Bed-wetting: A sticky problem


HELLO Readers. Today I discuss the tricky, irritating and even offensive habit of bed-wetting on the part of children. By bed-wetting I mean urinating in bed while in sleep. This habit can be diabolical and even offending if the bed-wetter is an adult.

Some bed-wetting adults have seen their marriages fail to work. Let me point out at the outset that occasional bed-wetting can occur in any child especially when the child is extremely tired.

But sometimes a more serious problem can be behind this anomaly. When a child is not aware that he or she wets the bed at night while sleeping, this phenomenon is known in medical parlance as primary nocturnal enuresis.

It may occur every night or just once or twice a week. In all children, the development of urinary bladder function control and night-time urine production is a slow process. Parents should know that few children are dry at night before the age of three, and that bed-wetting is quite common up to the age of eight.

In most cases a delay occurs in the development of the normal pathways of urinary bladder function control within the brain and nervous system, which eventually mature.

There is a large genetic influence, and bed-wetting runs strongly in families. Other contributory factors include anxiety, stress, constipation, urinary tract infection and, occasionally, diabetes or kidney failure.

Daytime enuresis or loss of urinary bladder control during the day is less common. Some children (or adults) may wake as they pass urine or be aware of the sensation of needing to urinate.

Any other symptoms, such as pain on passing urine, indicate a possible underlying cause, such as infection. Medical treatment is rarely started before the age of six, but there is plenty that the family can try to do at home.

In addition, it may be worth visiting a health worker to rule out any treatable causes. I must stress here that bed-wetting children should not be punished. Parents or care givers should not scold bed-wetting children or punish them.

Instead, they should take practical steps such as putting a waterproof sheet on the bed. Parents and care givers can also plan a routine in which a bed-wetting child is woken out of sleep and taken to the toilet.

Medical treatments include anti depressants (used for their affect on enuresis -- not depression) and nasal sprays of anti-diuretic hormone, which concentrates urine at night.

These do not cure bed-wetting, but provide a temporary solution. Anti-depressants and nasal sprays are best used on a temporary basis for holidays or sleepovers. Bed-wetting travelers find a lot of solace in the use of anti-depressants and nasal sprays.

It could be extremely embarrassing if a visiting adult wetted the bed of his or her host. Now let us look at other aspects of disturbed sleep in children. Some children long hours without falling asleep at night.

In fact, sleep problems are the most common cause for concern among parents of young children. The problem is a major issue for one in five families in this country.

Almost every child has disrupted sleep now and then. Sleep problems range from difficulty in settling to sleep, nightmares, night terrors or sleepwalking and excessive sleepiness during the day.

The cause of sleeping problems is often not clear. Newborn babies alternate between brief periods of sleep and wakefulness. As they get older babies sleep for longer periods at night, but habit and routine play a large part in encouraging this.

Physical factors such as bed-wetting, general illness and developmental delay can cause sleep problems in children. Psychological factors that can cause sleep problems include anxiety about separation from parents.

Other psychological factors may include fears (for example, of the dark or the screams of wild animals such as hyenas that prowl at night), depression and drug abuse (in older children).

Problems in the child’s bedroom such as cold, damp or noise may be other factors. Nightmares, terrors and sleepwalking may be caused by traumatic experiences or other stress, but also tend to increase when a child is very tired and not getting enough rest.

Depression can cause a child to wake up quite early in the morning. Sleeping problems can cause daytime sleepiness, behavioral problems, growth delay (growth hormone is only deployed during deep sleep) or poor performance at school.

In a nightmare, a child wakes up in an anxious state and may remember the bad dream. In a night terror the child is terrified and may appear to be awake but, in fact, is not.

In this state, the child cannot coherently respond to the parent. It can be very difficult to establish the causes for sleeping problems and drug treatments are seldom appropriate.

Nightmares and terrors are sudden disruptions of sleep, during which the child becomes (or appears to become) partly awake. Episodes can occur at any time of night but terrors usually occur during the first or second hour of sleep while nightmares occur much later.

I must point out here that it is not known exactly how or why nightmares and night terrors occur. However, excessive tiredness, lack of sleep, an irregular routine for sleep and stress or anxiety may be contributory factors and may increase the risk.

Parents should know that night terrors are not an illness and have no longterm effects. Therefore, they do not usually require any specific treatment. During an episode parents should keep calm.

It can be distressing to see a child upset, but he or she will not remember any of it the next day.

Good luck.

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