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Night enuresis corresponds to a situation in which the child involuntarily loses urine during sleep, at least twice a week, without any problem related to the urinary system being identified.
Bed wetting is common among children up to 3 years old, as they cannot identify the urge to go to the bathroom to urinate or cannot hold. However, when the child pees on the bed very often, especially when he is more than 3 years old, it is important to take him to the pediatrician so that tests can be done that can identify the cause of bedwetting.
Main causes of enuresis
Nocturnal enuresis can be classified into:
- Primary enuresis, when the child has always needed diapers to avoid bed wetting, as he has never been able to hold the pee at night;
- Secondary enuresis, when it arises as a consequence of some triggering factor, in which the child returns to bed wetting after a period of control.
Regardless of the type of enuresis, it is important that the cause is investigated so that the most appropriate treatment can be started. The main causes of nocturnal enuresis are:
- Growth retardation: children who start walking after 18 months, who do not control their stools or have difficulty speaking, are more likely to not control their urine before the age of 5;
- Mental problems: children with psychiatric illnesses like schizophrenia or problems like hyperactivity or attention deficit, are less able to control urine at night;
- Stress: situations such as separation from parents, fights, birth of a sibling can make it difficult to control urine during the night;
- Diabetes: the difficulty in controlling urine can be associated with a lot of thirst and hunger, weight loss and vision changes, which are some of the symptoms of diabetes.
It is possible to suspect nocturnal enuresis when the child is 4 years old and still peeing in bed or when he pee in bed again after spending more than 6 months on urine control. But for the diagnosis of enuresis, the child must be evaluated by the pediatrician and some tests, such as urine exam, ultrasound of the bladder and urodynamic exam, which is done to study the storage, transport and emptying of the urine, must be performed.
6 steps to help your child avoid bed wetting
The treatment of nocturnal enuresis is very important and should be started as soon as possible, especially between 6 and 8 years of age, to avoid problems such as social isolation, conflicts with parents, situations of bullying and decreased self-esteem, for example. So, some techniques that can help cure enuresis include:
1. Maintain positive reinforcement
The child should be rewarded on dry nights, which are those when he is able to not pee in bed, receiving hugs, kisses or stars, for example.
2. Train urine control
This training should be done once a week, to train the ability to identify the sensation of a full bladder. For this, the child should drink at least 3 glasses of water and control the urge to urinate for at least 3 minutes. If she can take it, next week she should take 6 minutes and the next week, 9 minutes. The goal is for her to be able to go without peeing for 45 minutes.
3. Waking up at night to pee
Waking the child up at least 2 times a night to pee is a good strategy for them to learn to hold the pee well. It can be useful to pee before going to bed and set an alarm to wake up 3 hours after bedtime. Upon waking up, one should immediately go to pee. If your child sleeps more than 6 hours, set the alarm clock for every 3 hours.
4. Take medicines indicated by the pediatrician
The pediatrician may recommend the use of medications, such as Desmopressin, to reduce urine production during the night or taking antidepressants such as Imipramine, especially in case of hyperactivity or attention deficit or anticholinergics, such as oxybutynin, if necessary.
5. Wear sensor in pajamas
An alarm can be applied to pajamas, which make a sound when the child pees in the pajamas, which causes the child to wake up because the sensor detects the presence of pee in the pajamas.
6. Perform motivational therapy
Motivational therapy should be indicated by the psychologist and one of the techniques is to ask the child to change and wash his pajamas and bedding whenever he pees on the bed, to increase his responsibility.
Usually, the treatment lasts between 1 to 3 months and requires the use of several techniques at the same time, with the collaboration of the parents being very important for the child to learn not to pee in bed.