When is it a problem?

by Healthy MOM™ Dr. Ilana Dickson, Samaritan Pediatrics Physician

For many children, bedwetting is not uncommon. Although most children are potty trained overnight by 5 years of age, 15% of them will still have trouble keeping their bed dry and rates among children 15 years and older can be as high as 1 to 2%. And this problem is exhibited more in boys than in girls.

Most reasons for bedwetting are benign and will resolve with time. However, waiting for this to happen can be challenging. Both parents and children can be filled with anxiety as they wonder if something is seriously wrong. It can be socially embarrassing as it may keep children from going on sleepovers and families from going on vacations. And let's face it, who wants to be washing sheets on a regular basis? On the more practical side, it is a major inconvenience and nuisance.

The majority of bedwetting can be attributed to one or more of the following: 

• Your child's bladder is maturing more slowly than usual
• The amount your child's bladder can hold is smaller than others
• Your child has difficulty waking from a deep sleep
• There is a strong family history of bedwetting
• Vasopression (a hormone that helps hold urine) is decreased 

Less commonly, bedwetting can be associated with medical or emotional problems. Medical problems can include, but are not limited to: diabetes, constipation, urinary tract infection, pin worms or kidney disease. Emotional problems are usually due to psycho-social stress factors in the home or at school. Medical and emotional problems can be diagnosed by a physician, however these serious conditions are by far the minority of the root cause of bedwetting.

The following points are things you may try at home: 

• Talk with your child about this and encourage him/her to get up out the bed if he/she feels the urge to go to the bathroom overnight
• Make sure your child wears clothes that are easy to maneuver overnight if he/she gets up to go to the bathroom i.e. undergarments that pull off easily
• Make the path to the bathroom easy and accessible with proper lighting as needed
• Make sure your child uses the bathroom before bed
• Restrict your child's fluid after dinner
• Protect the bed with a waterproof sheet to avoid a mattress that smells of urine
• When your child does wet the bed, simply place a towel or two on the wet spot thus avoiding the changing of sheets in the middle of the night
• Include your child in the morning clean up of the soiled sheets as part of a daily routine and maintenance
• Never tease or allow siblings to tease your child about this problem
• In an effort to "goal-motivate" your child, create a calendar of stickers to represent dry nights and offer a reward after a certain number of dry nights 

Other modes of treatment may be tried in conjunction with your physician and include bedwetting alarms, medications, talk therapy as well as number of alternative therapies. 

If you are the parent of a bed-wetter, remember that this problem is one that in most cases will resolve over time and require minimal to no intervention. It is also important that you remember how common this problem is -- this may be especially difficult when you observe that your 3- or 4-year-old is dry at night but your 5- or 6-year-old is not. 

For more information please go to the American Academy of Pediatrics at www.aap.org/healthtopics/toilettraining.cfm.

*Information in this article obtained from an "UpToDate" review article called: Bedwetting in Children, May 2009.

Healthy MOM™ is brought to you courtesty of Samaritan Health Services.

MOM Magazine indavertently omitted the source from Dr. Dickson's Apr/May Healthy MOM article "What to do when a stomach virus strikes." The source, Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics), has been included in the revised article found here.

Our good friend and Mid-Valley Healthy MOM Dr. Ilana Dickson just reminded us that the Expectant Parent Class is coming up on Wednesday.   Check out this link for more info!

http://www.samhealth.org/aboutus/newsevents/classesevents/Pages/1802.aspx

From the Desk of MID-VALLEY Healthy MOM Dr. Illana Dickson

Reach Out and Read:

A program that promotes early literacy at pediatric offices nationwide by giving new books to children and advice to parents about the importance of reading aloud.

Program launch at Samaritan Pediatrics, the only participating program in Benton County, on Friday November 5^th, 4-6 pm, in the Samaritan Pediatrics waiting room (Samaritan Professional Center, 3517 NW Samaritan Drive, Suite C).

Cake and punch will be provided;

Tips on reading aloud will be demonstrated by volunteer readers,

And OSU's Benny Beaver will be present from 4-5 pm.

A few facts from Reach Out and Read program website:

There is a crisis in the public education system in our country. More than one-third of American children enter kindergarten without the basic language skills they will need to learn to read. Those critical early literacy skills include recognizing the letters of the alphabet, understanding that books move from left to right, and being able to understand and tell stories.

Despite the billions of dollars Americans have invested in remedial reading programs, those millions of children who enter school unprepared are highly likely to never catch up. In fact, 88% of first graders who are below grade level in reading will continue to read below grade level in fourth grade. (Juel, 1988) And reading difficulty contributes to school failure, which increases the risk of absenteeism, dropping out, juvenile delinquency, substance abuse, and teenage pregnancy - all of which perpetuate the cycles of poverty and dependency.

The answer is to "immunize" children against illiteracy in the critical years before they enter school, when interventions can have the most dramatic impact. In fact, Nobel Prize-winning economist James J. Heckman found that economic returns on dollars invested in early education are as high as 15-17% per year - higher than other traditional economic development strategies.

Reach Out and Read promotes early literacy and school readiness with a research-tested, evidence-based model that's proven to help children develop the language skills they will need to learn to read and succeed in school.

There are currently 4,654 Reach Out and Read Programs in U.S.* and so far 6.4 million books have been distributed to 3.9 million children

For more info on Reach Out and Read go to their website at www.reachoutandread.org

Healthy MOM is brought to you by Samaritan Health Services.

MOM Magazine's Healthy MOM, Dr. Dickson, is brought to you by Samaritan Health Services.

Dr. Dickson wrote a very insightful article on postpartum depression in the June/July issue of the magazine. As a follow up to that article, she has provided the following questions to elicit information about postpartum depression:

• How are you feeling about being a new mother?
• How are you coping with the additional stress of a new baby?
• Are you able to sleep when the baby is sleeping?
• How is your appetite?
• Do you have enough energy to do the things you need to do for yourself, your baby, your work?
• Have you been feeling sad or depressed over the past week?
• Have you been feeling anxious, worried, or irritable over the past week?
• Have you been having difficulty concentrating or remembering things?
• Do you find yourself crying for no reason?
• Have you been having thoughts of hurting yourself? Anyone else?

If you wouldl like to talk to someone about how you are feeling postpartum, here is a list of local resources:

Local resources:

Babies First and CaCoon, here via Benton County Health Department,  (541)967-3888 x6910

Oregon WIC Program (Women-Infants-Children) (541)766-6835

WellMama Pregnancy & Postpartum Support Services, 24hr message line (800) 896-0410, info@WellMama.org - www.WellMama.org@ WellMama

Clinical psychology resident, Debra Carriere, Ph.D. (541) 754-0070

Your obstetrician or midwife should also be able to give some advise as to how to seek help as well as offer antidepressants if deemed necessary.

http://www.aap.org/sections/scan/practicingsafety/Modules/Parenting/Parenting.pdf

See the June/July 2010 Healthy MOM article here, or in your local MOM Magazine.