Bed-wetting must be differentiated from the situation
where the child’s nappy or pant is wet all the time during
the day as well as at night. In such a condition, immediately see
your doctor to rule out urinary infection, any congenital abnormality of the urinary tract, diabetes or diseases
connected with the nervous system.
You need worry about bed-wetting only if your child is constantly wetting his bed in sleep after his fourth
birthday. Ordinarily, as soon as the bladder of a child aged 3 or
more becomes full, he gets signals from his bladder to empty it. In some families, this system takes more time to develop.
It is possible that your older child or even your husband had
a similar history. And
knowing this usually helps the prognosis. Incidentally, girls tend to achieve bladder
control earlier than boys. It is reported that 77% of children suffer from enuresis if both parents were
enuretic as children, and 44% when only one parent has a positive history. If one identical twin has enuresis,
there is a 40% to 50% chance that the other will have the same problem, independent of the parents’ status.
For non-identical twins, this likelihood decreases to 20%.
CAUSES: Bed-wetting beyond the age of 4 is possibly due to a delay in the maturation of the nervous system that
controls the bladder mechanism — for inherited reasons
or otherwise.
Take note, however, if your child who has remained dry
all through the night for a sufficiently long period reverts
to bedwetting. There are usually psychological factors causing such ‘accidents’. Examples of these could be sibling
rivalry due to the arrival of a new baby, moving to a new house,
joining a new school or emotional disturbance because of a problem
at home or in school.
MANAGEMENT: A child who wets the bed is not doing it ‘to teach you a lesson’, nor are you an
inefficient parent. The fact is that he cannot control his bladder. Hence,
he deserves to be understood rather than punished. He
should not be put to shame for this act in the presence of
others, especially his friends. It appears that, in general, development
of bladder and bowel control is a
maturational process that cannot be accelerated by early onset and
high intensity of toilet training.
Some parents restrict the intake of fluids towards late evening; it is worthwhile seeing if this works for your
child. Another method is the ‘alarm
device’, an electric appliance connected to a pad on which the child sleeps. As soon as
the child passes the first few drops of urine, the alarm
rings. If your child is amenable, explain to him that this is a signal for
him to wake up and pass urine. Otherwise, wake him up yourself, have him put off the alarm and pass
urine.
Gradually, he will be conditioned to stop passing urine as soon as
he hears the alarm. In due course of time, he will be
conditioned to control his urge to pass urine until he wakes in the morning. Continue using the alarm
device for a month or
two after control has been achieved.
Drugs may be prescribed in resistant cases. Imipramine is commonly prescribed. If used and found helpful, it
must be continued for a period of 3 months. Do not use this drug without the advice of your doctor, because it has
known side effects. Desmopressin, in the form of a nasal way, has also been found to be helpful. An oral
preparation of desmopressin (not yet available in the market) is preferred because nasal delivery can be
compromised by the common cold and allergic rhinitis. Fortunately, most cases can be handled without drugs and
with the help of a competent and sympathetic physician.
Laughter And The Passage Of Urine
Mention may also be made of children who, although they otherwise have full control of their bladders,
involuntarily pass urine when they suddenly burst out laughing. This condition improves spontaneously as the child grows up.
