Can cutting back on caffeine help manage bed-wetting in children?

Limiting caffeine intake appears to reduce the severity of primary monosymptomatic nocturnal enuresis (PMNE) in children, as shown in a study.

After 1 month, an intervention that restricted caffeine intake to <30 g per day led to a significant increase in the frequency of dryness at night compared with a control intervention that allowed 80–110 mg of caffeine intake per day, a team of Iran-based researchers reported.

The mean number of bed-wetting episodes dropped from 3.5 times/week at baseline to 2.3 times/week at 1 month in the intervention group. In contrast, the mean number of bed-wetting episodes in the control group was 3.4 times/week at baseline and remained relatively stable at 3.2 times/week at 1 month. [BMJ Paediatr Open 2023;7:e001899]

Caffeine restriction also led to a significant reduction in the severity of enuresis, with 54 children (20.2 percent) showing improvements (dry at night) as opposed to only 18 children (6.7 percent) in the control group (relative risk, 0.615, 95 percent confidence interval, 0.521–0.726; p=0.001).

The present data indicate that caffeine limitation can effectively manage PMNE, with a number needed to treat of 7.417, according to the researchers.

Missed opportunity

Addressing nocturnal enuresis in children often begins with simple behavioural interventions, as recommended by the International Children's Continence Society. These intervention techniques include limiting fluid intake before bedtime, urinating before sleep, and reducing caffeine consumption. While their efficacy is a matter of debate, they have proven effective alone or in conjunction with medication. [J Pediatr Urol 2021;17:172-181; Cochrane Database Syst Rev 2013:CD003637]

Given the low cost and ease of implementation, behavioural interventions should be considered as part of any comprehensive treatment plan for children with enuresis, the researchers said. Unfortunately, many children are not receiving this basic advice, with a study in Italy indicating that more than 90 percent of children were not advised on these simple behavioural changes. [Ital J Pediatr 2020;46:128]

The researchers view it as a missed opportunity, especially because caffeine consumption is a common habit among adolescents and children. [Int J Environ Res Public Health 2021;18:12389]

“Although it is not recommended to have caffeine restriction for every child, it may be considered in cases resistant to treatment. Preliminary evidence according to the caffeine limitation and PMNE is accumulating, but a more comprehensive study is needed to clarify topics of uncertainty. This study was the initial way to define clues to the reasons for PMNE and its severity,” the researchers said.

Study details

The current study included 534 children with PMNE who were 6–15 years of age. They were randomly assigned to the intervention group (n=267, mean age 10.9 years) or the control group (n=267, mean age 10.5 years).

Children in the control group consumed cocoa milk and 2–3 cocoa ice creams per week; 1–2 cups of tea or coffee or cappuccino and 2–3 cans of cola per week; and 1 chocolate or a chocolate cake or a chocolate biscuit a day. On the other hand, those in the intervention group consumed one or two cups containing 100 cc of light tea and were prevented from having other caffeinated food items.

Feed frequency questionnaire was used to record the amount of caffeine consumption, and all children were asked to return 1 month later to assess the recorded data.

More research needed

Currently, there is no sufficient high-grade evidence to show that caffeine may contribute to the pathogenesis of enuresis, the researchers acknowledged.

“A greater conception of the impact of caffeine on enuresis is needed to further improve the treatment of enuresis. Furthermore, associated pieces of evidence between LUTS and caffeine are sparse and often observational. Given the matter of these materials in daily life and their realized impact on the severity of PMNE, high-quality evidence is needed,” they stated.

The researchers called for trials with a large population to obtain more objective evidence in the future.

The need for a deeper understanding of the effects of caffeine on enuresis should enhance its treatment, they acknowledged. More research on this topic can also help to develop new therapeutic approaches.