bedwetting in children
Parents often worry about child's bed-wetting habit
If all those mornings having to clean up wet, sloppy bedsheets have got you worried about your toddler’s bed-wetting habits, fret not; you are not the only one. Bed-wetting is a common problem among young ones that most children soon grow out of.
Bed-wetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night.
There are multiple reasons for bed-wetting ranging from organic causes to psychological causes. The cause sometimes also lies in the home environment, anxiety and stress levels of the care-givers of the children, in schools, due to peer pressure, bullying, and so on. Many causes have been explained scientifically and many are just hypothesised.
For infants and young children, urination is involuntary. Some degree of bladder control is achieved by 4 years of age in most children. Daytime control is usually achieved initially, while night time control comes later. The age at which bladder control is expected varies considerably.
Enuresis or bed-wetting can be mainly classified into two types- Primary and Secondary. Primary bed-wetting refers to bed-wetting that has been ongoing since early childhood without a break. Secondary bed-wetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).
Factors affecting bedwetting
• Bed-wetting is more common in boys.
• Development and maturity of the child
• The child's overall physical and emotional health
• Lower socio-economic status
• Poor school performance
The child should avoid excessive fluids, chocolate, caffeine, carbonated drinks, or citrus in the evening. It is important that the child urinates before bedtime. Fluid intake should be restricted to two hours prior sleeping.
It has been suggested to never ridicule the child for bed-wetting, especially in front of others as it could have a great negative impact. When cleaning the wet bed involve the child without making her feel guilty or giving her a punishing look. Always encourage the child and reward her for dry nights. The attitude of parents is very important in handling this situation.
There is also an alarm system which has been used by some paediatricians. Bed-wetting alarms have a special moisture sensor placed in the child's pajama that triggers a bell or buzzer to go off at the start of urination. The alarm is designed to awaken the child so she can get to the toilet and finish urinating. In the first few weeks of use, however, it is usually the parents who are woken-up by the alarm. This has been helpful in certain cases but it has also been observed that on stopping the treatment, the relapse rates are high.
In difficult cases certain medicines like desmopressin have been used by the doctors. This may give symptomatic relief but should be prescribed with great caution.
This drug imitates ADH in the body, which is secreted by the brain; it increases the concentration of the urine and reduces the amount of urine formed. It is recommended to be taken just before going to bed and is also used as a stopgap measure to help children attend camps or sleepovers without embarrassment. Side effects are uncommon but include headache, runny nose, nasal stuffiness, and nosebleeds.
When to seek help
A child bed-wetting beyond 5 years of age should be seen and assessed by his paediatrician. After assessing whether the bed-wetting is isolated or associated with some other disease, the doctor determines what investigations need to be done.
The common investigations which are done are the urine examination to rule out urinary tract infection, routine blood tests, ultrasound and Xray of the region of the kidney, ureter and bladder to look for local pathology, blood sugar, and also sometimes MRI of the spine to rule out a neurological cause leading to poor bladder control.
Bed-wetting is a common problem and its causes are multi-factorial. Management of a child with bed-wetting requires a systematic approach and a multispecialty involvement, where parents play the lead role. The issue being sensitive and embarrassing for the child should be dealt with very tactfully by both; the parents and the doctors.
This article is written by Dr. Manish Mannan, Consultant, Pediatrics and Neonatology, Paras Hospitals, Gurgaon.
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