Strategies to Maintain a Bedwetters' Self-Esteem
Bedwetting in children can be a sensitive issue, especially as the child grows older. Handling the situation appropriately, therefore, is so important in maintaining your child's self-esteem, avoiding embarrassment and truly helping him on the path to dryness.
The techniques often recommended to deal with bedwetting, also called enuresis, vary from doctor to doctor and from parent to parent. They range from doing nothing to the most extreme – administering medications. Different methods work for different families, so it's very important that parents discuss their individual situation with their pediatrician to determine the best treatment options.
While the techniques vary, there are several strategies you can use when dealing with enuresis that promote positive interaction with your child.
1. Be upbeat and avoid scolding.
This is by far the most important thing to remember when your child wets the bed. "Parents should not scold children or make it a form of punishment," says Dr. Pradeep Nagaraju, interim chief of urology at Mount Sinai Hospital in Chicago.
Scolding often arises from a misunderstanding of what actually causes bedwetting. "The misconception about primary nocturnal enuresis is that there's something wrong with the kid, and there's not. The child cannot sense the urge while asleep and is not lazy or spiteful," says Dr. Frederick Kaskel, professor of pediatrics at the Children's Hospital at Montefiore in the Bronx, N.Y. "The family unit must work together and not take out frustrations on the child. Abuse does happen this way, both physically and emotionally."
In fact, says Dr. Cynthia Ferrell, assistant professor of pediatrics at Doernbecher Children's Hospital in Portland, Ore., by taking out your frustrations on your child, you may propagate negative self-esteem. Remember, wetting the bed is embarrassing enough without being reprimanded.
"Scolding the children or making them feel inadequate does nothing to make the problem better and actually can worsen the self-esteem issues these kids are already dealing with," says Dr. Ferrell.
Dr. Nagaraju also points out that such punishment can lead to even more problems with incontinence. "They end up with dysfunctional voiding," he says, which often turns wetting into a daytime problem as well.
2. Prevent teasing.
When a child wets the bed and has a sibling that does not, teasing often happens. It can be especially troublesome when the non-bedwetting sibling is younger and has already developed nighttime control.
*Alyson, the mother of 8-year-old Ryan who struggles enuresis, found that it has been a bit of an issue between her son and younger daughter. Her daughter often reports when Ryan has wet the bed, but, says Alyson, more in a helpful, not mean, way and never in front of anyone outside the family. "He does get mad at her," though, she says.
The American Academy of Pediatrics' (AAP) guidelines on bedwetting suggest that parents set a "no teasing" rule in their family. "Do not let family members, especially siblings, tease a child who wets the bed. Explain to them that their brother or sister does not wet the bed on purpose," says the AAP. It also may help to explain if it's genetic that Mom or Dad also wet the bed when they were young.
While you are working through bedwetting, it may be helpful to use disposable absorbent underpants. When children wake up feeling dry, there is less embarrassment or feelings of shame.
3. Convey the attitude that bedwetting is not a big deal.
"The more I make a big deal out of it, the more it becomes a big issue for him," says Alyson. Instead, they have explained to him that it is not his fault and that, in their case, it is genetic – Alyson's husband, his brothers and their nephews have all had problems wetting the bed.
The AAP recommends dealing with the situation just the way Alyson and her family have. "Do not make an issue of the bedwetting every time it occurs. Make sure your child understands that bedwetting is not his fault and that it will get better in time," says the AAP.
Let him know that almost all children grow out of bedwetting in time and, says the AAP, the majority of cases are caused by "delayed maturation of bladder control mechanisms" – he simply needs time to develop further, but he is completely normal.
4. Avoid the use of medication unless it is truly necessary.
"I don't like to use [medications] until other types of therapies have been tried," says Dr. Nagaraju.
Other treatments include limiting fluids and waking the child up at night to use the bathroom.
One reason to avoid using medications too early, according to Dr. Mark Stein, chief of psychology at Children's National Medical Center in Washington, D.C., is that they often have a high relapse rate. This is likely because while medication may stop the wetting temporarily, it does not help solve the underlying issue – be it sleep problems, an under-developed nervous system, etc.
Another reason to avoid medications as long as possible are the side effects. The most common medications used to control bedwetting list as side effects: chills, weakness, dizziness, headache, nausea, constipation, high blood pressure and more seriously, seizures, shortness of breath and heart attack.
No matter how you choose to deal with your child's bedwetting, be sensitive to your child's feelings about the issue and discuss the problem with your pediatrician. With a little research and consideration, you will know you are making the best decisions for both you and your child.