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Question: I have an autistic child who still wets the bed at age 7. He is high-functioning, and completely potty trained, but still has this problem at night. I worry about talking to our doctor about it because I am hesitant to medicate him for this, because I think he will outgrow it. Any ideas for how to handle this, or how to ask my own doctor about it, while not getting pills involved? Answer: Bedwetting, or enuresis, is very common, affecting up to 20 percent of children, mostly boys. It is caused by delayed maturation of the mechanism that allows control of urination, so most grow out of it by the age of 10. It is hereditary, but there is no association in the medical literature between autism and bedwetting, although medications sometimes used in the treatment of autism can make bedwetting worse. An evaluation should be undertaken to rule out urinary tract infection and sugar in the urine. In addition, physical examination to rule out a neurologic cause is warranted. If these are normal, then simple measures can be instituted to help until the child grows out of the problem. Fluids should be restricted in the evening, preferably nothing after 7 p.m. (depending on bedtime). Scheduled awakening for bathroom visits may help; start by waking every three to four hours, and adjust to shorter or longer intervals based on results. Medications can be used, but are not always effective and do not cure the problem; the only cure is time.
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