Sunday, July 10, 2005

Bedwetting: Debunking Myths and simplifying treatment

Bedwetting is an extremely common pediatric problem. This is underdiagnosed due to unecessary shame and guilt associated with it among parents and even children.
Common Facts & Myths about Enuresis
First the stats
Almost 10 % of 10 year old kids wet the bed occasionally, you are not alone!
After the age of 5 years only 15 % children wil become dry every year without treatment.
In most cases treatment of bedwetting should begin between 6-7 years only, anything before that and there is good chance that your kid will grow out of it.
Bedwetting is a develpomental issue, something the child does during sleep without prior knowledge. Do NOT blame / punish the child or yourself. Your kid is not being lazy or stubborn, he really does not know. What the child needs is reassurance and encouragement.
Bedwetting tends to run in families, so if it is true, telling the child 'daddy used to do this' may help increase their self esteem.
TREATMENT Options simplified:
Before going to the doctor
Sleep half an hour early - a less tired child is going to sleep 'light' and therefore is more likely to wake up to go to the bathroom.
Lots of water in the day, restricted fluid at bedtime (not more than half a glass 2 hours before sleeping), avoid caffeine (carbonated fizzy drinks)
Star chart and positive reinforcement - Put stars (or stickers) on a calendar in the child's room for every dry night. IF the child remains dry continuously for a few days, give him some small reward (if this does not work for around 15 days, get a doctor's opinion)
Just what the doctor ordered
Remeber that any bedwetting beyond 6-7 years can have a lot of social consequences like other kids making fun of the child, difficulty in sleeping over with friends and relatives etc. More importantly only about 1 in 6 kids every yeare will outgrow this problem after this age spontaneously, therefore get it treated.
3 major treatment options are:
DDAVP - It is a hormone that is usually present in th body and this leads to a decreased urine production at night. It is said that a deficiency of this hormone may lead to bedwetting, therefore treating the child with a tablet or a nasal spray may be useful for preventing bedwetting. This is especially very effective for 'emergencies' like social occasions nightouts etc. where rapid control is needed. The only problem is that long term treatment is needed since on stopping this medicine there is a high chance that bedwetting will recur.
Bedwetting alarms are now available at leading pharmacies in India too, and over a period of around 3 months they are very useful in decreasing/ stopping bedwetting altogether. For quicker relief these may be combined with DDAVP.
Imipramine tablets are a cheaper treatment option however these have significant side-effects like nervousness, tiredness and intestinal problems.
Remeber for most kids bedwetting is nothing more than an inconvenience or at worse a social problem.
If a previously dry child starts bedwetting
Daytime bedwetting in an older child amy be because of Diabetes, Urinary tract infection or psychological problems like sibling rivalry etc.
Any other associated symptoms like urgency while passing urine, fever, abdominal pain etc.
Based on an article in medicinenet

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