Dear Dr. Paul: We have a four-year-old daughter who has been toilet trained since she was two. Recently, she started wetting the bed at night, but has no problems during the day. We do not suspect any problem at pre-school since she really seems to love it. Any idea of what should we do?

Dr. Paul Answers: Wetting the bed at night, or nocturnal enuresis occurs in up to 20% of five to six-year-olds.

As the name suggests, the bedwetting is only during the night without any daytime accidents. Additionally, there is usually a very strong history of bed wetting in the family.

There are two types of bedwetting: Primary nocturnal enuresis means that a child has never been dry at night. Secondary nocturnal enuresis is like your situation, when a child has had a period of dry nights lasting at least six months before starting to wet the bed again.

Although the exact cause is unknown, we believe that it has to do with a child's inability to control the bladder at night. We do not consider it abnormal for younger children to wet the bed because, in most cases, full night-time bladder control or maturity is achieved by five years of age. at night. There is usually no psychological cause of primary bedwetting, although psychological or emotional stress may be an important factor in secondary nocturnal enuresis. Fortunately, in most bedwetting children, there is no medical cause or problem and after a medical examination and assessment, parents are relieved to find this out.

Should you worry about the bedwetting and try to stop it? That depends on the age of the child and on how much the child is affected emotionally. The older the child, the more serious the potential social effects. There is no question that bedwetting can interfere with a child's social development, and, therefore, contribute to a low self-esteem. Under these circumstances, there are effective treatment strategies available. However, in situations where the child is young, or not affected emotionally or socially, the following simple tips may help:

* Use the reward/calendar system: The child fills in a calendar and is rewarded when, for example, he has been dry for seven nights in a row.
* Wake the child up to go to the bathroom before you go to bed.
* Restrict fluid intake before bed time.
* Practise bladder exercises. They may help increase the strength of the bladder. Simply, ask the child to hold in his urine as much as possible during the day.

The most important thing to understand is that in most children, nighttime bed-wetting will go away on its own. In the meantime, when a child wets the bed she should never be punished. Remember, the child is not doing this on purpose. Taking a relaxed, positive, loving and understanding approach is best for the whole family!

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The information provided in this column is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.