Pearls of Wisdom: Overcoming Bedwetting

Although it’s a common issue that millions of families face, the stigma and shame attached to bedwetting or  nocturnal enuresis” is very real, especially to your child. Bedwetting is rarely caused by a serious medical condition and often resolves on its own, but the recurring matter can cause anxiety and embarrassment, not to mention precious time and money spent on doing laundry or buying new sheets.

The involuntary passing of urine after the age when bladder control should have been established is a common but perplexing problem that parents discuss during their doctor visits. The prevalence of this problem at 10 years old is 3% for boys and 2% for girls. The condition is divided between two forms; primary enuresis, when the child has never been dry at night and secondary enuresis, where the child has been confident for at least a year and then starts to wet the bed again. Around 75% of all enuretic children have primary enuresis and 50% of late school aged children have secondary enuresis.

Persistent bedwetting is usually secondary to inadequate and inappropriate toilet training. Parents who forcefully demand that their child use the potty when they’re not ready often elicits an angry reaction as the child unconsciously defy them by wetting the bed. In contrast, parents who are not sensitive to toilet train their child can sabotage the child’s attempt to successfully be potty trained. Certain psychological stress unrelated to toilet training such as moving to a new home, arrival of a new baby, divorce or death in the family can also affect bladder mastery. These types of bedwetting problems have a better prognosis, are self-limiting and easier to manage. Thankfully, very few cases are related to organic pathological conditions such as a urinary tract infection or bladder pathology.

Even during the most frustrating incidents, parents must keep in mind that bedwetting isn’t always caused by ineffective potty training, or your child; rather, it’s a result of miscommunication between your child’s brain and her bladder during sleep. It can also be a factor of genetics. Most children who wet the bed have at least one parent who had the same issue during their own childhood.  It’s important to be understanding, and to utilize a motivational/praise system like stickers for dry nights. In case of an accident, have your child help in changing the sheets and explain to him that this is not a punishment.

Sometimes the use of a bedwetting alarm which has a sensor that detects moisture can help by training the child’s brain to be more sensitive to full bladder signals. Have your child empty her bladder before retiring to bed, and limit fluid intake after dinner. Occasionally, your pediatrician may prescribe a drug called Desmopressin that signals the brain to produce less urine at night.  The downside to this remedy is it only lasts for a short period of time and a child can relapse when he discontinues the drug. It can be reserved for sleepovers, vacations, camps or other social over-night events.

Every year, a significant number of children ages 5 and up that used to wet the bed stay dry with no intervention. Still, parents should be proactive and should not feel embarrassed to approach the subject with their pediatrician. There is reason to remain positive as the prognosis for this condition is excellent for dry nights ahead. I always remind parents that during your child’s infant and toddler years, every day can seem like a year but in retrospect, years pass like a day. Bedwetting is almost always a temporary challenge and won’t last forever, any more than diapers will!

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

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Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Potty Time

PottyTrainingOne of the most challenging tasks that parents face is toilet training their child. Every mom and dad who has bought, changed and disposed of stinky and wet diapers appreciates and celebrates this monumental milestone. No parent has a built-in GPS to help navigate the road to “potty town” and even the experienced parents will see variations in readiness from one child to the next.  Remember, too, that forcing little ones to pee/poo using the toilet or potty chair before they are ready can lead to difficulties. Although as parents we anticipate each new stage with eagerness, some things must come naturally.

Though many creative strategies have been developed and tested (star charts, prizes, songs, help from siblings, even talking toilets!), realistic parenting is all about setting developmentally appropriate expectations for children and offering praise and positive reinforcement when it’s due.  Trust me, approaching this sensitive subject with optimism and encouragement is far better than resorting to negativity, regardless of how challenging potty training becomes.

Many children show interest in using a potty between 18-24 months of age. However, some children may not be ready until after 2 ½ years old, so it’s best to let your child’s behavior and actions guide you. Just like speech, motor skills, and cognitive development, toilet training will happen when your toddler is ready. Once he is able to sense the urge to go — or does a noticeable jig — and verbalizes the need go to the toilet or potty chair, you’re on the right track to successful potty training. Another factor to remember: the process can be affected if there are stressors at home like illness, death, divorce or separation, moving, or any other crisis that impacts the family.

The Academy of Pediatrics recommends the following tactics to facilitate successful toilet training:

  • Decide what words to use to describe body parts, urine and bowel movements. Use terms that will not offend, confuse or embarrass anyone.
  • Pick a potty chair that a child can easily get onto with feet touching the floor. If you use a child-size seat attached to an adult toilet, place a stepstool beneath to support her feet so that she can bear down with ease.
  • Help your child recognize signs of using the potty and encourage him to inform you before, not after, the fact.
  • Make trips to the potty part of a routine. Once you see telltale signs, take your child to the potty and explain what you want to happen.
  • Encourage the use of training pants to make him proud, as this is a sign of being a “big kid.” Don’t get upset when accidents happen since it may take weeks, even months, before toilet training is completed.  Frustration is normal, but try not to let your child sense your frustration.
  • Last and most importantly, give loads of encouragement and positive reinforcement during the whole process to keep your child interested in being diaper-free. Be their cheerleader! Showing lots of excitement when the toddler uses the potty properly will ensure a healthy transition.

Awareness of your own tone and approach is what truly guides toddlers into a success story. Children try very hard to make their parents happy and proud of them, so try your best to applaud your child’s efforts and keep a sense of humor as she tries to master this new skill. It’s just like riding a bike, and once your child gets the hang of it, they’ll never forget how!

Do you have any methods of your own? Post in the comments below, or head over to BabyLegs’ Facebook page and look for today’s post on potty training. Share your wisdom with other BabyLeggers for helpful tips.

Warm Regards,

Dr. Pearl

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.