Bedwetting or Enuresis:
Enuresis is defined by involuntary urination after the age of expected bladder control it is generally reserved for children six years of age or older.
Epidemiology-20% of children at the age of 5 years wet the bed at night. 10% wet the bed at seven years, 5% at the age of ten years.
Nocturnal enuresis is more common in males than females. 70% of children with enuresis have a parent who has enuresis.
Enuresis again is not abnormal in a child who is four years old so expecting them to be dry through the night is unreasonable. If they are dry thru the night then you are merely lucky.
It is important to take a good history. If the child had been trained thru the night, has any abnormalities of the spine or there is any abnormalities in the stream then they need a further work-up.
Children who have this problem need to undergo a work up. Urinary tract infections, sugar in the urine, abnormalities of kidney/bladder function, and other more obscure reasons. Usually the urine is examined and perhaps cultured.
Therapy- education is important. The parents need to remain positive and to refrain from aggressive attempts at therapy until the child is around 6yrs. Alarm systems are the most effective of all interventions. They usually take time to work. There is drug therapy but all of the therapies have there side effects and are usually not used first line especially in younger children.
Prognosis- is excellent with 15% resolution rate every year without any treatment.
It is difficult to say what is normal when you are presented all of a sudden with a four year old child especially since sometimes friends or family may not remember what it is like to have children. This is a common situation for persons who adopt a child. The American Academy of Pediatrics puts out a definitive source on raising children. It talks about all the different things that parents usually will/may need to know such as what is the proper water temperature in your home? Does my child need vitamins? What car seats have been recalled because they are unsafe? Etc. “It is called caring for your young baby and child”. It covers birth to age 5, I do not get any royalties and it does not pay for the pediatrician retirement home but it is an excellent source of information put out by pediatricians.
By James Reilly of Adoptiondoctors.com and Adoptioneducationclasses.com