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Beating the bed-wetting blues

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Bed-wetting may be expected among potty-training toddlers but the condition persists for up to 7 million U.S. children ages 6 and older, causing enduring shame and embarrassment. While effective treatments are available, a new nationwide survey shows that many parents mistakenly think kids can fix the problem all on their own and the subject is not commonly discussed at the doctor’s office.

And it appears parents aren’t likely to be getting too many answers from their healthcare providers. Nearly 70 percent of respondents said the topic of bed-wetting never came up during their child’s routine physician visits, according to the poll, which was conducted by the National Association of Pediatric Nurse Practitioners and the Dysfunctional Outpatient Voiding Education (DOVE) Center at The Children’s Hospital of Philadelphia.

The results don’t surprise Amy Dunlop, one of the surveyors and a pediatric nurse practitioner at the Christie Clinic in Champagne, Ill. It is not common for parents to bring up the subject of bed-wetting because they or the child may feel embarrassed, she says, or they assume that the child is capable of fixing the problem if he or she really wanted to.


Healthcare providers also “don’t ask or ask in the wrong way,” says Dunlop. While bringing up the issue should be part of their routine, she says, “there may be a reluctance ... because it is a time-consuming issue.”

Dunlop has made it clear to her patients that the topic is important by hanging a poster on her door about the frequency of bed-wetting. She says parents seem to be more comfortable talking about the issue when they know their kids aren’t the only ones affected.

But when healthcare providers don’t ask about bed-wetting, parents need to speak up, says Dr. Seth Schulman, director of the DOVE Center.

Parents should not make the mistake of thinking that disciplining the child will help, he says.

“Most importantly, never punish your child,” he says. “It’s not their fault.”

When parents don’t understand bed-wetting, Schulman says, they may punish the child for something he or she can’t control. On the other hand, parents may blame themselves and avoid getting professional help because they worry that they’ll look like bad parents.

But neither children nor parents should shoulder blame. Bed-wetting is thought to be caused by several factors, including the inability of the child to sense when the bladder is full, a small bladder that must be emptied more frequently, or abnormal sleep patterns, such as deep sleep, that may prevent a child from waking up.InsertArt(2063183)FINDING THE RIGHT TREATMENT

A variety of solutions are available. “What works best depends on what works best for the family,” says Schulman, who works daily with families seeking treatment.

Single-parent homes may need to choose methods that don’t require as much time from the parent, while larger families should plan to speak with other siblings to prevent any teasing and discouraging remarks.

The National Kidney Foundation suggests that parents limit how much the child drinks at night and before bedtime, and also wake the child up during the night to go to the bathroom.

Another option is a moisture alarm, which is worn by the child and goes off when moisture is detected. If successful, over time the child will naturally awaken when the urge to urinate occurs.

As for medication, desmopressin and imipramine are two frequently prescribed drugs that have been shown to help. (The new survey was funded by a grant from Aventis Pasteur, maker of desmopressin.)

In addition, Schulman suggests, “it’s always helpful to have a routine in the house. In the morning, kids can be responsible for changing their bed sheets.” Children who help out are reassured that they are contributing to the solution, and older children, especially, are saved the embarrassment of having their parents changing their soiled sheets.

With some time and effective treatment, experts say, kids plagued by bed-wetting can finally look forward to dry nights — and brighter mornings.