The night is a terrible time, long associated with ghouls and other foul creatures but none of these mythical beasts can compare with the real life terror of bedwetting. For someone who's not suffered from the condition, it may seem like a trivial issue but for children who suffer from it's anything but that. Dr Pankaj Deshpande, a paediatric nephrologist writes more about the issue:
There are children who fear sleepovers; children who're perfectly normal in every other aspect except the fact that they wet themselves at night. One in every 5 children wets themselves before or till the age of five. But parents are often dumbfounded because they don't know what they need to do with these kids.
Figure out if it's actually bedwetting
The primary aim in such children should be to ensure that there is no serious cause of bed-wetting. The child needs to visit a doctor. Conditions like diabetes or certain problems in the kidneys can cause too much urine and hence the wetting at night. These children will also pass too much urine in the day and be constantly thirsty. Certain problems with the spine, bladder or neurological problems can cause wetting at but these problems will be visible during the daytime as well. These problems might include having no bladder control or control on defecation. Basically, these problems need to be ruled out.
The first step for parents after this is to consider whether the child is suffering from an irritable bladder which can be due to stimulant drinks like tea, coffee or fizzy drinks and these children need different therapy.
If he/she does suffer from bedwetting
However, if your child is only wetting at night then it's considered as Primary Nocturnal Enuresis. The first thing I'd like to do is reassure parents that there's no problem with your child's kidney or urinary tract. This occurs due to delayed maturation of the bladder. As the bladder has to learn to hold bigger volumes of urine in the night, the time at which this is achieved varies. In some children, it occurs earlier and in others, later. That does not mean that the children who are bed-wetting have abnormal bladders! To cite an example, a child learns to walk at about 9 months of age. But there are others who learn to walk at 12 months or 15 months. Does this make them abnormal? No. These are normal variations. Similarly, the bladder matures at different times in different children. Hence, though a majority may be dry at 5 years of age, 20% children are still wetting themselves at night.
The parents need to understand that this figure drops as children grow older and by 10 years of age, hardly 3-4% will have bedwetting and by 15 years of age, less than 1% will be troubled by it. More often than not, one of the parents or relatives has also had this irksome problem when they were younger. And as they are dry now, the child will also eventually be dry. (Read: Understanding urinary tract infections in children)
What are the treatment options?
Does this mean that no treatment is required or available? On the contrary, treatments are available. One needs to understand that there is no overnight cure. We need to 'teach' the bladder to achieve its goal faster. To that extent, positive re-enforcement is required. A star chart is the first step in this process. However, even before treatments, certain basic issues need to be addressed.
The child needs to avoid stimulant drinks like tea, coffee, fizzy drinks etc. While fluid restriction is not required, gulping gallons of fluid/water at night does not help. Keep that to a minimum in the evening.
Star charts help to reward children for dry nights achieved so that the child strives to achieve more dry nights subconsciously. About 70 % children can achieve dryness with this method. However it has to be continued for months on end to achieve effects (at least 6 months). If star charts do not help, there are bed-wetting alarms, where electrodes placed in the underwear set off an alarm in the ears to wake the child up. This also helps in conditioning the child's bladder. Success rates of 75-80% are quoted in this measure.
Some parents tend to wake the children up so that they will not wet. While it may work, it has to be a consistent measure and often plays havoc with the parents' and child's sleep.
Short term solutions
All the measures mentioned above are long term solutions but what if your child wants to go for a sleepover? There are medications available in the form of tablets that will work very effectively and keep him/her dry at night for a short period like a month or two. But sadly these medicines are only temporary solutions and don't work long term. Unfortunately, it does not work in that manner and the only long term solutions are mentioned above.
What about parents? How can they help? They need to understand the problem and how it will get better. Do not scold your child for bed-wetting. He/She is not being lazy. Help them overcome it by the simple steps mentioned above. To reiterate, it is not a serious medical problem but more an annoying condition that will resolve eventually. These children not only look normal but are also normal!
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