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BEDWETTING   Enuresis, or bedwetting, is an involuntary discharge of urine occurring beyond the age when a child should have bladder control. It is a common problem affecting 15% to 20% of five-year-old children. Usually, a child learns bladder control by two and a half to three years of age. Accidents can occur and it is quite common for the preschool child to wet his bed. Bedwetting is two to three times more common in boys than in girls. It ceases spontaneously in 15% of those involved each year, becoming much less common when the child approaches puberty. Most children outgrow this problem eventually. By the time a child is about five or six years old and starting school, parents should treat this condition.

Only rarely do real physical abnormalities cause this condition. About one in ten may have some physical disorder such as a bladder infection. If your child is able to stay dry during the day then it is unlikely he has a serious physical problem. It sometimes seems to run in families, suggesting an inherited tendency. Usually, a combination of physical immaturity and a reaction to emotional stress cause this problem.

Physically, the child's bladder has not expanded to its full size and forces the child to urinate more frequently. Most children who wet the bed are particularly sound sleepers. They fail to achieve wakefulness in time to avoid wetting the bed.

Some children, having become dry, revert to bed-wetting when something upsets or worries them during the day. This suggests that stress may be a contributing factor in some cases. Some factors that may trigger bedwetting include a move to a new house, marital conflict, birth of a sibling, or death in the family.

There are five general categories of treatment for enuresis: psycho- and hypno-therapy, motivational therapy, bladder training, medication, and conditioning therapy. The first group, psychological counseling and hypnosis, are useful for only a minority of the children with enuresis. We reserve this type of treatment for those who have severe behavioral or emotional problems.

The most important single factor in resolving childhood bedwetting is a high level of parental love and understanding. Parents often become angry at the amount of washing they have to do. However, remember that your child is not wetting the bed to spite you or to make more work for you. He has little control over what he is doing. This behavior is embarrassing to the child and he wishes consciously to be able to stop wetting the bed. Re-assure your child. Tell him that it doesn't matter that he wets the bed. Tell him you love him just as much. Tell him that you will both work together to get him dry. Prepare your own mental attitude to accept temporary failures and relapses.

Motivational therapy involves giving the child positive reinforcement for dry nights but no negative reinforcements for wet ones. Child and parent can chart the dry nights. Give your child a small token or reward if he has one or two dry nights. With increasing success, you can give him a more substantial reward. You can incorporate this responsibility into a behavioral chart. I will post an article on behavioral management in the near future. You should NOT punish or humiliate your child. Older children should launder their own soiled bedclothes and pajamas.

Some authorities believe that children with enuresis have a small bladder capacity. Sometimes, bladder stretching exercises may help. During the day, encourage your child to hold his urine as long as possible to learn bladder control and to increase bladder capacity. The child should void before retiring. Do not give your child liquids after dinnertime.

Medication, such as imipramine (Tofranil) is effective but relapses and drug tolerance may occur. The newest drug to be used for enuresis is DDAVP (desmopressin), an antidiuretic. This drug decreases the production of urine. Administration is by nasal spray. The drug produces a rapid response and seems to be effective. However, relapse rates are high and the medication is very expensive. As with any medication, you should be aware that side effects may occur.

The use of conditioning devices, such as an alarm that rings when the child wets a special sheet is usually not necessary. It is helpful in the persistent cases, where motivational techniques fail. It is a relatively inexpensive form of treatment and is helpful when used in combination with other techniques.

Remember, bedwetting is usually not a serious condition and spontaneously resolves as the child gets older. Using the above treatment techniques will resolve this problem sooner. It usually takes more than just one night to overcome bedwetting, but your child will remember your love and understanding for a lifetime.

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