PARENTAL ADVICE FOR BED-WETTING (ENURESIS) IN SMALL CHILDREN 4-6 YEARS OLD

Introduction

Bedwetting at age 4-6 years is very common and is therefore not seen as abnormal.

Approximately one in six children will still wet the bed more than two nights per week at this age.

There is often a history of other bedwetters in the family. In the vast majority of these children no cause is found, they are normal children who have not yet learnt to recognise the signals necessary to control their bladder at night.

Few, if any, children wet the bed deliberately and they would be dry if they could. Punishment is therefore totally inappropriate and can add greatly to the distress felt by the child and make the situation worse.

Factors affecting bedwetting

1. Infections - Any child who complains of burning when passing urine, or is getting frequent high temperatures with no obvious cause and has a wetting problem, should be discussed with your family doctor who can arrange a simple urine test to exclude infection.
2. Day-wetting - Children with night-time wetting sometimes have daytime problems as well. They go to the toilet very frequently to pass small amounts of urine - they may have "small bladders". Increasing the amount of fluids taken in the early part of the day will help to increase the size of the bladder. It may be necessary and desirable to send an extra drink to school or nursery. The child should also be encouraged to go to the toilet at regular intervals before they are "desperate", i.e. at breaktimes, mealtimes, etc.
3. Bowels - Constipation is another frequent cause of both day and night-time wetting. It is therefore very important that you check your child is having regular soft formed bowel motions. If this is not the case you should seek advice and treatment from your family doctor.
4. Behaviour - Being allowed into parent's or sibling's bed following bedwetting may be seen as a "bonus" by some children and this could encourage the wetting to continue. Some children will also gain pleasure from the attention received by bedwetting even if this is negative. It is important to acknowledge the bedwetting to the child and to offer positive suggestions such as:
   a. asking your child to keep a simple chart with a small reward for a dry night;
   b. asking your child to help you strip the wet bed in a matter of fact way that does not include blaming the child
   c. encouraging your child to drink more fluids by day.
5. Self-esteem - Bedwetting children often have very low self-esteem and although they may not seem to care about wetting the bed it does upset them. It is therefore essential that these children are praised and encouraged as much as possible in other areas of their life to help them feel better about themselves.

Summary of how you can help your child to become dry

1. By staying calm, not punishing the child and praising when appropriate.
2. Encourage plenty of day-time fluids. Don't give tea, coffee, chocolate or fizzy drinks in the evening.
3. Check for constipation.
4. Encourage your child's self-esteem by giving praise and encouragement for other activities.

If your child is still wetting after the age of 6 years, you can seek specialist help at your local enuresis clinic. Please ask your health visitor, school nurse, local clinic or family doctor.

It may help to contact ERIC (the Enuresis Resource and Information Centre) who offer support via a telephone helpline service, advice on purchasing bedding protection and enuresis alarms, and also a pen-pal service for older children, when they can share the problem or learn from someone who has successfully stopped wetting.