It was a sleepy day at hospital when a mommy walked in with her son. For us doctors esp peads personel, we do listen to the complains but also draw inference from the look and also from what they are not telling. Gotta play CID at times. 😜🙋Latest lawn suit from a branded collection stitched absolutely identical to the cover picture, Chanel shades and a Charles and Keith hand bag. Coming along with a 10 year old boy who was appropriately dressed but wasnt meeting the eye. The confidence that reflected in mothers personality very obviously lacked in the kid.
After the initial greetings (which we peads personel do to build repo with the patient)
I inquired for their reason to be there.
Mommy: “THIS kid has become a source of embarrassment for me! I have tried everything but he doesn’t seem to stop. I have bought him toys, i take him to dubai for outings but no he wouldn’t understand. I even tried punishing this stubborn one but simply wouldn’t stop wetting the bed! You want to know what he did just over the weekend? He went over to his aunt’s place for a slumber party with cousins and he wetted their bed. An utter disgrace for our family!”
During all this the little boy squirmed so badly, with eyes looking down had almost disappeared in the couch. I could feel his cheeks burning of embarrassment. Wanted to slay the mommy like anything. However controlled myself.
After a few basic questions i sent the mommy out for a while and started general talk with the child. Within a few mins talk i could figure out that the kid was good at studies. Had only a very few friends. Because of this problem was ridiculed greatly by siblings as well and his parents were at the verge of their divorce.
I told the mommy to visit me alone the next day. She needed to be explained in detail what was actually happening.

Let’s understand what’s happening!🤷

A few basic terms that will be used again and again.🤯

Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older
Primary enuresis: Enuresis in a child who has never established urinary continence for more than six months
Secondary enuresis:
Resumption of enuresis after at least six months of urinary continence.
Nocturnal enuresis(bedwetting):
Enuresis that occurs during sleep.

♋Nocturnal enuresis is three times more common than daytime wetting and is more common in boys.
♋Primary nocturnal enuresis is caused when there is a difference in the capacity of the bladder with respect to the urine production at night and the inablility of the child to awaken in response to a full bladder. ♋If the bladder is of small size.

♋If they are making more urine. (because of diabetes or simply if they drink more).

♋It can also occur if there is any persistent stress or trauma.( parental divorce, sexual abuse, trauma at school, hospitalization, neglect due to a new younger sibling)
♋Secondary enuresis more commonly occurs secondary to sleep disorder, nocturnal polyuria and constipation.
♋The point to understand here is that these kids are more likely than other children to have subclinical psychological symptoms like inferiority complex, shame, irritability, timidity, impatience and isolation from other kids. They face parental stress (e.g., emotional, social and financial stress) which causes intolerance and frustration in them.

Treatment Options for Enuresis

⏺️Motivational therapy

Motivational therapy includes telling the child that its completely okay, and that we know it happened unintentionally and that we will helo you overcome this thing
This shows that you are reassuring the child, supporting him, helping him overcome his guilt, and encouraging him to take responsibility for it (this is in context that although the child did not cause the condition intentionally but he or she has a role in treating it).

⏺️Actions speak louder than words.

You will have to show it with your behavior that you will help him over come it. For that you will have to wake up yourself to wake the child to void at times during the night. This is an intensive task and can leave the parents frustrated and the child sleep deprived.

⏺️Positive reinforcement

It also helps in bringing about the desired change (e.g., 🌟 sticker charts for rewarding periods of not wetting the bed ) but make sure that it isn’t emphasized to such an extent where inablility bto achieve dry nights may worsen the child’s self-esteem.

⏺️Liquid intake limitations.

Fluid and caffeine intake are minimized before bedtime. Allow only sips from two hours before sleep time. A tip that works well is that you offer kids liquids earlier in the day so that they are not thaaaat thirsty at bedtime.

⏺️ Gotta go before bed time!

Make sure that the kid uses the toilet just before going to sleep…. No matter how sleepy he may be. No matter how he doesnt feel the need to pee.

⏺️Establishing a routine.

It has been observed that when a routine is established their anxiety decreases. And gives them less chances to throw tantrums. They should know that they have to drink more water during the day, less in the evenings, they should know when they have to do their homework, when to play and when to lie down for bed time.

⏺️ Bed times are happy times.

Use bedtime as an opportunity to connect with your kid. Listen to him, tell him stories, you can even use this time to mentally prepare your kid to wake up for the loo during the night.

FOR OLDER KIDS:
⏺️ ENURESIS ALARMS:
Another thing in use is Enuresis alarms (bells or buzzers) which is triggered by a moisture sensor in the bed pad or pajamas. A duration of six to sixteen weeks is required for treatment.Older kids who are motivated to resolve the issue are good candidates for these alarms. However, sleep disruption is a common problem with alarm use. The Factors that can ensure a good response to enuresis alarms include a cooperative family, no coexisting emotional and behavioral problems, small bladder capacity, and frequent bed wetting.

⏺️OLD IS GOLD-THE ALARM CLOCK.
Enuresis alarms may not be commonly available. So, in its replacement an alarm clock can be used. It is a simple, inexpensive, safe, and modestly effective alternate to an enuresis alarm and it does not even require bed-wetting to evoke a conditioned response. Alarm is put at 2-3 hour intervals So that it wakes the child for voiding when the bladder is full, but before bed wetting occurs.

⏺️ MEDICINE:

If nothing works then there is also an option to go for medicines. For that you will have to contact a Pediatric Nephrologist who will get some tests done and then start treatment accordingly.

Things NOT to do!

⚠️Never criticize your kid

⚠️Don’t scold him over this

⚠️Don’t let other siblings tease him or make fun of him.

⚠️Never compare your kid with other kids

⚠️Don’t let the kids room be completely dark that may scare the kid and not let him use the toilet at night.

⚠️Don’t let ur child be constipated.

This happens especially when the babies are being potty trained. From the fear of going to poop in the pot they start holding on to it. Finally, the body turns off the sensation because it is continually being ignored. So now, constipation puts pressure on the bladder, thickening the wall of the bladder, decreasing its overall size, and also interfering with some of the bladder signals to the brain.

Let’s sum it up!👩‍⚕️

This is a task where your patience will be tested for sure. Washing the bed sheets in the morning, drying the sheet and the bed and task to answer to every body’s queries might leave you frustrated and irritated. But please know that it is an unintentional act, something in which your kid has no control over. If given the cooperative environment, your kid will be able to over come it. We can’t just soooosh our magic wand to correct it, it will require patience, dedication persistence and team work to win this battle.
There is no single method that guarantees the result. All these methods when used simultaneously help in achieving significantly fewer wet nights, higher cure rates, and lower relapse rates.

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