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Find out when it should be a reason to worry about bed-wetting

Parenting
 Photo; Courtesy

Bed-wetting is an upsetting problem for both the parent and the child. As soon as parents hear that other children of the same age are dry at night — certainly by three or four years of age — they will start to worry if their child is not.

 The child feels ashamed and under pressure from peers who boast of being dry at night. By the time a child is five, everyone concerned will see bed-wetting as a problem.

Is your child ready?

When should parents start worrying about bed-wetting? Most children will be dry during the day by age 3. However, some children may have immature bladders, leading to difficult night control.

There are also children whose sleep patterns are immature. Their arousal patterns in sleep are not developed enough to alert them to get out of bed to stay dry. These children need to develop their own schedule, which must be respected.

It is also thought that unlike other children, some who wet their bed may not make increased levels at night of the anti-diuretic hormone (ADH) that limits the amount of urine produced. As a result, it may be more difficult for them to go through the night without urinating.

Whatever the cause, peer pressure can add guilt and feelings of inadequacy, but they won’t speed up a child’s developmental patterns. Parents need to be patient and to wait.

They also need to help the child understand the reason for her ‘lack of success’. Otherwise, it can lead her to a poor self-image.

When there’s regression

In cases where child starts to wet her bed after having been dry at night for the previous six months or more (secondary enuresis), it is good to have a medical examination. Her urine should be checked for infection, evidence of diabetes, and other medical causes for new or prolonged bed-wetting.

Urinalysis can detect kidney or bladder infections that might contribute to urinary incontinence in both boys and girls.

Often, a brief, temporary bout of renewed bed-wetting in a child who had previously been able to stay dry through the night can occur when a child is stressed by the coming of a new sibling, for instance.

How parents can help

Staying dry at night must become the child’s goal, not parents’ or society’s. Parents must relax the urgency they feel. They may discover that they are driven by their own embarrassing childhood memories of bed-wetting, since bed-wetting that continues after age five without other medical causes often runs in families (familial nocturnal enuresis).

This can help parents focus on their task of listening to the child’s feelings and supporting her own efforts to stay dry.

If there are issues of poor self-image, of psychological immaturity, or of self-evaluation, they need to be addressed.

If the child is under too much pressure from those around her — from school, peers, or family — they need to be lifted as much as possible.

Parents shouldn’t probe, but they should make themselves available.

*Ask your child to hold to her urine a bit longer during the day to help increase bladder control.

*With the child’s permission, you can wake her before you go to bed. At that point, she must take control, or it won’t work. Don’t carry her to the bathroom.

*An alarm clock by the bed to wake her up at 2 am might help, when she’s ready. Before that, it is unnecessary pressure that will work the wrong way.

*When your child wants to talk, you can discuss her feelings, the pressures on her, and the fact that her bladder may need to grow up and it may take a little while for her to learn to wake up in time. If this is a real dialogue, it can be reassuring to her.

Seeking help

If bed-wetting continues past the age of five for girls and six for boys, or if it interferes with a child’s adjustment-her own self-image, her ability to relate to her peers, or her ability to see herself as a successful female, consult a paediatrician skilled in these issues.

Once medical causes have been excluded, a child psychologist or psychiatrist should be consulted.

Helping a child to feel better about herself could strengthen her at an important time in her development. She may also be ready for other strategies - medication or a pad that senses when she begins to wet and sets off an alarm - if she is interested, and if these are offered as support, not punishment.

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