Yellow spot of agony

Yellow spot of agony

Bed-wetting

Yellow spot of agony

Bed-wetting is a hidden problem of childhood, wherein the child passes urine without his/her knowledge after the age of five years while sleeping.

It is purely a myth that it is caused due to the laziness of the child. Bed-wetting affects approximately 15-20 % of children who are five years of age, 10% when they are seven years of age and 8% at age of nine years, and this may have a serious impact not only on the affected child’s development and behaviour, such as loss of self-esteem, social difficulties, cognitive problems, psychological problems, but also affect their family.

Majority of children achieve complete control of bladder (day and night time) by five years of age. A child is considered to have bed-wetting if s/he keeps on passing urine involuntarily in bed at least two times a month after the age of five years.

Bed-wetting is not an ordinary issue to be neglected. To help children achieve dry nights, parents should:

Never punish, criticise or blame the child.

Encourage and praise the child for dry nights. Giving rewards or putting stars in their notebook can help.

Encourage the child to urinate before going to bed even if s/he does not have the urge to do so.

Limit the intake of liquids in the last two hours before bed time. It is recommended to give 40% of the fluid requirement of the whole day in the morning, 40% in the afternoon and 20% in the evening. Avoid caffeine-based drinks (tea, coffee, cola etc.) two  hours before bedtime.

Remain calm and don’t show disgust and disappointment. Remind the child that you are with him through this journey of getting dry.

Consult your doctor for guidance.

But there are some circumstances where it becomes mandatory to consult a doctor (preferably a paediatric nephrologist), especially when you or your child feels frustrated by the bed-wetting.

If your child is at least six to seven-years-old and has never been able to stay dry overnight, or if your child wets undergarments while awake even after the age of three years, you should immediately consult with a doctor. You should also take care if the child has urgency (runs to bathroom to pass urine), frequency (passes urine very frequently, more than eight times in a day), hesitation (difficulty in starting or maintaining a urine stream) or dribbling (passing some more urine after completing the act of urination, or sleep apnea (pause or shallow breathing during sleep.

Treatment options for bed-wetting include:

Motivational therapy: A token and reward system involves using a chart to keep track of the child’s progress with a gold star for every dry night. About 25% of the children get relief by motivational therapy alone.

Behaviour therapy: Behaviour therapy requires supportive parents, a motivated child and a doctor with patience. The child should be encouraged to void frequently enough to avoid urgency and daytime wetting of undergarments. The child should void once in the morning and at least once during the school time, after school, at dinner time and before going to sleep. Constipation, if present should be managed properly and if required a stool softener can be given.

Use of alarms: The alarm system is used for children who are older than seven, and are well motivated along with their parents. This alarm system is used for at least six months for good success. With good response, the alarm therapy is continued till at least 14 consecutive dry nights are achieved. Alarms therapy is usually effective in 60-70% of children, but relapse is quite common.

Drug treatment: Drugs alone for initial treatment of nocturnal enuresis are never preferred and are usually not considered before the age of eight. The drug which is used for bed-wetting is Desmopressin (DDAVP).The dose and duration of this drug is decided by the doctor. As these drugs have certain indications and some side effects, they should be taken only under the doctor’s supervision.

(The author is consultant paediatric nephrologist, Sir Ganga Ram Hospital, New Delhi)

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