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Helping Bed-Wetters Overcome the Habit

Punishment's never the answer, say experts

MONDAY, Feb. 18, 2002 (HealthDayNews) -- Bed-wetting is an issue that neither kids nor their parents even want to think about, much less talk about.

That's probably why many don't realize it can be effectively treated and cured in a relatively short period of time.

The lack of understanding and communication about the issue were a central focus of a panel discussion on bed-wetting that was featured in a recent issue of Infectious Diseases in Children.

Medically referred to as "primary nocturnal enuresis," bed-wetting typically is considered a problem if children are unable to stay dry through the night after about age 5 or 6. The problem is more common in boys than in girls.

But unless the bed-wetting started after a child had been dry through the night for at least six months, experts say that the problem is probably not behavioral.

"Most parents feel bed-wetting is behaviorally or emotionally grounded, and they try to address the issue on that level. But, [if there hasn't been a prior period of staying dry at night], it's not the case, medically" explains Dr. Alan Greene, a pediatrician and assistant clinical professor at Stanford University School of Medicine.

The condition is, in fact, believed to be largely hereditary and has even been linked with the 13th chromosome, says Dr. Mark R. Zaontz, head of the Section of Pediatric Urology at the Children's Regional Hospital in the Cooper Health System in Camden, N. J.

"We know that if both . . . parents wet the bed when they were young, there's about a 77 percent chance that one of their children will have the problem, too. If one parent had the problem, you have about a 44 percent chance that a child will. And if neither parent had bed-wetting problems, you have about a 15 percent chance," Zaontz explains. "So there's a very strong hereditary component."

According to Greene, experts understand that bed-wetting is specifically caused by a combination of two important developmental components: kids needing to urinate at night more than is normal, and their undeveloped internal signals, which wake up most adults at night when they have to urinate.

"As we get older, people stop making as much urine at night, and we also tend to become more aware of external signals to wake up more easily," says Greene.

"There are some people who will have the greater need to urinate at night but who are awakened by the internal signals, and there are some people who are deep sleepers but who don't have that increased need to urinate at night," Greene adds. "But it's the combination of both of those things that causes bed-wetting" in children.

The two treatments that doctors say are the most effective, however, treat the two bed-wetting components separately.

One approach helps develop the internal signals, through use of underwear or pajama linings equipped with a moisture sensor that triggers an alarm when even a drop of moisture is present.

Because the bed-wetting child is still a deep sleeper, the alarm at first usually only awakens an adult in the house, who then can take the child to the bathroom.

But the routine of being awakened and taken to the bathroom night after night can help children develop the internal signals to wake themselves up when necessary.

"It's like when you start a new job and have to wake up much earlier," says Zaontz.

"At first, you'll need an alarm clock to wake you up, but over a short period of time of being awoken by the alarm at the same time, you'll probably start naturally waking up just a few minutes before that alarm goes off," he says. "So these devices work on that same principle, and after about 12 weeks, kids can establish more attentive waking patterns."

Another popular approach is to address the need to urinate with medication that works to reduce the amount of urine a child produces overnight.

The medication, called DDAVP, is a synthetic form of a hormone, called vasopressin, that naturally reduces the amount of urine the body produces at night.

"(DDAVP) has been shown to be very effective," says Greene. "The child makes less urine at night, and if they're on the medication, just the rhythm of staying dry can get them in a permanent habit until they grow out of the problem."

Although the two methods are the most popular choices recommended by doctors, they are not the most common exercised by most parents.

"Punishment is one of the most common things people do in response to their childrens' bed-wetting, and all that does is makes things worse," says Greene.

Even those who try more sensitive approaches, like positive enforcement charts, are addressing the issue on a behavioral level that probably won't work, Greene adds.

"If the positive reinforcement charts haven't work in two weeks, they're likely not going to work at all and tend to instead leave kids feeling even more discouraged and powerless," he says.

Both experts say parents and doctors need to take more responsibility in discussing potential bed-wetting problems.

"There are many kids out there with bed-wetting problems, but if the parent doesn't volunteer the information and the physician doesn't ask, the child is probably not going to get the proper treatment," Zaontz says.

Greene adds that parents -- and kids -- shouldn't be shamed into silence, because bed-wetting is a widespread problem.

"There are, in fact, an estimated 5 million to 7 million children over the age of 6 in this country alone who suffer from bed-wetting problems," Greene says.

What To Do

The American Academy of Pediatrics offers this helpful information on bed-wetting and school aged children.

Read more about bed-wetting at the American Academy of Family Physicians' familydoctor.org.

SOURCES: Interviews with Mark R. Zaontz, M.D., head, Section of Pediatric Urology, the Children's Regional Hospital at Cooper Health System, and professor of surgery and pediatrics, Robert Wood Johnson Medical School, Camden, N.J.; Alan R. Greene, M.D., pediatrician, assistant clinical professor, Stanford University School of Medicine, Palo Alto, Calif.
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