Medically referred to as enuresis, there is a myth that laziness is the sole cause of bedwetting in children but it may be more of a genetic condition. Why do children wet the bed and how can you help? VERA ONANA elucidates on this controversial topic by engaging experts in paediatrics and clinical psychology, in this report.
It is many a mothers’ nightmare to deal with soaked night clothes and beddings as well as the stench that emanates from those items the next morning. While some mums are lucky to have children that gain control of their bladder early enough, some are not. Enuresis, generally known as bed wetting, is a major issue in many homes and a serious challenge for many mothers.
However, as rampant as the condition is, it is shrouded by a cloud of secrecy that makes it even harder to deal with. While mothers can easily talk about other medical conditions like asthma, allergies or malaria, they may be reluctant to talk about a bed wetting child.
Certified in paediatrics by the American Board of Paediatrics, Dr Atinuke Uwajeh of the Paediatric Partners Hospital, Victoria Island, Lagos, stated that bed wetting among children is relatively common especially before the age of five years.
“Bed wetting is often a stage in normal development of children and most children are able to have dry nights by the age of five.”
She pointed out that nocturnal enuresis, which is night time bedwetting, is more common in boys while diurnal enuresis, known as day time bedwetting, is more common in girls.
Dr Uwajeh clarified that while most children are able to attain dry nights by the age of five. Approximately 15 per cent of five-year-olds will experience some form of enuresis and about 15 to 25 per cent of these will resolve spontaneously within the year. Although frustrating for parents, bedwetting may not be considered a problem till the child is after six years of age.
Bed-wetting may be genetic
Researchers say there is no one single cause of bed-wetting, but if one wants an easy target, one may do well to consider one’s own DNA. Scientists have even located some of the specific genes that lead to delayed night time bladder control on the chromosomes 13, 12 and eight. Therefore, majority of bed-wetting may be inherited.
Dr Uwajeh corroborated the scientific claims saying “there is a genetic predisposition with bed-wetting. Seventy-five per cent of children with nocturnal enuresis have a first-degree relative who also wet the bed in childhood. The risk of a child being affected is 43 per cent if one parent had enuresis but becomes as high as 77 per cent if both parents had enuresis.”
Other causes of Bed-wetting
While genetics may be just one reason for enuresis, researchers claim that a number of other factors likely contribute to bedwetting in children. Dr Uwajeh attests to the fact that the causes of bed-wetting are multifactorial. Aside from genetics, she itemized the following:
- Difficulty waking up from sleep
- Slower than normal development of the brain. This reduces the child’s ability to stop the bladder from emptying at night.
- Delayed bladder maturation. The brain and bladder gradually learn to communicate with each other during sleep but if this takes longer to happen in some children, bed wetting is imminent.
- Hormonal factors (low anti-diuretic hormone ADH). If a child does not produce enough anti-diuretic hormone, which is the hormone that slows urine production at night, the child may wet the bed.
- Infections- Urinary Tract Infections (UTIs) in children may be another reason.
- Constipation- Full bowels press on the bladder and can cause uncontrolled bladder contractions during waking or sleep.
- Spinal cord anomalies
- Abnormalities in the urethra in boys or ureters in girls
- Certain foods—foods or drinks that contain caffeine or alcohol or certain medications like diuretics cause the bladder to fill up at night and there for cause enuresis. Some children have habit polydipsia, that is, they drink sips of fluids through the night and this may predispose them to enuresis.
When should a mum start worrying about bed-wetting?
According to scientists, bedwetting that’s caused by medical problems is genuinely rare. Though Urinary tract infections, sleep apnea, diabetes, spinal cord problems, and deformities of the bladder or urinary tract all are worth mentioning, they may not probably be worth worrying over, experts say.
How can you help your bed-wetting child?
Dr Uwajeh said “most kids are already embarrassed that they had ‘’an accident” while sleeping already. This is not the time to shout, abuse or beat the child. They know it is bad, they are embarrassed, they are also concerned about the smell and it is even worse if the child is in boarding school. To help your child, it is important to have your pediatrician examine your child to be sure there are no treatable causes like bladder infection, constipation, brain developmental problems or hormonal problems.”
She highlighted other home remedies to be:
- Limiting fluid intake after dinner at night.
- Regulating your child’s period to empty the bladder or urinate. I tell most parents to make sure the child urinates before going to bed and the again to use the alarm system to wake up the child in the middle of the night to use the toilet.
- Let your child know it is okay to get up in the middle of the night to use the toilet.
- Use alarm system. There are a number of bed wetting alarm devices in the market that could be use. This helps to condition the child to wake up at regular intervals.
- Use a reward system when there are episodes of dry nights.
- Punishing your child for bedwetting does not solve the problem. It is okay to make the child help clean the room and help with the laundry but let your child know it is not their fault and if a first degree relative had the same problem, share that information with your child too.
Bed-wetting and your child’s mental health
Mental health expert, Senior Lecturer, Consultant Psychiatrist and Clinical Psychologist at the Department of Mental Health, Obafemi Awolowo University/Teaching Hospitals Complex, Dr Boladale Mapayi, speaks on bed-wetting and its psychological implication on a child.
How does bed-wetting affect a child’s psychology?
Enuresis is an extremely stressful condition for the child. A child who has not attained dryness by the time his/her siblings and friends have is often prone to ridicule from family and friends which will usually make the condition worse. The child is often plagued with embarrassment and guilt which can be worsened when people around, especially family, castigate the child for a behaviour which is not under voluntary control.
What kind of mental issues can develop in a child who is constantly bedwetting and is being ridiculed?
A number of children with enuresis have problems with low self-esteem, depression, anxiety and even suicidal ideations/attempts. Some children will develop externalizing symptoms, such as delinquent or aggressive behaviour. Often, this is due to lack of understanding by family members, friends and the larger society.
How does it affect the self esteem and confidence of a child?
Enuresis will usually diminish self-esteem but this can be greatly helped by support from the family. We must understand that the vast majority of children with enuresis may outgrow it without need for medication.
Does stress and anxiety have a relationship with bed-wetting?
Definitely, a number of children develop enuresis with a new source of stress, for example, the birth of a sibling, moving into a new house or even physical or sexual violence witnessed or experienced. This is an important factor that is essential for parents to take note of. In a child with enuresis, stress and anxiety often worsen the situation, so every form of punishment for wetness will create a vicious cycle that can only make the situation worse.
How can mothers help without trampling on the sensitivity of the child?
- Help your child to regain control. Assist to clean up but let the child take responsibility. It is important that the child knows it is not punishment but that accidents do happen.
- Maintain a strict no teasing rule in the house among siblings.
- Even when you are tempted to, never react in anger, you must always remember that this is not the child’s fault.
- Ensure that your child does not miss out on activities because of the enuresis. Try to address barriers like providing extra underwear, disposable night wears, a cover for the mattress and dietary advice like keeping away from caffeinated drinks and reducing drinks at night or short term medication.
- You should always plan with your child and have the child take an active role in the management of this condition. Talking about how common enuresis is and how it tends to run in families and how most people overcome it eventually will alleviate the fears of the child.
What roles can older siblings play?
Older siblings need to show empathy and support. It is important to keep a no teasing rule when it comes to bed-wetting. The child with enuresis must not be the butt of any joke. The support a child experiences at home will definitely inspire and raise morale to deal with the outside world.
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