Parental anxiety

An interesting paper reporting on a survey of doctors and parents:

“Although both [parents and doctors] thought that bed-wetting is a maturational problem, the parent group thought emotional causes were important and were less likely to accept small bladder size as an etiology.”

Medical research in the last generation has found genetic, hormonal and physiological causes for bedwetting. That would explain why doctors focus on those factors. Parents who don’t know about those studies probably still accept an earlier generation’s belief that bedwetting has emotional or behavioral causes. Or maybe it’s parents’ natural human tendency to believe that their children can control things to a greater degree than their children actually can; that a child could stop wetting if he tried hard enough.

An even more interesting result:

“Parents thought that children should be dry at a much younger age than did the physicians (2.75 vs 5.13 years, respectively)”

Wow. “Should be dry” before age 3.

Perhaps the parents interpret, “children should be dry”, as, “when would I like my kids to be dry”. Three might be a defensible answer to that. Most parents would like their kids to be dry by 3. I would have overjoyed, although given their genes, I didn’t expect it. (I’m sure Mom would really have loved for all her kids to have been dry at 3!)

On the other hand, that’s a high expectation. Surveys say that most kids still wet the bed at 3. I’m generally skeptical about the accuracy of these sorts of estimates, but these surveys seem well constructed.

Part of it may be that parents don’t remember when they stopped wetting the bed themselves. Most – almost all – of us stopped wetting the bed when we were too young to form a memory of it. An excessively rosy belief in one’s toddling maturity probably colors it back a year or two. I don’t remember when I stopped (although I certainly remember when I started again!), and I would be skeptical of anyone’s memory of being dry before 3. The only memories I would trust would be of people who wet the bed until well into school age, and even they would probably tend to nudge that memory.

The doctors may interpret the survey question as, “At what age can one expect most children to be dry?” Plausible surveys indicate that is about 5.

The right question is, “when should I become concerned”. Current medical wisdom seems to be age 7 or 8, unless the child starts wetting again after being dry (secondary enuresis), or bedwetting is affecting the child’s emotional state, or the child has other symptoms of diabetes, urinary tract infection or other medical problems.

Beyond age 7 or 8, one should test and keep an eye out for more serious causes. But the best approach to bedwetting itself is to keep calm, manage the consequences and wait to outgrow it.

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8 thoughts on “Parental anxiety

  1. Pingback: Relax | Bedwetting Mom

  2. Stumbled across your web site again while looking into adult bedwetting trends and characteristics. I am a nurse practitioner that works in neurology and sleep medicine. I must admit I did not wet past age 4 or 5 but all my male friends did wet and nightly at that into teens. My interest likely stems from this experience growing up but I being dry was a ruthless teaser. My first cousins wet well into teens and late teens. In the 70’s most parents used diapers to manage bedwetting. Something I found great humor in teasing over.

    Ever heard of the “Karma Train”? Well my punishment for this ruthless teasing was a visit from the Karma Train during my final semester of my BSN program. Managed to fracture my spine and rupture a disc. Cathing and the diapers first initiated by classmates tired of helping changing bed and laundry would be a daily fixture for life the next 28 years until Botox. Could be grateful that I wasn’t paralyzed until the past ten years or so.

    So into my real reason to replying to your post. It concerns a recent research study I read in a sleep journal. It basically contradicts all current treatments and recommendations regarding enuresis (bedwetting) management. I do share with my patients who my be struggling or have children struggling with night time wetting. The researchers studied bedwetters to bedwetters who wore diapers and compared them to a control group of non-wetting children during overnight sleep studies performed in a sleep lab. Here’s what they found and this totally supports wearing pads, briefs, liners, night diapers, or whatever you want to call them. The diapered children had identical sleep architecture to the dry kids at night. This in turn resulted in normal sleep with normal release of growth hormones at night and thus less behavioral issues in daytime secondary to poor sleep. Take home message is use diapers at night for bedwetting. Just make sure it’s done with care, love, and compassion. Wet beds don’t speed up the time a child is going to get dry.

    My youngest stepson wet till 11. His mother who is also a nurse decided to return to night diapers from age 9 till 11 when he dried up. Funny thing that was shared long after that experience was she wet till 11 and wore diapers. She never considered doing this with her son until after we started dating and she learned of and totally accepted my broken plumbing. The child hated that at that age but as an adult will gladly admit to preferring diapers over a cold wet bed. I rest my case. If knowledge from the above events helps some parent and child to a better nights sleep without shaming or punishment then my penence for my uncaring teasing growing up has been partially forgiven.

    George RN, MSN, FNP

      • Here’s the article. Unfortunately since my subscription to the professional journal has expired, I can’t get the entire citation for you. The article is titled “Night diaper use and sleep in children …..” Published in 2013 in Sleep Medicine, Volume 14, Issue…. Written by Jonathan Kushnir, Vered Cohen-Zruba….

        Cat, this should allow you to search MEDLINE, or MedPub and see the abstract. I hope you can find it. I’ve seen the entire article and it’s fascinating the outcome of their findings, yet the current clinical mind set is to avoid use of garments because they will delay achievement of night time control.

        Well if this theory really worked I think most kids would dry up by age 3-4. Personally I believe it’s a maturational thing with the production of ADH (ie antidiurectic hormone). I’ve had first hand experience with this hormone with onset of severe sleep apnea and narcolepsy over 9 years ago. As a result of the apnea, my nocturnal output was around 2 liters a night. Never woke me because of a spinal injury and entrance into 24/7 incontinence in 1987.

        Thanks for your great posts. Having some experience with the topic by default, the honest sharing and trying to not make it a big deal in one’s life is the real deal. Just keep doing the next right thing till one finds a solution that works best for them and spouse. I traded diapers recently for Botox. The trade off is cathing is only way my bladder will empty even up to 700 cc’s. The old way was lucky if held 180 cc’s before wet. Sorry about digression but too cool to be free from ……..

        George

      • George:

        Thank you. I’ll have a look at it and maybe post something about it.

        And thanks for the kind words. Best of luck to you!

        Cat

      • Thanks, George. I have found the abstract, but I haven’t yet gotten the chance to see the whole article. It looks interesting and certainly seems to confirm what I’ve been writing: Bedwetting children (and adults) will sleep better if they wear protection.

        It is interesting that apparently a wetter wearing protection has the same sleep quality as a non-wetter. That certainly argues for protection.

      • As a clinician in neurology and sleep medicine I totally ascribe to the belief that fragmented sleep is unhealthy. The implications are huge. Although there are many who make money by trying to alter the nocturnal sleep profile to affect dryness at night. It’s big business with the alarm companies. Quick fix, not.

        Only 1% of kids get past teens still wet at night. What you point out in “Parental Anxiety” is so well discussed and so on target with respect of how to handle it. Sadly, current and ignorant attitudes do more to harm those growing children because it’s all about how the parent and family deal with the topic.

        Discrete is best and the rest is just time and let the poor child sleep. It works. Too bad most have not fortunate enough to read you genuine and honest blog. It would help so many others get it right.

        George FNP

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