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.]
