Friday, February 25, 2011

Health Care and Bedwetting

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a developmental stage. Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, nighttime bladder control simply may not be established. If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting, according to the Mayo Clinic.

A number of things can cause bed-wetting, according to FamilyDoctor.org. Some of the more common causes of bed-wetting include the following:
•Genetic factors (it tends to run in families).
•Difficulties waking up from sleep.
•Stress.
•Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night).
.•Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night).
•Urinary tract infections.
•Abnormalities in the urethral valves in boys or in the ureter in girls or boys.
•Abnormalities in the spinal cord.
•A small bladder.

Bed-wetting is not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom. Children achieve bladder control at different ages, according to Family Doctor; and by the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to 6 years of age is not unusual, even though it may be frustrating to parents. If a child is younger than 6 years of age, treatment for bed-wetting usually is not necessary. Although most children who wet the bed are healthy, your doctor can help you determine whether your child’s bed-wetting is caused by a medical problem. First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes.

According to Family Doctor, your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home. Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

The most important reason to treat enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by the parents, according to Medscape.com. Most children with enuresis feel very much alone with their problem. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic. A positive attitude and motivation to be dry are important components of treatment. Children with enuresis benefit from a caring and patient attitude by their parents; punishment has no role. A positive approach by the physician is also important to instill confidence and enhance compliance. Many children have given up on the concept of dryness, and an optimistic attitude should be encouraged. Behavioral modification with positive reinforcement may enhance treatment results. Consistent follow-up is important to gauge the therapeutic results. An explanation of the probable cause of the enuresis is important for every family. If a child has no daytime symptoms or has experienced significant dry spells in the past, the presence of a structural abnormality as a cause of the enuresis is unlikely. This should be explained to the parents to allay any fears about other causes and to reassure that invasive investigations are not necessary. Parents should be asked to provide specific examples of potential causes that have them worried, so that these often irrational fears can be discussed and relieved. Much more detail can be found at this site: http://emedicine.medscape.com/article/1014762-treatment.

Bed-wetting can lead to behavior problems because a child may feel guilt and embarrassment, according to Family Doctor. 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. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem. It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child). Remind your child that it's okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child's mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying disease, according to eMedicineHealth.com. In fact, a true organic cause is identified in only about 1% of children who wet the bed. However, this does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient. There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months). Much more detailed material about bedwetting can be found at this site: http://www.emedicinehealth.com/bedwetting/article_em.htm.
 
According to ChildDevelopmentInfo.com, almost all children outgrow their bed-wetting habit. As children mature, their muscles become stronger and their bladder capacity increases. They tend to sleep less deeply and to become more sensitive to messages the bladder sends to the brain. There are two approaches to treatment: Medical or Behavioral. The medical treatment usually consists of the use of one of two drugs--Imipramine (Tofranil) or Desmopressin Acetate. Behavioral treatment is often more effective and certainly is safer than medical treatment. While behavioral treatment may take somewhat longer to show results, the improvement usually continues indefinitely. More info about treatment can be found at this website:  http://www.childdevelopmentinfo.com/disorders/bedwetting.shtml.
 
Although embarrassing for children, and frustrating for parents, bedwetting can be resolved over time with patience, encouragement, and treatment. Remember that the condition is most likely temporary and should be resolved in time. Talk with your family doctor, and discuss the situation with your child in a non-theatening manner. It's just as much a difficult circumstance for your kid as it is for you. Understanding, common sense, awareness, and love rule the day. Take a deep breath and don't lose control. Keep in mind that you were a child once, too.  

Until next time.

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