Sunday, October 22, 2006

Understanding Bed-Wetting in Children

Bed-wetting in children is more common than most people would like to believe. In fact it is believed to be widespread among children who are six years of age and younger and it is more common in boys than it is in girls. Approximately five to seven million children develop a problem with bed-wetting on an annual basis. The most general definition for bed-wetting is simply wetting the bed at night during sleep. The technical or scientific name for bed-wetting is nocturnal enuresis (or just enuresis) while some people simply call it sleep wetting. It is believed that an estimated 15 percent of six-year-old children wet their beds regularly while this percentage drops to five percent for 10-year-old children.

Despite plenty of research, the medical community has not been able to isolate one particular reason while bed-wetting takes place. Instead doctors believe it can often be traced to more than one factor. Any girl who is four years or older who wets her bed on a consistent basis is deemed a bed wetter by doctors and for boys this is anyone who is five years or older. The ability to control the process of the bladder throughout the daytime hours tends to develop first while the ability to control it at night during sleep comes later on. The tendency to wet the bed does not strike all children and studies show that it does tend to decrease with age. Most healthcare professionals do not believe that bed-wetting is a sign that a child suffers from serious psychological or medical problems as compared to children who do not wet their beds at all. Bladder control is a life skill everyone must master but all children do not learn it at exactly the same time in their lives and that is okay. Most children beyond the age of five do not suffer from nighttime bladder control problems but there are many that do. Those who do need support and understanding from their families, and not criticism and scorn.

Type of Bed Wetting

Bed-wetting is generally categorized as either primary nocturnal enuresis (or primary bed wetting) and secondary nocturnal enuresis. Primary nocturnal enuresis (PNE) means that a youngster has developed bladder control during the daytime waking hours but for a span of at least six months has suffered consistent episodes of bed-wetting that has now become a chronic problem. Secondary nocturnal enuresis (SNE) means that for at least six months nighttime bladder control was mastered but then suddenly it has started all over again.

Causes of Primary Nocturnal Enuresis

Primary enuresis is believed to be caused by a number of different factors. First of all it has been found to have a strong genetic link. If a parent, grandparent, aunt, uncle or cousin was a bed wetter as a child then future generations are likely to inherit the condition. A great deal of children have deep unconscious sleeping patterns that do not allow them to awaken when their bladder sends the message to the brain that it is full and needs to be emptied. Another common cause of bed wetting in children is having a neurologically immature or physically immature bladder. The bladder and nervous system are closely connected and for reasons unknown, in some children the development of the central nervous system lags behind that of the bladder and therefore it cause nighttime bladder control to develop slowly. It is believed that some children simply have a bladder that is smaller than average and therefore this means their bladders hold less liquid and need to be emptied more often.

There are believed to be physical causes of primary nocturnal enuresis as well such as a bladder infection that has gone undiagnosed (undiagnosed bladder infections can get worse and make their way up into the kidneys to cause further damage). Approximately one to two percent of children who wet their beds do so because of a urinary tract infection that requires a visit to the doctor and antibiotics to clear it up.

Other causes of primary nocturnal enuresis include problems with the ureter in both boys and girls, and for boys only, a problem with the workings of the urethral valves; abnormalities of the spinal cord and hormonal related factors such as not having enough of the antidiuretic hormone which serves to decrease the amount of urine that is made by the kidneys. Children who are plagued by chronic allergies, those who suffer from learning disabilities or children who suffer from attention deficit disorder (ADD) are believed to have higher incidences of primary nocturnal enuresis than do other children who do not experience these problems. In some, but not all cases of nocturnal bed-wetting, the condition occurs alongside a variety of sleep disorders such as sleepwalking and night terrors. However this is the exception as opposed to the rule.

Causes of Secondary Nocturnal Enuresis

Secondary nocturnal enuresis is almost always psychological in nature and related to stress in one way or another. Very often once the stress trigger has disappeared from the life of the child, so will the episodes of bed-wetting. The three most common stressors to trigger secondary nocturnal enuresis include starting school for the first time, the birth of a new brother or sister, and being hospitalized or having to visit a parent or grandparent who has been hospitalized. While school and the birth of a new baby can be exciting to contemplate, for many children they are highly stressful as well.

Other stressful events can also bring on a bout of secondary enuresis such as difficulties with schoolwork or difficulties dealing with peers or a teacher; being bullied at school or in the neighborhood; abuse or neglect that takes place at home (or seeing a family member caught in the cycle of abuse or the neglect and/or abuse of a beloved pet); death; financial problems experienced at home; divorce; alcoholism or other forms of drug abuse; fear over circumstances that seem beyond the control of the child; parents who are always fighting or fighting among siblings, etc.

What Can Be Done About Bed-Wetting?

Doctors believe that the most appropriate way to end bed-wetting for good is to retrain your brain to either wake yourself in the night when your bladder is full or else to allow you to sleep peacefully through the night and hold in the urine until you awaken to empty it in the morning. Both of these ways can be accomplished by performing special exercises meant to strengthen the bladder such as for example, visualizing yourself remaining dry throughout the night, reading books about staying dry all night; holding off using the toilet until late in the day to ensure that your bladder will be empty or close to empty at bedtime and in other cases, using a special alarm that is attached to either your underpants or bed clothes that alerts you if even a drop of urine is spilled. If your bladder begins to let go while you are sleeping, the alarm will sense it and will cause the alarm to either vibrate or buzz, thereby waking you up. There are also drugs such as Desmopressin Acetate (DDAVP) and Imipramine (Tofranil) that can be prescribed but doctors like to exhaust all other options before resorting to prescribing bed-wetting medications for children. The sleep alarm has proven to be extremely effective in a great deal of bed-wetting cases.

How Parents Can Help Their Children

Parents can do a lot to comfort, support and reassure their bed-wetting child that he or she is as normal as every other child and that the bed-wetting situation will eventually pass. Have plenty of patience with your child and never judge your child or get angry or punish your child for behavior that is beyond his or her control. Children do not wet their beds because they want to. It is instead an involuntary reaction. Parents can help their bed-wetting child by making doubly sure that the child does not drink too many liquids close to bedtime. Any liquids with caffeine or a lot of sugar or artificial dyes such as chocolate, soda pop and fruit juices should be avoided in the evening after suppertime. These types of drinks can also make a child very hyper which makes calming down for bedtime even more problematic. Always encourage your child to use the bathroom before he or she turns in for the night, more than once if necessary. You might even want to wake your child up in the middle of the night to inquire if he or she needs to use the toilet. Another important thing to do is to always praise your child on the days he or she wakes up completely dry. Children who are bed wetters often suffer from lack of self-esteem so anything you can do to bolster their confidence is so important.

No comments: