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.]

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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.

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.

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.

Effects of bedwetting

Medical surveys of children and parents report that bedwettters have a sense of “social difference and isolation“. Wetting the bed causes “distress and low self-esteem“. Bedwetters  have significantly lower self-perception of their scholastic skills, physical appearance and athletic competence, which worsens if bedwetting continues into adolescence and teens. Children in one survey rated parental fighting and divorce as the only things more stressful than bedwetting.

Interestingly, self-esteem improves if bedwetting is managed, even if it isn’t cured.

Parental anger or frustration is strongly correlated with negative emotional and psychological effects.

In my experience, that’s correct: A parent who is tolerant and reassuring and helps manage the physical consequences will also minimize (or even eliminate) shame, isolation, fear and loss of confidence and competence.

I didn’t feel shame or fear or isolation as a teenage bedwetter. It didn’t make me shy or withdrawn or wary. I didn’t feel physically, emotionally, intellectually or socially diminished.

For me, the bad effects were physical: The sodden wretchedness of a wet bed; the bulky discomfort of a diaper; greasy, smelly rash creams; the time and effort of putting on, taking off and laundering diapers.

My first teenage wet bed was a shock. The next few were disheartening, as I realized that it wasn’t a fluke. I didn’t just wet the bed; I was a bedwetter. I was even more unhappy when disposables proved inadequate and I started wearing a cloth diaper.

But within a few weeks, all that had passed. Neither wetting the bed nor wearing a diaper bothered me. After a month, it barely registered on my consciousness. A diaper dealt with wetting, and the washing machine dealt with a diaper. Changing was just another bedtime and morning routine. I could easily hide it on a sleepover or trip.

Perhaps the reason that I wasn’t afraid or ashamed was that my basic personality was already formed. I was already confident and happy.

On the other hand, my siblings were all chronic bedwetters before (and into) their teens, so their personalities were formed under the influence of bedwetting. Although we range from artistic to nerdy to pragmatic, none of us is shy or lacking self-esteem. If my siblings had any shame or fear about wetting the bed, they didn’t show it.

The difference, it seems to me, is family. My parents didn’t treat it as a shameful problem. It wasn’t a big deal. It wasn’t even a small deal. It was what it was, and it was easy to deal with. It was a private matter, and easy to keep private.

My older sisters were as big an influence as my parents. I idolized them. They were smart, outgoing, athletic and confident. They were daredevils. They both wet the bed regularly until they were 16 or 17.

Wetting the bed didn’t seem to affect their personality or outlook. It certainly didn’t hamper their social lives or dampen their enthusiasm for sleepovers or trips. They certainly didn’t seem to fear discovery.

Ugh 2

Jake and I had a chat. I told him that I loved him no matter what he did. That it didn’t bother me that he wet the bed, and it shouldn’t bother him, either. That it didn’t mean that he was a baby. That it wasn’t his fault, it was just an accident of biology.

However, he had to take responsibility. He had to get his wet sheets and pjs into the wash, wash himself and get into clean sheets and pjs. And that he had to do it just as soon as he knew his bed was wet. If it was during the night, he should wake me up to help him. And he shouldn’t try to hide it, because that was not going to work.

Jake was horrified that I’d discovered his secret. He was embarrassed. His excuse: He didn’t want me or his sisters to know he wet the bed. And he didn’t want to have to go back to wearing diapers (his word).

I told Jake that he didn’t need to wear a pullup (my word), especially if he were only having an occasional accident. I said that he might change his mind if he wet the bed more often. I told him that I knew how awful it was to wake up in a wet bed and, if it was me, I would wear something if there was a chance I would wet the bed.

I told him that wearing a pullup didn’t make him a baby, or change who he was. After all, his older sister had worn one when she was his age, and she was turning out OK. (He would never admit it, but he does think that Emily is a lot more than OK.) He would have to wear protection when he was away from home, but he had to do that even before this accident. He wanted to know how long he would have to do that, but I just said, “We’ll see.”

When we were done, Jake seemed relieved and happy. He promised he’d take care of things if it happened again, and I believe that he will. I promised that I wouldn’t tell his sisters.

He was dry last night.