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.

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.

“You will grow out of it” – followup

Following up to “You will grow out of it”:

I don’t want to encourage pessimism. Nearly everyone does outgrow it, almost all (97%, if this and many similar surveys are accurate) by age 10. Even 7-year-old bedwetters are overwhelmingly likely (80%) to stop by age 9.

Parents tend to start worrying about bedwetting at a ridiculously early age (3 years, if this study is to be believed). Judging from postings on the internet, worry becomes obsession by school age.

Doctors, on the other hand, are generally unconcerned about bedwetting per se up to age 7, and downplay concerns even up to age 10. And with good reason; almost everyone in those age cohorts does outgrow it.

On the other hand, doctors are concerned if there are other symptoms of something other than late-developing hormones or bladders.

The pessimism is for teenaged bedwetters. That study indicates that a child that wets at age 10 is probably still going to be wetting at age 20. That’s a very tiny fraction of the population, but it’s a real problem for those in that fraction.

“You will grow out of it”

An interesting medical journal article, which is likely to be depressing to a teenage bedwetter (and parents).

Nothing surprising in the basic findings: Parents of a 5-year-old (or even 8-year-old) bedwetter shouldn’t be very worried. First, it’s common: About 16% of 5-year-olds wet the bed, with boys about twice as likely as girls. More important, the vast majority (about 80%) of 5-year-old bedwetters will stop wetting by age 9, and 85% will outgrow it by age 19.

Unfortunately, that means that a teenager who wets the bed is unlikely to outgrow bedwetting. Most 9-year-old bedwetters will still wet the bed at age 19.

And frequent bedwetters are the ones least likely to outgrow it. Kids who wet at least 3 nights a week are more likely to continue wetting the bed. At age 5, less than 15% of bedwetters wet every night. By age 19, almost half of the remaining bedwetters wet every night.

Conclusions:

The present finding suggesting that PNE [primary nocturnal enuresis, i.e., bedwetting] spontaneously resolves with increasing age probably applies only to those with mild enuretic symptoms. There are significant differences in characteristics between younger enuretic children and older subjects. As age increases there is an increasing proportion of enuretic patients with more severe bed-wetting. Enuretic children aged >10 years and adolescents have significantly more daytime urinary symptoms and incontinence.

“Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study”, Yeung et al. Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong. BJU International. Volume 97, pages 1069 to 1073 (May 2006).

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.

Frequency

I’ve always had a few dry nights a month, sometimes two or three in a row.

Lately, I’ve had dry weeks. Last month, I had two dry stretches of over a week each.

When I was in high school, I had a similar pattern. After a few years of chronic wetting, I wet only a few times a year. I thought that I was finally done with it. But it came back. The cause was (and is) still there. There’s no current or likely treatment for it. Even if I stop wetting for a while, it will probably come back.

Still, it’s nice to wake up dry.

The kids are outgrowing their bedwetting. Except for a few isolated accidents, Emily has been dry for months. She’s taken pullups to camp again, but that and sleepovers have been the only times she’s worn them in a long time. Jake hasn’t had an accident or worn a pullup, even to a sleepover, in over a year. Megan is getting some dry nights. Maybe by this time next year, I’ll be the only bedwetter in the family.