used to participate in after school sports or other activities with their friends may now be spending their days on a computer or playing video games. Dr. Franco said roughly 50% of his patients can be cured once issues with constipation are resolved.

If a child begins to wet themselves, parents should increase physical activity. It can help relieve both constipation and stress in kids. If parents suspect constipation is an issue, they can increase their child’s intake of dietary fiber with raisins, dried apricots or prunes. With extra fiber, parents will need to monitor how much water their child is drinking and make sure they’re staying hydrated. Lastly, parents should reassure their child that things will return to normal eventually.

If a parent has tried those steps and wetting continues, it might be time to seek help from a pediatrician. Even specialists like Dr. Franco have been able to see patients regularly through video visits.

“If there is an issue with stress, try to minimize those stresses in some way, shape or form. Obviously in this scenario, it’s a little bit hard. But I think parents should try to do their best, and if necessary, seek help from a professional that can help guide you with your children to help minimize that stress,” Dr. Franco said.

General advice for bedwetting

The following recommendations are made on a routine basis for all our patients who have issues with bedwetting. Since bedwetting can have multiple causes it is important that we try to eliminate as many causes as possible since we do not have any way of knowing definitively what the primary mechanism for the wetting in your child is. We have included the following recommendations, which are an integral part of our program to help children become dry at night.

• Have your child urinate 5-7 times per day, upon waking, 10:00 a.m., noon, 3:00 p.m., dinner and bedtime.
• Drink most of the fluids before dinnertime.
• Make sure dinnertime is at least three hours before bedtime.
• Make sure your child is well hydrated during the day and drinks at least the following amount of fluids per day:
  • 5 yo = 5 8oz glasses (40 oz. or 1200 ml)
  • 6 yo= 6 x 8oz glasses (48 oz. or 1440 ml)
  • 7 yo= 7 x 8oz glasses (56 oz. or 1680 ml)
  • 8 yo= 8 x 8oz glasses (64 oz. or 1920 ml)
  • 9 yo or over = 8 x 8oz glasses (64 oz. or 1920 ml)

• Last drink should be one hour before bedtime and only 2-3 oz. No more.
• No milk or dairy (yogurt, shakes or ice cream) at dinnertime or after dinner.
• Avoid sugary deserts or snacks after dinner.
• Avoid overly salty foods at dinner or afterwards.
• Avoid high carbohydrate snacks after dinner.
• Make sure that your child urinates before bedtime.