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Pediatrics/Bedwetting at 6.5 years

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Question
Hi doctor,
My daughter is 6.5 years and still bed wets at nights.

She never realises the wet too during sleep and never realises when I  change    her the pants. Sometimes I wake her up and take her bathroom to urinate. But she never remembers it the next day. That much deep sleep she gets.

So how to stop her from bedwetting? Please guide me.

Answer
Hi Ms Sudha,

This problem is most common in deep-sleepers. It is known to run in families; it is more common in children where there is family-history of the same problem.

It should be clearly understood that it is a problem that always gets resolved sooner or later. However, it is also a fact that there is no "quick fix" solution to this and one needs to have loads of patience and approach the problem gently and systematically.

The first step in treatment is of course, restriction of fluids after 7 pm. Avoid any drinks with caffeine (e.g., cola drinks). The child is asked to urinate before going to bed. Older children who don’t like “being told” about it every day may respond favourably to a sign at their bedside or on the bathroom mirror. Ask the child to promise to himself and/ or pray before going to bed that he would wake up from bed for passing urine. It is to be done daily irrespective of results. It is preferable to wake him up at mid might again and make him pass urine. Avoid using diapers. Although diapers make the child (and parents!) comfortable, they interfere with motivation for getting up at night.  However, they can be used selectively for camping or overnights at other people's homes.

The child should be encouraged to drink a lot during the morning and early afternoon.  The more the child drinks, the more urine child will produce, and more urine leads to larger bladder. Thus, it helps in increasing bladder capacity.

These children do not like being wet.  They feel quite guilty and embarrassed about this problem. They need support and encouragement, not blame or punishment.  Siblings should not be allowed to tease bed-wetters.  Home needs to be a safe haven for the child.  Punishment or pressure will delay a cure and cause secondary emotional problems.  In fact, sometimes bedwetting is a channel to relieve anxiety/frustration/anger by the child. Thus, any reprimands, punishments, name-calling etc. for bedwetting certainly become impediments to success:  Bedwetting worsens. Verbally and non-verbally (your body language) must suggest that you are "with" him for this problem and you do not "accuse" him for this: as it is definitely NOT in his control.

“Positive reinforcement” does wonders in these children: By positive reinforcement, I mean rewards for being dry at night. You must maintain a WRITTEN diary/ calendar and mark the days he was dry. Keep realistic "targets" for him and pre-decide appropriate rewards for achieving the targets. For example, if he wets almost every day, he must be rewarded even for single dry night in a week (reward like an outing or extra play time, etc); if he wets 3-4 times a week, the reward should be for 3 consecutive dry nights. Gradually he would move up the ladder.

When your child wakes with wet sheets, have your child help you change the sheets. Explain that this isn't punishment, but it is a part of the process. It may even help your child feel better knowing that he or she helped out. It should not look like a punishment to the child.

If she doesn't improve within few months of following this, please follow-up with your doctor to plan further treatment.


Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

+91-9818356846, +91-11-45535647

www.KumarChildClinic.com  

Pediatrics

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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