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CJULY 24,1997 AUGUSTA FOCUS
10A
Bed-wetting could create back-to-school anxiety
- While millions of children in the
- U.S. suffer from bed-wetting, many
- won’t speak about it for fear of
- rejection and humiliation by their
friends. The good news is that
- successful treatment is available.
' The problem is not developmental
- or emotional, but a physiological
. problem. Back-to-school physical
" examinations offer parentsa chance
to talk with a physician about the
. condition.
' Untilthisyear, 13-year-old Bobby
- never had friends sleep at his house
. because he wet the bed. He had his
'own room since his brothers
» wouldn’t share onewith him. Bobby
' was too embarrassed and never felt
,normal. “My family didn’t even
: want to be around me,” said Bobby.
“I think they thought I was a freak.
My brothers made fun of me. I
hated it.”
. There are five to seven million
* children in the United States just
- like Bobby. They suffer from pri
. mary nocturnal enuresis, more com
monly known as nighttime bed
- wetting. Although many children
outgrow bed-wetting by age six, for
some it may continue into adult
hood. Statistics show that, of chil
dren who still wet the bed, only 15
percent of bed-wetters outgrow the
problem each year.
“Thebiggest misconception about
bed-wetting is that it’s a form of
rebellious behavior,” explains Dr.
William J. Cromie, chief of Pediat
ric Reconstructive Surgery at the
University of Chicago. “The child
is not wetting due to anger or to be
spiteful. They do not have any
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orders at a very young age. Early screenings can give parents the
assurance they need about their child’s development and identify
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control over this condition.”
Doctors have agreed that bed
wetting may undermine a child’s
normal development. The child
feels inadequate and ashamed, and
suffers from low self-esteem. The
bed-wetter is usually withdrawn,
hiding from family and friends, and
avoiding social situations that may
reveal the problem. :
“Bobby was always so angry,” said
hismother, Jean. “Hewasfrustrated
and woke up crying every morning.
Hehad toshower in the morning, but
he wanted to be like his brothers and
shower the night before.” This is a
very stressful period in a child’s life.
Bed-wetting may also cause anger
and frustration in other family mem
bers, too.
Unfortunately, one-third of the
parents still punish the child who
wets.
When Bobby continued to wet
the bed, however, Jean didn’t pun
ish him. She empathized with
Bobby because she had been a bed
wetter, too. Researchers have re
cently found agene that causes bed
wetting. If both parents were bed
wetters, thereisa 75 percent chance
that their children will also wet. If
only one parent had a history of
bed-wetting, there is still a 40%
chance that the child will wet. Bed
wettingalso occurs more frequently
in boys than girls.
Some studies suggest there is a
lack of an antidiuretic hormone
(ADH) that limits the amount of
urine produced while the child
sleeps. This can mean that the
child produces more urine during
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The bedwetter may feel
inadequate, ashamed, and
suffer from low self-esteem.
the night than thebladder can hold.
“There are many possible causes,
including a small bladder, a muscle
or a hormonal problem. It could
also be a combination of factors,”
explains Dr. Alan Greene, a Califor
nia-based pediatrician with an en
uresisspecialty. “The medical com
munity also studied the correlation
Although many children outgrow
bed-wetting by age six, for some it
may continue into adulthood.
between bed-wetting and deep
sleepers,and found that bed-wetters
have a harder time waking up than
other children.”
However, regardlessofthe causes,
medicines have been helpful in
treating the condition. But some
parents are hesitant about taking
their bed-wetter to the doctor. It is
estimated that only 40 percent of
parents seek medical attention for
their child. Perhaps it’s due to the
stigma attached to this condition.
Even parents fear humiliation and
a sense of failure when they can’t
control their child’s condition.
“Onceyour childisover six-years
old, it’s important to have him ex
amined to rule out any other uri
nary tract infections or other medi
cal conditions,” explained Dr.
Greene. “It will be treated at any
age if it’s really problematic for the
child and family.”
Therearea variety for treatments
for children like Bobby and Scott.
“You will have some success and
relapse no matter what treatment
you use,” said Dr. Cromie. “How
ever, the treatment is used mainly
to help reduce the embarrassment
and social pressure that these chil
dren experience.”
Behavioral modificationisapopu
lar first step in treatment. This
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includesrestrictingtheamountand
type of fluids after dinner and en
couraging the child to go to the
bathroom before bedtime. Reward
ingthe child and encouragingthem
tostaydryisimportant. Dr. Greene
urges parents to help the child be
come more excited about waking
uptourinate. However, if this form
of treatment is not working within
a few weeks, discontinue it.
Conditioning alarms are a very
successful treatment for bed-wet
ting. It consists of a moisture sen
sor that is attached to the child’s
undergarment. At the first sign of
moisture, the alarm emits a loud
sound and the parent wakes the
child to go to the bathroom. “Al
though sometimes successful, there
ismuch tension over usingalarms,”
says Dr. Cromie. “this device con
ditions the parent and can be very
exhausting for parent and child.
Veryfew peopleare willingand able
to continue with it. Therefore, the
withdrawal rate is very high.”
Behavioral modification and
alarms may take months before
producing positive results. Parents
also play a large part in the success
of these treatments. Parents are
the ones to motivate their children
and the ones who much awaken at
night toanswer the call of thealarm.
Prescription medications, how
ever, have brought new hope to
bed-wetting patients. Imipramine
has been used, but response rates
tend to be lower than those seen
with DDAVP. Today, DDAVP, a
nasal spray that provides the child
with the missing nighttime antidi
uretic hormone, has produced high
success rates. In one study of the
spray, 82 percent of the children
achieved total or improved night
time dryness.
The nasal spray is simple to use.
The child inhales a prescribed num
ber of puffs one hour before going to
bed. It merely reduces the amount of
urine the child puts out every night.
Bed-wetting results in physical,
psychological and emotional prob
lems. There is also a financial bur
den on the family as well. Jean
replaced rusted metal bed frames,
worn-out mattresses and clothing.
Alarms, the cost of training pants,
sheets and medications can also
total into the thousands of dollars
over many years to treat this condi
tion. “The drug was worth investi
gating because of the potential ben
efit to Bobby’s bed-wetting,” ex
plained Jean. “It’sreally helped his
self-esteem. If you would’ve known
my child last year, you wouldn’t
believe the change.”
With the right treatment, chil
dren can enjoy sleepovers, family
vacations and holidays with
grandma. Just ask Bobby, who's
now sharingaroom with hisbrother
and was surprised with a brand
new bed from his parents. And he
hasn’t wet the bed in months.