Is Your Child Bed-wetting?

Bed-wetting is an important issue related to childhood. While it is normal up to a period, it becomes cause of concern if persists beyond that. Let us look into the matter and try to understand it.
What is normal? Toilet training in children begins around 2 years of age when they start perceiving the bladder control and can tell when they feel the urge to to micturate. Nearly by the age of 5 years, 90-95% of children are nearly completely dry by day and 80-85% are dry by night. Concern for parents arise when their child wakes up in morning soaked in urine even after the age of 5 years known as nocturnal enuresis in medical terms.
It may be primary or secondary. Primary is when nocturnal urinary control is never achieved, and secondary is when the child had remained dry at night for some months initially.
Predisposing factors:
1. Sex: 60% are boys.
2. Family history: positive in 50% cases.
3. Genetic: chromosome 12 and 13 may be involved.
It’s in the genes! If one parent had been affected each child has 44% risk of enuresis. And if both parents had been affected, then the chances in each child go up to 77% of being affected!

It generally ceases spontaneously in approximately 15% of involved who do not have any day time enuresis with each year after 5 years of age, can occur in adult  in <1%.

Causes:
1. Delayed maturation of brain which control the bladder sensation.
2. Sleep disorders: Most children are difficult to arouse in 1st third of night and easy in last 3rd but children with enuresis have an opposite pattern.
3. Constipation
4. Urinary tract infection
5. Diseases like chronic renal failure, diabetes and spinal abnormalities.
What to do? The best approach is to avoid active treatment in children less than 6 years of age and parents need to be REASSURED that the condition is self limiting and will stop by itself.
Precautions:
1. Restrict fluid intake of child to 60 ml after 6-7 pm.
2. Child should void before going to bed.
3. No tea coffee to child after 4 pm.
4. If child snores during bed time, see a doctor to check for adenoids.

Motivational therapy:
Child should not be scolded or humiliated for getting up wet rather should be given reward in any form for dry nights.

Conditioning therapy:
Also known as alarm therapy in which a loud vibratory alarm is attached to moisture sensor in the underwear of child and it rings during voiding. It is considered curative in 50-60% of cases. If this is not available, then an alarm after every 2-3 hours can be set for child to wake up and void, but it can be very cumbersome for the entire family.

Self hypnotic therapy:
It helps the child to psychologically deal with enuresis and motivates the child to void at night if she awakens with distended bladder.

Drug therapy:
Regarded as second line and used only to relieve symptoms. Drugs like desmopressin and imipramine are used only upon prescription by a doctor.

So if your child is bed wetting even after 5 years of age, do not worry! A bit of reassurance, precaution and medical consultation shall do the trick for you.