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Home and Family
Bedwetting
by A. Ross M.Ed.

Many parents have asked me for advice on school children who still wet their bed. It is not my field and I have little experience in the subject. Thus, everything in this article is from research done during the past year and from two interviews granted me by experts in this field who see patients every day.

Up to the age of five, 25% of children have never yet been dry at night. It is not even regarded as a problem, although by then it is already a nuisance to parents: the piles of laundry, the morning showers, especially if there are several children with the same problem in the family. At the age of six, there seems to be a remarkable drop in the numbers, with about 1% of the children becoming dry spontaneously, without any treatment. Only about 1% of people still suffer from enuresis (the professional term used by doctors) by the time they are 15.

In former days, parents were reluctant to consult a pediatrician, because they felt ashamed. Nowadays, people do not feel that it is such a stigma and are asking for help earlier. Often, they will be advised that this is normal behavior for small children and it is not considered a problem until after the age of six, by which time, as shown, there has often been a spontaneous cure.

Heredity as being a cause of enuresis has recently been confirmed by the finding of a gene in chromosome 13 connected to the disorder. Research into this finding and what can be done about it is being continued. A family history of enuresis is found in most children who have this problem. One study has shown that 77% of children in families where both parents had the same problem will have it. 44% of children in families where only one parent suffered from enuresis will be affected, whereas in families where neither parent had it, only 15% of children will suffer.

If the problem solves itself in ninety-nine cases out of a hundred, why bother to treat it at all? First of all, older children may suffer badly because of their terrible secret. They can never sleep over at a friend's house, nor do they want friends staying with them. They may feel guilty, and they certainly don't feel good about themselves with the nightly wet pajamas and sheets. Furthermore, the parents don't feel any better about the situation and however hard they try not to show frustration or disapproval, children can sense that they are upset and frustrated by the continued problem.

Never shame, blame or punish a child for wetting the bed. It is not his fault. On the other hand, do not pretend the problem doesn't exist. Tell the child in a matter- of-fact way to put his sheets into the laundry hamper each morning and not to leave them under the bed.

Some people feel that deprivation of drinks at bedtime will help the situation. This is a false premise, as curtailing fluid intake near bedtime has not been shown to be in the least beneficial. By the same token, waking the child at night might save you some wet sheets, but it will not help the child learn control.

When the doctor has ruled out the possibility of some chronic infection, malformation of the body or perhaps diabetes, he will prescribe treatment. In the rare cases of a physical problem, the treatment will be quite different.

There are three types of treatment for enuresis.

There is motivational therapy, which involves charts with stars, prizes or rewards for every dry night. Many doctors encourage this treatment before going on to the second and most common treatment, which is behavior therapy. This consists of an alarm which works either through ringing or by vibration. As soon as the child begins to wet, the bell awakens his reflexes so that he controls himself. It is not a quick cure and involves parents and the child, but is the most successful of the three treatments. The third treatment is drug therapy. This has sometimes severe side effects and is not usually recommended for younger children. It is advised when all else has failed. When a person is one of the 1% of over-fifteens who still wet the bed, there are other options open to him. Either hypnosis, diet therapy (especially eliminating caffeine) or psychotherapy. These treatments have been known to work for a few cases.

If a young man with this problem is in the army, he is teased mercilessly by his fellow recruits and is discharged before the end of one week. One doctor reported that a chareidi boy was drafted into the army and was determined to be dismissed. A friend advised him to wet the bed at night, but he was simply unable to do so. His reflexes were too well conditioned.

Regressive Enuresis

So far, we have been discussing a child who has never been dry at night. What about the child who has been dry for some months or even years, and then begins to wet the bed again? This can be triggered by any traumatic event in the child's life, and most frequently occurs between the ages of five and eight. Either the arrival of a new baby, sickness in the family, moving house etc. Parents should consult their doctor promptly if their child has what is known as "secondary enuresis."

Parents of sufferers should try not to listen to old wives' tales. Well-meaning friends are often eager to share their knowledge of "cures that really work." Nor should they allow their child to be treated by quacks. There are excellent doctors with a very high rate of success, especially in Israel. In England, the treatment is free, unless one goes privately, and in Israel, the Kupat Cholim pays quite a large percentage of the costs. Whatever treatment your child receives, try to keep him feeling good about himself and assure him that there is light at the end of the tunnel.

[Ed. I had success through a Kupat Cholim doctor who prescribed medication which did the trick within three months, on a boy past ten.]

 

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