nocturnal enuresis in children
The Bed-Wetting Problem
Ashima is a 7-year old girl who wakes up each morning only to cry in shame. As usual she seems to have wet her bed once again. It is the very same story each morning. Her father shouts, her mother screams while her Gangu bai grumbles and her little sister snickers. But what can little Ashima do as she does not even feel the urge or remember the sensation of passing urine. If only she could, she certainly would not do it and have to face this filth and embarrassment each and every day.
This has been going on for years and her parents are really worried. They feel that she might never stop. They have shown her to their family doctor who suggested that they take her for counseling to a child guidance clinic.
Bed-wetting is considered a habit disorder
Bed-wetting, also called Enuresis, is one habit disorder that causes trauma, pain and disturbance to all concerned. It is the parents who normally wake up each night to check on the child, maybe even to disturb her sleep to check on whether she wants to go to urinate. And then when she wets her bed, it is the parents and the maid who have to change and wash the sheets and air the room. And what about what the little girl has to go through herself? Can you even begin to imagine her pain and shame at having lost control once again? She feels inadequate and totally at a loss, especially when she is aware of the trouble that she is inadvertently causing to other members in her family.
Delayed Developmental Milestones
Sometimes, when the doctors are not able to pinpoint a physical cause for this problem, the mental capacity of the child must be looked into, as it is quite possible that the child could be mentally deficient. In such cases, as a rule, most of the developmental milestones are generally delayed and toilet training could start much later than usual.
The child guidance clinic is a good place to start investigations as the enuresis could be a case of serious maladjustment. Some children do not want to accept basic responsibilities like tying their own shoelaces or going to the toilet. They want to prolong their infancy and total dependency much longer than is normal. This could even be the result of sibling rivalry or jealousy. Because when a younger child is born, most of the attention gets diverted and the older one does everything possible to get it back, on a conscious or even subconscious level.
I remember reading about the case of six year old Nitin. An extremely well-adjusted child who had learnt to brush his teeth, change his clothes and tie his shoelaces by the age of five. He performed very well in school and was a well-behaved, intelligent young boy. He displayed absolutely no signs of any sort of behavioral disorder right until his mother was carrying her second child. One evening she sat and explained to him that he would soon have a little baby to play with. And that very night little Nitin wet his bed for the very first time.
All was well until his mother delivered a baby girl. Then the enuresis started once again until the time that she was discharged from the hospital. It seemed to have stopped for awhile as Nitin tried to play and grow fond of his little sister. Then on her first birthday it started once again and did not stop for about three to four months, at the end of which his parents sought professional help.
After studying his case, the counselor realised that Nitin was torn between hate as well as outward displays of love towards his sister. These dual feelings in one so young were what had manifested in the form of this habit disorder. The counselor helped him to feel secure, loved and wanted once again and the enuresis disappeared after about a year of therapy.
Weak Emotional Foundation
Bed-wetting is common in both timid and weak as well as in strong aggressive children. The child has a basically weak emotional foundation and could come from a broken home or any kind of disruptive, unstable atmosphere. Either one of the parents could be physically or psychologically missing and the child could be feeling insecure for some reason. In highly aggravated cases, sometimes the child cannot even control the urge during the day and could embarrass himself in public leading to a further complex. Then it would be difficult to ever send him anywhere, even to school.
In some cases placebo drugs are given to the child to make him feel that he is being physically treated for the problem. But much, much more important is his mental welfare and sense of belonging as most of the time; enuresis has a deep psychological foundation. Therefore it is important that both the parents accompany the child for counseling.
Change in parents' attitude is all that is required
In most cases, a simple change of attitude on the part of the parents is all that is required to solve the problem. If your child feels safe and secure in a home filled with love, most personality disorders get sorted out on there own, if at all they were to arise.
Q: My nephew is six year old. He continues to bed wet at night though he is completely toilet trained during the day. Is this normal? How can we help him get bladder control during the night?
Aditi (Mumbai, India)
A: Please follow the instructions below:
1. No water after 6 PM
2. Make him void urine before going to bed
3. Keep alarm 2 hours after sleep time and wake him up and make him pass urine.
4. Do not make him guilty of his bed wetting by scolding or commenting in front of others.
5. Make him change the wet sheets.
6. Make him keep a dairy in which he will write the date and picture of a sun for dry days and umbrella for wet nights. At the end of 1 month give him a reward for the dry days.
7. In day time encourage him to delay passing urine for as long as possible. This will increase the bladder tone.
8. When he does pass urine after holding ask him to interrupt the stream on command for about 4 to 5 times during the passage.
If all these fail consult a child psychiatrist. But remember it will take about 6 months for this method to be effective
Q: My neice is 14 years old and still wets her bed. She has lost all interest in her studies. Please help.
Anju (Dubai, UAE)
A: Ask your niece to stop drinking water from around 7 p.m. Tell her to make sure she visits the bathroom every night, before going to bed, so her bladder is empty. Make sure you read these articles on our site:
Also, make sure your daughter reads this:
It will help her see that she is not alone ? there are many others suffering from the same problem. It is not life-long, and millions of people wet their bed even at the age of 14. You could also take your child to a child psychiatrist in case you feel the reasons for bedwetting could be emotional or psychological.
Homeopathy drugs---Product Name: Dr. Reckeweg R 74 (Drops for nocturnal enuresis)
Manufacturer: Dr. Reckeweg & Co. Gmbh
Packing: Bottle of 22ml
Calcium phosphoric.D30, Ferrum phosphoricum.D8, Kalium phosphoricum D12, Pulsatilla D12, Sepia D6.
Nocturnal enuresis, bladder weakness. Many causes may precipitate nocturnal enuresis or bladder complaints and it is advisable therefore to elicit the deeper lying causes to those copmlaints. 'Spina bifida occulta' must be thought of. Inflammatory processes in the urogenital tract: compare R18 to be given in addition to or in alternation with R74. Involvement of the prostate gland: R25.
tryptomer 25 mg for nocturnal enuresis in children
Use of Amitriptyline hydrochloride is not recommended for children under 12 years of age.
The usual dose for adolescents 12 years of age and over is 10 milligrams, 3 times a day, with 20 milligrams taken at bedtime.
Saturday, February 24, 2007
nocturnal enuresis in children