It is a midnight ritual that has continued all of 8-year-old Roshan’s life — being woken up at midnight to go to the toilet. A great many of us are able to sense when our bladder is full, feel the urge of a full bladder and wake up to urinate. But many children like Roshan do not get woken up by the sensation of a full bladder, and therefore wet their beds. Roshan’s parents are worried he has still not gained bladder control at night.
They are not alone. The fact is, many kids, teenagers, and even adults, bed-wet every night unless they are woken up. While Roshan’s parents need not be alarmed, it is, however, time to take action, as bedwetting traumatises a child psychologically, not to mention the physical hassle. But the good news is, the condition is curable.
By the age of four or five, most children achieve night time bladder control, while day time bladder control is achieved by about three years. Bedwetting or enuresis is three times more common in boys than in girls.
“Ten to 20 per cent of boys over age 6 have this problem. If bladder control has not been achieved by that age, it is time to seek help,” says Dr. Shanthi Raj, consultant paediatrician.
Strangely, bedwetting is higher among children who have problems with tonsils or adenoids. And when you explore the family history, you will often find that the child’s father or an uncle would have had the same problem — enuresis runs in families.
If the problem persists after age 6, paediatricians explore the causes.
“While in many cases, the underlying reasons are not clear, in some children it may be because of an underlying urinary infection, worm infestation, emotional disturbances, family conflicts, hormonal imbalance or an anatomical defect,” informs Dr. Jayanthi Vyas, consultant paediatrician. First, this is investigated and if detected, treated appropriately. Medication is only a last resort and never to be given for children under age 11.
Strategies
When there are no underlying causes, as it happens in many cases, paediatricians recommend these strategies:
Restrict the intake of water or fluids after 7 p.m.
The child should be urged not to rush, but to empty the bladder fully before going to bed.
Increase the child’s bladder capacity by increasing the intervals between each visit to the toilet during the day time.
Get the child to set up an alarm that will wake him up in the middle of the night so that he can visit the toilet. Encourage him to walk to the loo, don’t carry him.
Ask him to commit to himself at bed time that he will wake up during the night to visit the toilet.
Praise/reward him after dry nights. Create a calendar and mark stars for dry nights and crosses for wet ones.
No punishment, but get the child to help wash the bed/linen in case he wets.
A bed wet alarm that sounds when the bed gets even slightly wet helps in many cases.
Making the child the centre of the strategy would reinforce in his mind the need to wake up to empty the bladder. Training should not be erratic.
“Parents should not point out or ignore bedwetting according to their moods,” adds Dr. Hemant Agarwal.
Remain supportive
Never punish a child for bedwetting. “Remember, it is an involuntary action, not something the child does out of laziness,” says Dr. Shanthi.
These children tend to be deep sleepers who do not get woken up by the sensation of a full bladder. Never tease a child about bedwetting. On the other hand, tell him it is a problem that many suffer from, but it is something that can and has to be overcome.
Remember that children feel extremely embarrassed by bedwetting. Make sure you love and support them. It is important if they are to overcome the problem.
At times, children who have achieved bladder control can suffer a relapse, because of stressful events such as conflicts at home, shifting of house, sibling rivalry and change of school. Building a child’s confidence and easing his stress become more critical here, besides the strategy mentioned above.
Insists Dr. Jayanthi, “More than anything, a child has to be positively motivated to achieve bladder control. That is the key to success.”
DOS AND DON’TS
l Don’t take the child to task or punish him for bedwetting
l Praise/reward him after dry nights
l Build confidence in stressful situations
l Encourage the child to visit the toilet at night
l Make sure he empties his bladder completely
l Set up an alarm so he wakes up at night to visit the toilet
l Involve the child in strategies to get over the problem
