Bedwetting may be embarrassing for growing children, but there are solutions for a dry and sound sleep too.
Bedwetting is involuntary urination in children during sleep. It can occur during the day as well as night. Night time bedwetting, which is the commonest, is called nocturnal enuresis.
Urination is involuntary for kids and it’s only by the age of four that they have some degree of control over the bladder. While daytime control comes easily, nighttime control takes time.
Bedwetting can be of two types:
- Primary bedwetting
- Secondary bedwetting
In this case, the child has not stopped wetting the bed since early childhood, which means the child has not had a dry night for a significant period of time.
Causes of primary bedwetting
The causes could be that the child cannot hold urine for the entire night or does not realize that he has to wake up when his bladder is full. Sometimes external factors, such as winter season and intake of excessive fluid during evenings, also add to this type of bedwetting.
Secondary bedwetting is bedwetting which starts again after the child has had a dry spell during the night for a significant period. For e.g. A 10-year-old child who was toilet trained at the age of four and had stopped bedwetting completely since then, starts bedwetting at the age of nine.
Psychiatrists opine that secondary type of bedwetting might be a sign of either a medical or emotional problem. Children may display other symptoms such aswithdrawn behaviour, poor school performance, poor appetite and disturbed sleep.
Causes of secondary bedwetting
Structural abnormality: Secondary bedwetting is also known to occur due to abnormality in the organs or nerves involved in urination.
Neurological issues: Psychologists suggest that secondary bedwetting is seen in kids with abnormalities in the nervous system or an injury of the nervous system. This abnormality/disease or injury may upset the neurological balance that controls urination.
Emotional stress: Stress could come in many forms – conflicts between parents, starting school, addition of a new baby to the family, moving homes, which also means having to make new friends, facing exams or sometimes physical/sexual abuse. These could be some of the reasons for secondary bedwetting, opine psychologists.
Other causes for secondary bedwetting include obstructive sleep apnea (excessively loud snoring/choking while asleep), pinworm infection (intense itching of the anal and/or genital area) and excessive fluid intake. Apart from this, experts say that in a lot of cases the children who wet the bed have a parent who did. So, these children will stop bedwetting at around the same age that the parent did.
Research has shown that while primary bedwetting can lead to depression, the secondary type can can be a complication of depression if not intervened at the right time and with the right approach.
Tips to deal with bed wetting
- Positive attitude: Many kids are afraid of darkness at night. So, at times even if the bladder gives the signal and the brain reads it, the fear of going alone to the dark bathroom leads to bedwetting. So, ensure that as a parent or care taker you create a scenario where in the child can comfortably wake you up to take him/her to the toilet. Never get irritated or grumpy about the fact that the child has disturbed your sleep by waking you up at night. This might discourage the child to wake you the next time. So do reinforce the positive attitude for waking you at night.
- Alarm Technique: Wake the child in 1.5 hours after sleeping to use the toilet. Ensure that you wake the kid completely. The child should be awake and alert when you are taking him/her to the bathroom. Never take the child to pee in a sleepy state. This activity has to be done without fail, religiously for about three months for any form of expected results. In case the kid is still wetting the bed, set the alarm twice at night.
- Behaviour modification technique: These are for kids above six years of age. Make them change their bed-sheet once you notice that they have wet their bed. This can be taken as one of the behaviour modification techniques. As no one likes to change stinky sheets, it could be a negative reinforcement for them, to take a lesson from this episode. It motivates them to try and be dry. Also, kids who are older are often times embarrassed by their parents discovering the wet bed. If they make a habit of changing their own sheets, it can save them the embarrassment.
- Be sensitive: Never tease the kids about bedwetting, especially in front of siblings or peers. At times this can be a very sensitive issue for them, but things are not in their control all the time. Remember not to mention the bedwetting episode even while reprimanding the child for some other reason. Parents should remember not to link this to any other topic.
- Rubber sheet: One practical tip is to have a rubber sheet permanently on the kid’s bed under the bed sheet, at least until the child has a dry night.
If all these attempts fail, then you need to see consult a psychiatrist for further help.
With inputs by Dr Abha Bang, Psychiatrist
Photograph via sxc.hu
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