Watch Dr. Kanner discuss this topic live this Monday, October 20th @ 8:20a.m on San Diego6 News In The Morning.
Background: Bed Wetting, or also referred to as Enuresis, is a condition that many parents face when their children have not adequately developed bladder control during sleep. The psychological ramifications for both the child and adult alike can be very distressing, for the control of bodily functions is a very important building block for a child’s developing ego and mind. Parental guilt then follows as the mother and or father feel responsible for their child failing to develop an important developmental milestone.
Typically, children are capable of mastering this task between 18 months and 3 years of age as their parents introduce the idea and help their child practice in a loving and non-punitive fashion. Once the diapers are removed and the child is introduced to the toilet and underwear, their bodies and minds adjust to this change and this then becomes biologically registered and applied to nighttime dryness as well. Most children then only infrequently have some minor accidents over the next few years or so.
Complications often arise in this process however, when a two outside factors do not consolidate:
Appropriate timing and persistence. In reference to timing, when toilet training is either introduced too early (prior to 18 months), or beyond two years, the child is, in the first case, not yet ready for this process and then feels ashamed and “bad” for failing. This may then result in a developmental and psychological problems which may then manifest in a variety of fashions, including withholding ( holding in of urine or ***), of other possible psychological symptoms. On the other side of the coin, if parents wait too long to introduce toilet training, then a habit of urinating in a diaper or pull-up becomes a habit that can be very difficult to break. An additional mistake that parents often make is the notion that the child will “become trained when he or she is ready on their own”. This type of thinking is the same as thinking that grade school children would do their homework without their parents making this a rule. In both cases, as well as with any developmental shift, the parents have to introduce the task at the “right” time. Of course some children are more mature than others and may or may not be “right on the timing track”, but the concept is developmental normalcy and working together with your child towards mastery.
Persistence is also necessary and must be done with finesse. As the parent introduces the “new” task, such as toilet training, a positive, loving, and non-punitive attitude of the parent assists the child in feeling successful and good about him or herself as they become more masterful. From a hands on perspective, the following are tips to help accomplish successful toilet training.
1. Do not attempt the process until at the least 18 months of age.
2. Once ready, remove all diapers and pull ups and switch to underwear.
3. Child-proof the bed with training sheets.
4. Do NOT punish mistakes
5. Reduce fluids by 5:30 each night to help train bladder control.
6. Reward accomplishments
7. Do NOT regress to diapers or pull-ups
8. Be encouraging and positive In most cases, when this process is followed, toilet training goes relatively smoothly. However, once a child has developed a bed-wetting habit, the parent is then placed in a difficult situation of having to help them break a trend that has become familiar and also registered into the child’s biorhythms. The longer this habit has been in place, often the longer it takes to help the child break it, but the loving, encouraging, and persistent parent can succeed in this process as well.
As with the introduction of toilet training, breaking a bed-wetting habit often is introduced by the parent, not the child. Here, the parent has to introduce to their child that they are at an age where they are capable of succeeding at something that they doubt about themselves and are frequently resistant to change due to a sense of control, familiarity, and even comfort. On the other hand however, children who bed-wet commonly feel embarrassed about themselves, feel out of control, and have limited self-esteem. For example, most children who bed-wet refrain from a sleep over at a friend’s house due to self-consciousness about having accidents or wearing a pull-up and then feel less than their peers due to this issue. One of the basic roles of any parent is to help their child optimize their development based on functional capability at various ages in order to help their child feel good about him or herself and in efforts of helping them move forward to the next stage of their development.
Breaking a bed-wetting habit involves the following steps and requires patience and dedication on the part of the parent and typically is a process, rather than an overnight “fix”, due to both physiological and psychological reasons.
1. Introduce the concept in a positive and non-punitive fashion.
2. Remove any diaper or pull-up at night.
3. Stop all fluids by 5:30 or 6:00pm.
4. Insist on empting their bladder right before bedtime.
5. Child-proof their bed and have plenty of extra bottom sheets handy.
6. When an accident occurs, do not get angry and help them change their sheets.
7. Encourage them to express their feelings in words about both this process and other event in their lives.
8. Celebrate success.Depending upon a number of different variables, breaking this habit may be quick or slow, but do not give up and maintain a positive and encouraging attitude with your child. In rare cases, there may be a physiological cause underlying the condition and if after two months of trying the above process, a consultation with your Pediatrician may then be a good idea to rule out any organic condition. In most cases however, the cause is psychophysiological in nature and will change over time leaving your child feeling stronger and more confident. As a parent, you will feel better as well for you assisted your child through a very significant developmental milestone.
Dr. Keith Kanner
Host - Your Family Matters
San Diego 6 News
San Diego Living Show
drkanner@sandiego6.com
