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Oops! I did it again!

Does your child require a moisture alarm? But before you fix one, try to analyse the reasons behind his bed-wetting, says APARNA KARTHIKEYAN

DON'T SCOLD THEM Childhood incontinence can be corrected with some psychological support

Little Priya has a secret that she is terribly ashamed of — at 7, she still bed-wets. She gets worried when her friends come home and begs her mum to hide the packet of diapers. "I'm scared they will find out about it, and call me `baby' and tease me mercilessly," she says. Arun too recalls being worried about the same thing — only, in his case, since the habit continued well into his teens, he was unable to participate in a lot of activities — like camping, or even spending the night at a friend's place. Both Priya and Arun (names changed), and many like them, suffer from incontinence during sleep, which is called `enuresis' (the technical name for bed-wetting).

Dr. B. Anubala, paediatrician, (who was Civil Assistant Surgeon in the Government Institute of Child Health and later Deputy Chief Medical Officer in BHEL) says bed-wetting is a common childhood problem. "Invariably, it stops by the age of two but in some, it goes on till five years of age and in about 5 per cent up to ten years, occasionally persisting till adolescence. Typically, boys are more prone to it than girls as they mature late."

Mother of all reasons

The mother (or even father) is really often the reason. Studies show that when one parent was a bed-wetter, there is a 40 per cent chance that the child will be one too. And when both parents were, there is a whopping 70 per cent chance that the kid will turn out to be a bed-wetter! Dr. Anubala elaborates further — "Incomplete voiding, genetic or hormonal factors, urinary tract infection, habitual constipation, nervousness, mouth-breathing and disturbed sleep are some of the common causes."

Bedwetting can be `primary' when the child hasn't stopped wetting at all, or `secondary' when the habit kicks in after a six-month dry-spell. Priya has some `good weeks' when she stays dry. "But when she gets upset about something — it can even be a Tamil-movie with a couple of ketchup-drenched-fight-scenes — the habit is back with a bang," says her mother. Emotional upheaval can often lead to bed-wetting even among older kids. Fear, anxiety, insecurity, depression and stress — almost all of them are potential triggers. Rarely, structural deformity of the bladder or spinal cord could be the reason, while childhood diabetes could contribute too.

Arun's mother recalls how irritating it was in the days before disposable diapers and washing machines to handle a bed-wetting child.

But even now, almost all parents of chronic bed-wetters are considerably annoyed to wake up to a soggy bed and direct their frustration and anger on the child. This unfortunately only alarms and shames the child, resulting in more unwanted nighttime `accidents'.

"With over-anxious parents, the issue is blown out of proportion," says Dr. Anubala.

"They should not admonish the child, lowering his self-esteem and making him feel guilty. They must understand that it can be corrected and give psychological support to the embarrassed child," she reasons.

Simple remedies

Some small changes in lifestyle can go a long way in helping the child.

*Proper toilet training

*Restricting fluids at bedtime

*Emptying the bladder just before going to bed — this is a must-do.

*Using the loo at regular intervals, especially valid for older kids who tend to hold back for hours on end when they're `busy' playing.

*Bladder exercises to strengthen the sphincter and pelvic floor muscle.

*Treating any infection in the urinary tract.

When none of these really help, the `moisture alarm' comes in handy. (It's a device that can be clipped-on to the child's pyjama or bedsheet. When the sensor pad gets wet, it sounds off the alarm and wakes up the child.)

This alarm has fantastic long-term success rates, and the child eventually gets conditioned to wake up even before wetting the bed.

"Medical intervention need not be resorted to unless warranted. Surprisingly, with a little patience and a lot of reassurance, most of the cases get resolved on their own," says Dr. Anubala.

What works with a child

"You know what?" Priya adds in a conspiratorial whisper, "It's not just me — my mum and her brother also used to bed-wet. My grandma told me. And they didn't even have `diapers' then... I believe the mattress was completely ruined!"

Reassuring a child that it's not just her/him who's doing this `terrible thing' usually works better than telling them to `stop this nonsense at once'.

"And," little Priya adds importantly, "my dad said I will get a treat if I don't wet the bed one whole week! I told him that I will stop completely — I wonder what I will get then!"

Rewarding a child has been known to work, while punishing only makes matters worse!

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