Published online October 2, 2006
PEDIATRICS
Vol. 118
No. 4
October 2006, pp.
1802a-1803
(doi:10.1542/peds.2006-1936)
Does Breastfeeding Prevent Nocturnal Enuresis?
Howard J. Bennett, MD
Department of Pediatrics
George Washington University Medical Center
Washington, DC 20037
To the Editor.—
In a recent article, Barone et al1 suggested that breastfeeding may prevent bedwetting in the 6 million American children who suffer with this condition annually. The study consisted of 55 children with nocturnal enuresis from a continence center and 117 matched controls from a general pediatric practice. The authors noted that 81.2% of the controls and 45.5% of the study subjects, respectively, were breastfed. The authors concluded that their case-control study supports the hypothesis that breastfeeding protects against the development of bedwetting.
Although it is an interesting article, there are a number of points that cast doubt on the authors' conclusions. Barone et al understated the role of family history in the development of bed-wetting. They wrote in their introduction that "familial causes for bed-wetting have been identified, indicating that some cases of bed-wetting tend to run in families."1 It is well known, however, that bed-wetting is strongly associated with family history.2 Approximately 45% of children wet the bed if one parent was enuretic and 75% wet the bed if both parents were enuretic.
The authors did not control for family history in the study. Twenty-one parents (38%) in the study group and 6 parents (5%) in the control group were enuretic as children. Although the authors were aware of these numbers, they did not take them into account in their analysis. They concluded that breastfeeding was the protective factor in the control group. However, the absence of bed-wetting in the control families could explain why many of these children were dry at night.
As a primary care pediatrician with an interest in bed-wetting,3 I have complete medical charts for all patients I treat with the disorder. In the past 2 years, I have managed 19 children with bed-wetting. All of these patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for nocturnal enuresis, and none of them were incontinent. Of this group, 14 (73.7%) breastfed for 
4 months, which is similar to the control group in the Barone et al study.
Bed-wetting has been present in human populations for centuries. Incidence data are not available from earlier time periods, but the historical aspects of bed-wetting have been reviewed in the medical literature.4 Because bottle feeding was not an option for most of human history, breastfeeding was the primary method of infant nutrition during the same time period that bed-wetting was recognized as a problem of childhood. Therefore, if breastfeeding were, as the authors speculate, "the first true preventative approach toward bed-wetting," nocturnal enuresis would be a disorder of modern times, not a condition that has existed throughout history.
These observations make a strong case that breastfeeding does not affect the natural history of bed-wetting.
REFERENCES
- Barone JG, Ramasamy R, Farkas A, et al. Breastfeeding during infancy may protect against bed-wetting during childhood.
Pediatrics. 2006;118
:254
–259[Abstract/Free Full Text]
- Jarvelin MR, Vikevainen-Tervonen L, Moilanen I, Huttunen NP. Enuresis in 7-year-old children.
Acta Paediatr Scand. 1988;77
:148
–153[ISI][Medline]
- Bennett HJ.
Waking Up Dry: A Guide to Help Children Overcome Bedwetting. Elk Grove Village, IL: American Academy of Pediatrics; 2005
- Glicklich LB. An historical account of enuresis.
Pediatrics. 1951;8
:859
–876[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
