When your child wets the bed

Contrary to popular belief, bed-wetting, medically known as enuresis, is not caused by drinking too much before bedtime, neither is it a mental nor behavioural problem.

It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom, and it certainly does not happen simply because the child wants to purposely irritate his parents.

Rather, your child’s bed-wetting may have more to do with you than you realise, and it’s important that parents understand what exactly makes their child do it.

Dr Joseph Anedu at Kidz Klinik, Old Hope Road in St Andrew, explains that there are two categories of bed-wetting – psychological and organic. Psychological includes that caused from stressful situations, for example, while organic stems from developmental issues.

Psychological

1. Stressful situations caused by bickering of parents or events in the house like sibling rivalry that parents may not know about.

2. Parents quarrelling with each other.

3. Divorce.

4. Loss of a loved one.

“Anything that destroys the emotion of the child can lead to bed-wetting,” Dr Anedu said.

Organic

1. Slower than normal development of the central nervous system, thus reducing the child’s ability to stop the bladder from emptying at night.

2. Hormonal factors (not enough of the antidiuretic hormone – this hormone reduces the amount of urine made by the kidneys).

3. Urinary tract infections;

4. Abnormalities in the urethral valves in boys or in the ureter in girls or boys.

5. Abnormalities of the spinal cord or a small bladder.

“Most cases of bed-wetting are not organic. But before you handle it, make sure the child does a test,” Dr Anedu advised. “Most times, medication is not necessary. But if a child is given medication, it is only for two to three months.”

Dr Anedu explained the two types of bed-wetting that exist – primary and secondary.

“The primary type affects babies who have never stopped wetting their beds up to the age of six, and then continues as the child gets older,” he said. “This cause is as a result of parents not paying attention to the child to help that child in potty training.”

He added: “The secondary type is where the child stopped wetting his bed between the age of five and six, but has started back some time later.”

Treating a child for bed-wetting before the age of five is not necessary, he said, and this is thought to be more harmful to the child than good.

“Bed-wetting is not a problem until after five or six years old,” Dr Anedu added.

Statistics show that bed-wetting is a fairly common occurrence among children worldwide, and it is said to affect between five to seven million children each year. It is more common among boys than girls.

“This is common in children up to 12 years old and may occur once per month,” Dr Anedu said.

Treatments

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide that your child needs treatment. There are two kinds of treatment: behaviour therapy and medicinal. Behaviour therapy helps teach your child not to wet the bed. This therapy is psychological and involves both parents and child.

“What we do generally is minimise the fluid intake. Even though fluid is not the cause of the problem, it can be a part of the solution,” Dr Anedu pointed out. “But this treatment has to be a team effort between both parents and child.

“We instruct the child not to have any fluid intake from 6:00 pm, to pass urine before going to bed, and waking up (parent has to wake child) several times during the night to pass urine.”

The process of waking up should happen at two-hour intervals. Parents should ensure that they check on the result of what is happening with your child by recording whether or not the child actually passes urine and at what time.

“That is why parents have to be fully involved,” Dr Anedu said.

After waking the child, parents need to ensure that he is fully conscious. A child who is not conscious of his/her actions will continue to wet his/her bed not realising he/she is actually able to get out of bed to pass urine. This will help him/her break into the habit of waking up to pass urine by himself/herself.

Psychological treatment

While working on the physical, you have to also work on the psychological. This entails counselling your child about whatever is stressing him and verbally letting the child know he has to make an effort to stop bed-wetting. The child has to make up his own mind about wanting to stop.

It’s true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn’t be made to feel guilty about something he/she cannot control. It’s important for him/her to know that bed-wetting isn’t his/her fault. Punishing your child for wetting the bed will not solve the problem, in fact it makes it worse.

Said Dr Anedu: “Involve the child without letting it seem you are forcing him. If you force him, that can worsen the situation and the child will – out of fear, become tense and pass urine on the bed.”

“The most important part of the treatment is co-operation between child and parent,” he added.

However, treatment for each child is never the same as each one’s emotional disposition will be different.