How can you help a child—disabled or otherwise—stop wetting the bed at night?
This is not something to impose, but to approach with patience and flexibility. It's harder still for children who cannot speak or show what they understand. Dr. Paul Lemoine is a pediatrician, father of eleven, and author of a remarkable book, Passing On Love: An Education in Listening to Your Child. Here he teaches us what attitudes we must bring to this problem. For adults, the situation is different and we may return to it later.
Analyzing such a complex problem in just two pages is difficult—but it boils down to one word: don't dramatize it. Never diminish a child for a mild, temporary condition. Except in a few medical cases that require treatment, bedwetting—when it persists after age four—is common. It stems from slight emotional and psychological troubles that will have no serious consequences if handled with good sense.
Three main causes exist: immaturity, defiance, and anxiety.
Immaturity shows in children who seem listless and resigned before the doctor. They cannot stand up for themselves. They cling to their mother instead of taking initiative. During the day they are not fully continent. Their underwear is often damp because their bladder remains at the stage where it empties reflexively—that is, when full. Just a few drops in their underwear pushes them to urinate passively, without effort or control.
Two extremes can cause this. Some children have worn absorbent, hermetically sealed diapers far too long—diapers that television celebrates! They are convenient for mother and child alike. What a shame to let slip that privileged moment in a child's emotional development—around eighteen months—when he gives his mother a gift: a "beautiful" bowel movement or urination that comes from him, and for which he receives a small sign of love in return.
On the other hand, other children, coddled by anxious, overprotective mothers, never develop initiative, courage, or confidence in themselves. Any emotional trauma can trigger temporary regression—a move, the start of school, the birth of a sibling.
The second cause is a child's resistance to pressure—an attempt to train him too early, or excessive severity from the father.
Anxiety often links to the other two causes, or acts alone. The child absorbs his parents' anxiety and makes it his own. If he falls asleep fearing he will wet the bed, he will. Some children too easily slip into playing the infant role, yet suffer greatly from it: they fear mockery, fear their classmates will find out, fear sleeping away from home.
What can you do?
Many medical prescriptions are useless or harmful:
- Limit fluids in the evening? It sounds sensible but doesn't work. In summer it's exhausting and puts too much focus on bedwetting, raising anxiety.
- Give a stimulant at night to prevent deep sleep? Sometimes it helps, but I refuse to compromise a child's sleep, which is so beneficial.
- A sedative when sleep is too light? Only in cases of severe agitation, when it's harmless, and only if the doctor prescribes it.
Harsh methods—threats of injections or the like—can work quickly through fear. But they suppress one symptom while worsening emotional disturbance, which then shows itself in another neurotic disorder. Perhaps less annoying, but graver for the child.
Sphincter retraining is useful when the child wants to cooperate. But don't do it by waking him at night: this annoys him and makes him urinate while asleep. Train during the day instead. Teach him to control himself when conscious. Ask him to urinate at set times, voluntarily, forcefully—"as if putting out a fire"—not passively when he desperately needs to. You can occasionally ask him to interrupt urination (he won't manage at first).
In truth, the only real treatment is to address the root cause.
In truth, the only real treatment is to address the root cause.
- It's simple to end defiance: replace harsh discipline with warmth, joy, and confidence.
- It takes longer to help a child mature. You must work on all levels, but chiefly on his emotional and mental growth. Eliminate everything that keeps him infantile—diapers, mean comparisons, excessive protection. Instead, foster independence. Invite him to help wash the sheets. Encourage his initiatives. He also needs physical and muscular maturity: sports and exercises will build his courage and self-trust.
- Eliminate anxiety. Reassure the child that this trouble is mild and temporary. Then speak of it as little as possible. The words "wet the bed" alone can remind some children of the comfort of being "the baby," while in others they stir a need to rebel and suddenly bring back fear.
He must take on light, reasonable risks—risks that let his abilities grow. If he falls, don't rush in with anxiety searching for an injury. If he cries a little, clinging to his mother's skirts, tell him with admiration: "Good! We're almost there." He will get up with a radiant smile. Am I drifting from the subject? No—this matters far more than medicine.
The main rule can be said in a single word: don't dramatize it.
- Paul Lemoine, 1994 - Ombre e Luci no. 99