Last week I described the problem of enuresis (bed wetting) -- how it is fairly common (10-20 percent of seven year olds) and how there are a large number of contributing factors.
I have recently become aware of the statistic that approximately 3 percent of marine corps inductees have wet the bed within a year prior to their induction.
The majority of the contributing factors to enuresis are initially beyond the control of the child, and are therefore not punishable offenses.
Although motivation should be there -- so that when the child is physically capable of being dry, shear force of habit does not prolong the problem unduly -- there should be no undue coercion or punishment.
Watching for this "readiness" time, while minimizing the damaging effects that enuresis has on the child's self-esteem, is the real goal.
This problem really should be evaluated first by a pediatrician who sees chronic problems. It is infrequent that a referral to a urinary specialist is needed. You should be aware, however, that in this problem there is a wide variation between doctors in the amount of workup and time spent in the office educating about the problem. Some do it well others don't take much interest in it.
It should not be a rushed "by the way, Johnny wets the bed" type of visit. Ask for an extended appointment. Don't take any other children with you, and don't talk about any other problems.
Expensive laboratory studies are usually not indicated, at least initially. What is needed is the physician's time -- time to take a thorough history and do a complete head-to-toe examination - time also to explain, teach and counsel, and more time to follow up.
The basic elements of treatment (preferably in this order) will probably be:
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Self-responsibility. Although the child can't usually help it, it nonetheless is his/her problem and really no one else's. Mothers are angry; father's either deny or are embarrassed; siblings tease and taunt; and the child is depressed and anxious.
Within the limits of his ability, the child can take total responsibility of the problem -- changing bed, washing clothes and sheets, having own bath, taking own medicine, etc., without coercion or belittlement.
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Bathing every morning. Urine has no odor until bacteria have worked on it, changing it to ammonia. Therefore, if clothes and bed clothes are washed every day, a protective mattress is used and kept clean, and the child bathes in the morning, there is little need for the other children at school to even know, much less tease about it.
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Minimize drinking liquids for two hours prior to bedtime. A small drink two hours prior to bedtime frequently controls the child's thirst. Parents may want to take the child to the bathroom when they go to bed themselves.
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Eliminate food allergens. Stop any food which has in the past, even in infancy, caused food allergies for a month's trial period, Also caffeine containing drinks (yes even soft drinks) drunk any time in the day can influence enuresis both through bladder sensitivity and overall nervousness.
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Attempts at decreasing anxiety. Anything that increases anxiety in a child's life should be sought out and dealt with. Emotional conflict, anxiety, parental problems, etc., and even life style habits.
In my counseling I have seen everything from hard rock-and-roll music to unrestrained use of HBO with inappropriate movies, to frequent masturbation, to family arguments, to death threats at school, and many others affect or even precipitate the anxiety that reinstitutes the child's enuresis.
I recommend no TV during the hour prior to bedtime; but, instead, soft, soothing reading type music, and a quiet time with mom or dad each night.
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A discrete star chart. There should be five or six stars possible for every day -- one for being dry, but all of the rest should be under the child's conscious control (like washing own clothes, remembering no fluids, cleaning room, etc.).
Unless the child is very young, the chart should not be kept where the whole world can see it.
Rewards should be tailored to each child and should be designed to provide daily motivation as well as weekly.
Rewards should be specific for the child and should not involve any other member of the family. The last thing he needs is to have the family on his case because they didn't get to go to the show.
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Bladder stretching exercises probably don't hurt. Each day he tries to hold his urine as long as he can and then voids (urinates) into a measuring container.
As you record the amount on the calendar, over a period of time he should be able to gradually increase the amount of urine he can contain in his bladder.
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A wetting alarm may be used on the older child to use operant conditioning to train him to be sensitive to the "signals" coming from his full bladder. The best kind is the one in which the snaps fit right on the child's underwear. The wire extends up to an alarm, worn like a watch on the child's wrist. And it's LOUD!
The training is being done into the subconscious and, therefore, does not happen quickly. Over several weeks to months, the child gradually learns to wake up and go to the bathroom during the night if needed.
But they MUST get up! Many will be "too tired" and some even lay there and let the alarm ring. Parents should start the child out correctly for the first couple of weeks; hearing the alarm and making sure that he awakens, goes to the bathroom, changes clothing and sheets and re-sets the alarm before going back to bed.
[Parenthetically once a father told me that his son was such a "sound sleeper" that he refused to awaken - until he threatened a bucket of water, and actually followed through with it. "He only didn't awaken that once and never again," he said.]
Most children will tell you that waking up is preferable to having a wet bed!
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Medication may be used in the older child on an individual basis. The medication, Tofranil, seems to work by causing a small degree of urinary retention and possibly decreasing the amount of dream sleep. It is extremely deadly in a poisoning situation, especially to younger brothers an sisters.
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Hypnosis can sometimes be effective in an older child or adolescent; but, mainly when coupled with counseling.
[Some sources for alarms are: Pottypager: 1-800-497-6573; Nytone alarm: 1-801-973-4090; Nite Train'r Alrm: 1-800-544-4240; Wet-Stop Alarm: 1-800-346-4488]
Pituitary hormone, although more readily available now, should never be used for this minor condition.
Now, be sure and check the index (menu bars above) for: other related articles on this topic: or, recently answered questions, which are sometimes more specific.