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Parents, Public Misinformed on Bedwetting

Most still think it's a psychological problem, not a physical one

SUNDAY, June 13 (HealthDayNews)-- When an older child wets the bed, much more is at stake than soiled sheets.

Harsh, justified stigmas surrounding bedwetting persist, experts say, even though science has long understood that bedwetting is a physical, not psychological, condition.

In fact, in a recent survey of American parents, only 38 percent knew that bedwetting stems from physical causes.

"The issue has been 'Oh, these kids are lazy and they're not getting up.' That's really not at all the case," explained Dr. Marc Cendron, a professor of urology at Harvard University.

"What's happening is that these kids just have a nervous system that doesn't allow them to integrate the information that's sent up to the brain by the bladder and act on it," he said.

Urologists estimate that between 10 percent and 15 percent of children aged 6 and 7 wet the bed on a regular basis.

However, Cendron explained, as children's bodies mature, that number falls by about half each year, until only about 1 percent to 2 percent of kids continue to wet the bed by age 14 or 15.

In the mid-20th century, psychologists and pediatricians theorized bedwetting might be rooted in underlying stress or "acting out." That theory has long since been discounted.

"It's definitely a neurologic issue," Cendron said.

"What happens is that our bladder works rather independently of the brain when we're babies," he added.

For most children, brain-bladder neurological connections will mature with age, letting the brain receive signals that tell it when the bladder is full and when voiding is appropriate.

Those connections simply mature later in kids affected with bedwetting, Cendron said.

Unfortunately, that message hasn't been getting through to the public, according to Amy Dunlop, a pediatric nurse practitioner in Danville, Ill.

In the parent survey, sponsored by the National Association of Nurse Practitioners, a full 26 percent of parents said they believed bedwetting had psychological roots.

"The general public still understands this to be a mental health problem," Dunlop said. "So a lot of education needs to be done to teach parents that it's not the kid's fault, they're not doing it deliberately."

She said bedwetting -- known in medical parlance as nocturnal enuresis -- can be controlled, often by simple changes in daily drinking and voiding behavior.

"Many school-age kid do not drink fluids during the day," she pointed out. At the same time, they often avoid using dirty, crowded school washrooms.

"So these kids go all day without voiding or drinking until they get home," she said. Thirsty upon their return home, these children then consume large quantities of liquids in the hours before bedtime.

Encouraging kids to drink and use the bathroom during school hours can help diminish bedwetting over time, Dunlop explained.

Medical treatments are also available. Most effective is behavioral change therapy involving a moisture-sensitive alarm that goes off when sleep-time urination occurs.

"The basis of this therapy is essentially a conditioned response to the stimulus," Cendron said. "It takes a few months; it's a long-term therapy, and it's quite effective. The research shows that it works in 50 percent to 80 percent of cases."

Alarm therapy takes a real commitment from parents, however. "You have to remember that if a child is 8 years old, he's been wetting the bed for 8 years," Dunlop said. "It's going to take more than a week to correct this problem."

Medications also exist that work by either reducing the amount of urine produced by the kidneys or enlarging the bladder's holding capacity. These drugs have good track records in controlling bedwetting, with few side effects, Cendron said.

Still, it's the emotional toll of bedwetting that is of greatest concern to kids affected by the condition.

"It's not just the teasing," Cendron said. "It's the parental response, the disapproval, the punishment -- there's reports of physical abuse of kids who wet the bed because of the level of frustration that it causes. And it's a well-documented fact in the psychological literature that kids with bedwetting suffer from reduced self-esteem."

Parents can best help a child deal with bedwetting by offering compassion and support.

"They should make the child understand that it is not his or her fault," Cendron advised. "And then they should seek out medical advice."/p>

Dunlop agreed. "This is a fixable problem," she said. "They are not alone."

More information

For details on the causes and treatments of bedwetting, check with the National Kidney Foundation or the American Academy of Pediatrics.

SOURCES: Marc Cendron, M.D., professor, urology, Harvard University, and staff pediatric urologist, Children's Hospital, Boston; Amy Dunlop, RN, advanced practice nurse, pediatrics, Buranakul Pediatrics, Danville, Ill.; July 2003 National Opinion Poll, National Association of Pediatric Nurse Practitioners and Children's Hospital of Philadelphia
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