Nocturnal Enuresis(bed wetting)
Some children empty the bladder involuntarily and wet the bed at night beyond an age by which sphincter control is normally developed. An occasional lapse by a child should not cause undue parental concern, however if bed wetting occurs frequently then it is defined as enuresis.
There are two types of enuresis: primary and secondary.
Primary enuresis is associated with a delay in the maturation of the neural control of sphincters. It is often associated with problems like mental sub normality and such children have never been dry and continent. On the other hand secondary bed wetting happens many weeks to months after the child has developed sphincter control. Such children develop sphincter control at the correct age, but then for various reasons start bed wetting again. This may be due to overzealous attempts at toilet training by the parents, emotional disturbances in the child or parent child mal-adjustment.
Enuresis or bed wetting may represent a sub-conscious desire of the child to gain the care and attention of his parents as in earlier period of infancy or it may be a manifestation of sub-conscious resentment against parents. Thus enuresis often has a psychological basis.
However, the behavioural disturbance seen in a child with bed wetting may actually be the result rather than the cause of bed wetting and may be attributed to feeling of guilt or shame.
Children with bed wetting sleep deep during the night and it is usually difficult to arouse them from sleep. As a result, the signal from the distended bladder often get filtered at the sub-conscious level and hence lead to involuntary emptying of the bladder.
How to manage a child with enuresis?
The condition of enuresis or bed wetting is generally harmless and self limiting. Children and parents must be reassured about the benign nature of this condition. Approximately 15% of children aged between 5 &10 years wet bed at night. About 1% of the children continue to wet bed beyond 10 years of age. Every attempt should be made to minimise the emotional impact of enuresis in such children. Fear and emotional disturbances associated with bed wetting aggravate this condition; hence parent should not be excessively critical or reprimand their children for bed wetting. The bed sheet should be quietly changed in the morning without making the child conscious about it.
Parents should refrain their children from consuming beverages like tea/coffee, soda or sherbet after 5 o clock in the evening. Parents should encourage their children to habitually empty their bladder before going to bed.
Parents should wake up once during the night and make the children walk unaided to the toilet to empty his/her bladder.
Parents should also train children to retain urine for longer periods. This can be done by encouraging the children to drink plenty of fluids during the day, and persuading the child to hold urine for as long as possible.
With tact and empathy, most children will outgrow the episodes of bed wetting. Parents should remember that they play a vital role in the evolution of their children and their kind and sympathetic attitude will go a long way in development of good sphincter control in children.
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