Mike O'Hara noticed Bobby's enthusiasm the first night he visited Troop 240 as a Webelo. From the day he joined, Bobby was always first in line for a Saturday morning hike or a day-long fishing trip. Mike wished all his Scouts would meet the popcorn sales with Bobby's eagerness. Mike expected to see Bobby advance quickly through the ranks to First Class. Then, he changed his mind. At a troop meeting, Sue Johnson, the troop records keeper came to Mike with a disturbing observation. Her records showed that Bobby had never spent a single night camping with the troop.

"I remember other Scouts like Bobby," Mike told Sue. "They seemed so eager at the beginning. Then, they skipped campouts. It wasn't long before they stopped attending the troop meetings, too. Nothing I tried could get them interested in camping. I never could figure out why."

Sue, who is a pediatric nurse, offered a possible explanation. "Maybe Bobby has a physical condition that keeps him from camping overnight."

"But the parents fill out medical information forms when a boy signs up. I don't recall Bobby having any allergies, or asthma, or anything that would impact his Scouting," Mike protested.

"Maybe they don't want it in his records because they find it embarrassing. Maybe Bobby has a bed-wetting problem," Sue said.

Sue offered to get some literature from her office about bed-wetting. After Mike read it, he spoke with Bobby's parents after the next parent committee meeting. He told them how much he enjoyed watching Bobby's enthusiastic approach to Scouting and the potential he displayed. Then, he explained his concerns about Bobby's not being able to experience the entire Scouting program. He asked if Bobby had a physical condition that kept him from joining the troop on overnights. They seemed a little embarrassed but confirmed that Bobby had a bed-wetting problem. Mike reassured them that this was common and gave them Sue's literature.

Bobby's mom took the first step suggested in the literature and talked with Bobby's doctor to learn more about bed-wetting, and available treatment options.

Until he received treatment, Bobby never went camping with the troop because he always wet the bed. Bobby thought he was alone with his problem and was afraid the Scouts would make fun of him. After all, the teasing and taunting was close to home.

"My brothers made fun of me, and I felt my whole family thought there was something wrong with me," said Bobby.

There are approximately five to seven million children in the United States over the age of six just like Bobby. They suffer from primary nocturnal enuresis (PNE), more commonly known as bed-wetting. While most children outgrow bed-wetting by age six, and another 15 percent of older children stop wetting the bed each year without treatment, for some it can continue on for years. This can potentially cause embarrassment and undeserved shame that may in turn restrict social interaction and development.

No Scout wants to hang his sleeping bag up to dry for all the guys to see. If he leaves the wet bag in his tent he risks his tent mates complaining about the smell. Either way, he will likely become an object of ridicule in his troop at some point. So he simply stays home.

For the most part, the majority of families understand bed-wetting for what it is – unintended and unwanted – in short, an accident. Unfortunately, however, up to 35% of children who wet the bed are punished, which can compound the problem.

Physicians agree that bed-wetting may undermine a child's normal development. Bed-wetting usually occurs during an important stage in a child’s life: when he or she is establishing relationships with peers and siblings – relationships that are critical for social development.

"Bobby was always so angry," said his mother, Jean. "He was frustrated and woke up crying every morning. He wanted to be like his brothers and go camping with the Scouts, but knew it was impossible.

"Bobby's brothers didn't like going into his room because it smelled," Jean went on to say. "Bobby’s father didn't understand, either, and just thought it would stop. It put a lot of stress on all of us."

As Bobby continued to wet the bed, Jean did not punish him. Instead, she empathized with Bobby because she, too, had wet the bed as a child. Research indicates that bed-wetting tends to run in families: if both parents have a history of bed-wetting, their child has a 77 percent chance of wetting the bed. If one parent wet the bed, the child has a 44 percent of wetting the bed.

Besides heredity, another possible reason for bed-wetting may be hormonal. Some studies suggest one factor that could play a role in pediatric bed-wetting is insufficient nighttime quantities of antidiuretic hormone (ADH). Normally, ADH levels rise at night and reduce urine production during sleep. In some children, however, there is inadequate nighttime ADH production. As a result, such a child produces more urine than normal, the bladder overfills, and he or she wets the bed.

The exact cause of bed-wetting is unknown. In most cases, an underlying cause cannot be confirmed. Some physicians believe bed-wetting may be due to one or a combination of factors. Infrequently, it may be caused by a medical problem, such as a urinary tract infection.

While doctors believe there may be a number of reasons why a child wets the bed, there is one thing about which they agree: it is not the child’s fault.

"The biggest misconception about bed-wetting is that it's a form of rebellious behavior," explains Lori Semel, M.D., a board-certified pediatrician practicing in New York. "Parents must understand that the child is not wetting due to anger or spite. The child does not have any control over this condition."

"It bothered me that Bobby was so upset and didn't want anyone to know," said Jean. "I tried bribery, eliminating fluids and watching his diet, but nothing worked. We were waking up every hour and trying to get him to urinate, but we were all exhausted. The doctor decided to treat it and not wait for him to outgrow it because it was really affecting him."

The good news is that there are a variety of treatments for children like Bobby, even though "you will have some successes and occasional relapses no matter what treatment you use," said Dr. Semel.

Motivational therapies are a popular first step in treatment. In these types of treatments, motivation and positive reinforcement are extremely important. Positive reinforcement, such as praise or rewards for staying dry, can help improve self-image. However, a parent should reward the child for compliance with the treatment method chosen, not necessarily for dry nights. Punishment for wet nights will erode any progress, negatively affect a child’s sense of self-esteem, and compound the problem.

Behavioral modification and alarms may take months before producing positive results, however, and they require both parental and patient motivation.

Pharmacological (drug) therapy is also used to treat bed-wetting. These treatments are characterized by their rapid onset, with patients often responding within the first two weeks of treatment. Among the pharmacological therapies commonly used are the following:

• DDAVP^® (desmopressin acetate) Tablets contain desmopressin acetate, which is a synthetic analog of the natural pituitary hormone vasopressin (ADH), an antidiuretic hormone. Vasopressin, normally made in the body, plays several roles, one of which is regulation of water balance and urine production. Research suggests that DDAVP reduces urine production in children ages 6 and over who wet the bed by supplementing their natural level of antidiuretic hormone.

A response to DDAVP Tablets is seen within the first two weeks of treatment. Nighttime fluids should be restricted to decrease the chance of fluid overload. In clinical trials, the only drug-related adverse event seen in 3% or more of patients was headache (4% DDAVP, 3% sugar pill).

• DDAVP^® Nasal Spray has been available as a treatment for bed-wetting in children 6 years and older since 1989. Infrequently, high dosages have produced headache and nausea. Nasal congestion, nasal inflamation and runny nose have also been reported occasionally, along with mild abdominal cramps. These symptoms disappeared with reduction in dosage. Nighttime fluid intake should be restricted to decrease the potential occurrence of fluid overload; serum electrolytes should be checked at least once when therapy with DDAVP Nasal Spray is continued beyond seven days.

DDAVP Tablets may be more appropriate than intranasal spray for children with frequent colds and allergies (school children may experience as many as 10 colds every year; in addition, peak onset of allergic rhinitis is in childhood and adolescence). Children may prefer tablets because the formulation eliminates the feel, smell, and taste of nasal sprays, which children may find unpleasant. In addition, tablets may be taken discreetly, enabling children to participate with confidence in overnight activities.

"Our physician prescribed DDAVP Tablets. It was worth investigating because of the potential benefit to Bobby's bed-wetting," explained Jean. "Over the course of several months, DDAVP reduced Bobby’s wet nights. If you would've known my child last year, you wouldn't believe the change."

With the right treatment, children who wet the bed can experience Scouting to the fullest. Just ask Bobby, who never misses a campout, shares a tent with two of his fellow Scouts, and was just elected to Order of the Arrow by his fellow campers.

For more information, visit an educational web site dedicated to bed-wetting. It is located at http://www.drynights.com.