Tonsils and Bedwetting

Interesting study indicating that about half of the bedwetters (ages 5 to 18) with breathing difficulties while asleep (apnea or snoring) stop wetting the bed after a tonsilectomy. Those who stopped wetting “had significantly more arousals and obstructive apnea episodes but fewer awakenings than” those who continued to wet.

Confirming again a connection between sleep patterns and bedwetting.

Advertisements

Protection for better sleep

A very interesting article, suggesting that bedwetting children should wear protection to get a good night’s sleep.

The first finding is perhaps not surprising: undiapered bedwetting children have significantly worse sleep quality than non-bedwetters. Undiapered bedwetters have more activity during sleep and shorter periods of continuous sleep.

The second finding may be more surprising, and is certainly more interesting: Diapered bedwetters have significantly better sleep quality than undiapered bedwetters – indeed, the sleep quality for diapered bedwetters is substantially similar to that of non-bedwetters.

Results

In comparison to [non-bedwetters], children with enuresis who did not wear night diapers had poorer sleep quality as reflected by both actigraphic measures (more activity during sleep and shorter periods of continuous sleep) and one reported measure (lower sleep quality). However, no differences were found on any of the sleep measures between children with enuresis wearing night diapers and [non-bedwetters]. The reported sleep quality of all children with enuresis with and without night diapers was lower than [non-bedwetters].

Given the importance of quality sleep, the authors conclude that doctors and nurses should recommend that a bedwetting child sleep in a diaper:

Conclusions

Our results suggest that sleep patterns of school-aged children with enuresis who do not wear night diapers are impaired, and the sleep quality of children using night diapers is similar to those of [non-bedwetters]. Thus, clinicians and healthcare providers should consider recommending sleeping with night diapers for untreated children with enuresis, based on its positive impact on sleep.

This confirms my advice that parents offer protection to a bedwetting child. Indeed, this indicates that my advice was not be strong enough:  For a good night’s sleep, protection may be essential. As I say in the update to that post,

A bedwetter should wear protection.

A parent of a young bedwetter should insist on protection.

A parent of a bedwetter old enough to make a mature decision should offer and very strongly recommend and encourage protection.

The authors close with an interesting comment: Diapering at older ages does not have a negative effect on a bedwetter, nor does it perpetuate bedwetting. Diapering will lower stress and shame and improve “the child’s well-being and psychologic functioning”.

Speaking from my own, my siblings’ and my children’s experience, I think that is certainly true. A wet diaper is less stressful and shameful than a wet bed, and no child wants to wake up in either a wet bed or a wet diaper.

Of course, as I have suggested, it is probably not good salesmanship to call it a diaper, even if the authors of the study do!

Kushner, Cohen-Zrubavel, Kushnir, “Night diapers use and sleep in children with enuresis”

[Thanks to commenter George for passing on this citation.]

Cloth

Emily, my oldest (11), wants to try a reusable pant. She is only wet a few times a month, and thinks it’s silly to throw out a dry disposable most mornings. She is also worried about the environmental effect.

She doesn’t have any psychological aversion to cloth. When I was a teenager, I initially had an instinctive revulsion: It’s a diaper, for goodness’ sake! I am not a baby! But I was secure enough in my maturity and practical enough to understand that I wasn’t an infant and that cloth was the only adequate protection. Emily is mature enough not to have that reaction at all.

The main argument for disposables – convenience – isn’t that big a difference. A little more laundry (in a household with plenty of hot water whites to wash) is no more burden than disposing of disposables. There’s no need for the stink of a diaper pail if I launder wet things the same day. That’s what I did when I was a teenager, and I’d do that today.

My main worry is the capacity. The bedwetter pants my siblings had in my childhood wouldn’t be capable of holding Emily’s floods. I’m afraid that an adequate product would be the sort of diaper I had to wear.

So I gave her the project to research it.

Jake, my son, hasn’t wet in a long time. He still wears a pullup to sleepovers, out of his own choice. He’s not so much worried about the likelihood of an accident as he is about the consequences. If Emily goes to a reusable pant, perhaps he could wear one when he goes on a sleepover.

Emily’s project has seemed like such a logical idea that I’ve even thought of trying cloth myself when I get runs of dry nights. I’m not going to tell her to include my size in her research, but availability in my size might be a factor in the ultimate purchase.

My main reason for not wearing cloth is discretion. I don’t want my kids to see a big diaper in the laundry. I don’t want my kids or J to see (or hear) me wearing a diaper. The pads I wear are so thin and quiet that no one would notice. That isn’t true of an adequate cloth diaper and plastic pant.

The disposables are also more comfortable than I remember cloth diapers. Even the hourglass diapers Mom made me were a more uncomfortable bulk between the legs. Also, the quality disposable products keep urine away from the skin. That is not only more comfortable, it also reduces the risk of rash or irritation.

I’m not convinced of any ecological or other advantage to cloth. Cloth advocates do a good job of isolating only some of the benefits and costs without taking into account the entire range. Suffice to say that costs of manufacturing, use and disposal are well enough integrated in all forms of protection that I am skeptical that there is any hidden advantage. However, the equation changes if one is throwing out a dry disposable most mornings, and not having to launder a dry reusable.

Attitudes

Recently, my daughter (11) invited a friend for a sleepover. The friend’s mother called to tell me that her daughter wore a pullup when she slept away. She wanted to be sure that the mattress was protected against a leak. She asked me to give her daughter an opportunity for a discreet change in the evening and the morning. It was unlikely that the daughter would wet the pullup, and even more unlikely that she would wet the bed, but the mother asked me to give her daughter cover if she did. If that was all OK, she would let her daughter know that she could rely on me.

She was comfortable making the call. Her daughter is popular, outgoing and friendly. She has probably been to many sleepovers. The mother had made this call before.

I assured the mother that her daughter would be in good hands. I told her that her call was thoughtful – both for me and for her daughter – and refreshing. She had a good laugh when I told her that our beds were well protected, and that we could provide her daughter with a pullup from our own inventory. I was touched that she thought enough of my discretion to share the embarrassing confidence. She said that she always called before sleepovers, and parents were always discreet and helpful.

We had a little more talk about the subject. Our attitudes and approach were the same: Neither of us was (as J would say) fussed. It’s not a big deal.

I cannot imagine my Mom or any other mother of her (or any earlier) generation doing that. I can’t imagine them discussing this with even their closest friends. It was a shameful secret. Although I don’t think either of my sisters would have cared whether Mom discussed it with other parents, it would have mortified me that someone outside our family – and, worse, a parent of a friend! – would know.

Maybe I’m more old-school than I thought, because I’ve never made a call like that. I’ve never even thought of it.

Maybe it’s a sign that parents are accepting bedwetting for what it is: a delay in one (minor) element of physical development. It isn’t an emotional or intellectual defect.

And maybe parents are also confident that other parents see it the same way.

Improvement in options is probably the major factor. Life is a lot easier for a bedwetter and her mom than it was when I was a child. Today, the unpleasantness of adolescent and teenage bedwetting is insignificant, at least compared to my childhood.

A pullup is discreet. It disappears under pajamas. Even if someone else sees it, it doesn’t scream, “Bedwetter!” or, worse, “Baby!” It’s as comfortable as underwear. It prevents all the awfulness of a wet bed. It doesn’t stink. In the morning, you toss it in the trash.

The old days were uncomfortable, smelly and obvious. They required laundering. They required a hot, sticky plastic sheet, not a breathable and comfortable bed pad.

It’s easier now to accept it, and even to ask other parents to accept it.

On the other hand, the friend’s mother and I agreed that we’d never have that conversation with our mothers-in-law.

The good new days: Managing

The comments to this post by Gabrielle at DesignMom got me thinking about the dramatic improvement in bedwetting products – and, consequently, life for a bedwetter and a parent – since I was a teenager.

There might be a whiff of “in the snow, uphill both ways”, but I never pine for the good old days. The old days weren’t very good. For a teen who wet the bed, they stunk.

When I was a kid (and I’m not that old), the options were limited for a bedwetter older than a toddler. As Gabrielle says of her childhood,

After diapers, I wet the bed most nights. At some point, I was simply too big for the diapers available at the time.

… [T]here wasn’t really much for parents to do but put a waterproof mattress protector on the bed and wish for the best.

I outgrew bedwetting before I faced that. But all my siblings faced it. Drugstores and supermarkets – certainly the drugstore and supermarkets in my home town – didn’t carry products for bedwetters. For the older kids and teenagers, Mom bought hospital disposables (by the case) at a medical supply store.

Those disposables didn’t hold much. They were adequate for my siblings, who weren’t heavy wetters. But they always leaked at least a little, even for my siblings. There was always a little wet spot on the pjs.

Those disposables couldn’t be re-taped. If you took one off to go to the bathroom in the middle of the night, you had to throw it out and put on a new one even if the old one wasn’t wet. They didn’t have odor control, so your room smelled like urine even if they didn’t leak.

Even that was better than the options for earlier generations. For them, it was either (as Gabrielle puts it) a waterproof sheet and hope for the best, or a cloth diaper in a plastic pant. A diaper was effective, but it was a diaper. It may have been better than a puddle on a plastic sheet, but it was the same amount of laundry and the same smell.

That was the option I faced, too. Even the premium adult disposable of the time – Attends – was inadequate. For me, it was either a wet bed or a cloth diaper in a plastic pant. After the initial shock, being a bedwetter didn’t bother me. Wearing Attends didn’t bother me. But it took me a long time to accept a cloth diaper and plastic pant. That was the worst thing about wetting the bed.

These days, there are diapers/training pants available in so many sizes, that parents can now keep sheets protected pretty well if the child doesn’t mind switching from underwear to a “diaper” at night.

And there’s no reason a child should mind – particularly if you don’t call it a “diaper”. It’s just a way to deal with something that he can’t help. There’s no shame in it – either in wetting the bed or in wearing something to protect oneself and one’s bed. It’s nobody’s fault and it’s easy to deal with. Making a child sleep in a wet bed, is cruel and unnecessary punishment for something he can’t prevent.

Excellent blog post (and comments)

Every parent of a bedwetter should read this post by Gabrielle at DesignMom – and the comments (over 150 so far).

The money shot:

Yep. I wet the bed until middle school. And had a few memorable “accidents” into high school and beyond. As a child, of course I was painfully embarrassed about it, but as an adult it’s basically the least traumatic thing in the world. Outside of parenting conversations, I never give it a second thought.

Right. Let me repeat that: As an adult, having wet the bed until middle school – and even into high school – is basically the least traumatic thing in the world. I never give it a second thought.

The comments (over 150 so far) are intelligent, compassionate and good humored. Most are from mothers who themselves wet the bed until a relatively late age, or who have children who are wetting the bed at a relatively late age.

I have a few observations based on the comments, which I plan to post over the next few days.

What I learned from Mom: Childhood

Mom told me that her relaxed attitude toward our bedwetting was a combination of experience, necessity and bluff. She tried hard to keep her worries from us kids, so that our bedwetting (and dealing with our bedwetting) were much harder on her than it seemed to me.

Mom confirmed the genetic aspect: She wet the bed until she was a teenager. (She didn’t say anything about Dad, and I didn’t ask. But my nieces and nephews on that side are late bedwetters as well.) It had been hard on her – waking (and sleeping) in a puddle, feeling shame and inadequacy, fearing friends’ discovery, hearing the contempt of relatives, avoiding overnight stays, smelling the odor that lingered in a room and on clothes. Her parents did not allow her to wear protection, believing that would remove the incentive to stop wetting. They tried all the available cures: Drugs, alarms, waking, no drinks before bed, …

Because of that, she knew that bedwetting wasn’t something that one could control. She resolved to be relaxed, sympathetic and reassuring to her own children, and provide us protection against a wet bed.

She wasn’t at all concerned that my sisters wet the bed as pre-schoolers.

When my oldest sister was about to start first grade, Mom raised her bedwetting with our doctor. He confirmed that it was likely not something my sister could control, and that Mom and my sister should not be too concerned. Some kids took longer to outgrow it. While there were drugs that sometimes provided relief, he didn’t recommend them for children. They weren’t a permanent solution and they had side effects. He didn’t recommend alarms or waking, either. Sleep is just too important to children. Unless she showed symptoms beyond just wetting the bed, the only thing he would recommend was to manage the consequences.