Dealing With Nighttime Enuresis in Children
Many children have occasional enuresis, or wetting at nighttime, even though they have been toilet trained for years. Quite a few children who have been traumatized by interpersonal violence will have nighttime (and even day time) wetting that is often not effectively treated by medication or restriction of liquids. Even older children may have nighttime wetting; it is not uncommon for the problem to continue to occur in children who are victims of PTSD even into their teen years.
If medication and liquid restrictions do not help, what should you do? The first step is to accept that the wetting issue may not go away quickly or easily. The second thing to remember is that even though it is a frustrating problem, you should refrain from becoming punitive with the child when they wet. Giving consequences will likely only make the situation worse, and begin to erode and damage your relationship with the child. Once you have accepted these basic ideas, you can move on to the practical coping strategies listed below.
If the child is clearly in control of their bladder in the daytime, and the child is above the age of three or four, resist putting nighttime diapers or 'pull-ups' on the child. The reason for this is that when diapers are used, the child is being behaviorally shaped to depend on them. In other words, the longer they wear the diapers, the longer they will wear the diapers. As the child gets older, this is a social embarrassment as bad as wetting the bed. Diapers do not solve the wetting problem. For children to learn how to avoid wetting, they need to be able to feel the wetness on their skin!
Your next step is to get a cover for the child's mattress. Not just a top cover, but an all encasing, heavy plastic cover. In most cases, new mattresses are sealed in a plastic that is perfect. You can find some waterproof encasement covers in mattress stores or on the Internet. Then, be sure to have at least two or three sets of fitted bottom and top sheets, as well as a n extra blanket for the child's bed, so that there will always be a change of sheets available. You can take a regular top sheet and fold into quarters and place it under the area where the child's bottom lies, then put the regular fitted bottom sheet over this. Of course, if the child moves around the bed a lot, this measure may not have the intended absorption effect. It is a good idea to encase the child's pillow in the same fashion, because pillows can get wet too!
If the child wakes in the middle of the night to tell you they are wet, you should help the child first to take a quick shower, not just clean up with wet wipes and change clothes and sheets. The child should strip the bed following the shower, and take the wet sheets to the laundry area to be washed later. The reason for these measures is to make the wetting incidents a bit uncomfortable, not to mention press home to the child that wetting clean up is their responsibility. All of these procedures should be done in a matter of fact manner; try to hide the fact that you are tired and irritated by the problem. By the same token, if the child discovers they are wet in the morning, the same procedure should be done.
If the child sleeps through their wetting and it is not discovered till morning, you might want to try to ascertain when they usually wet. In most cases, this is either during their dreaming (intrusive nightmares about their abuse) or in deep sleep. You can check at intervals throughout the night to try and ascertain a pattern. If a pattern is found, you have a shot at being able to wake the child about thirty to sixty minutes before the known wetting time to use the toilet.
Last of all, there are devices on the market that sound an alarm when the child begins to urinate at night. Some are pads under the bottom sheet, while others clip to the inside of the child's underwear. The child will still wet themselves, but the idea is that the alarm begins to teach the child's sleeping mind how to pay attention to their full bladder, and to wake themselves up, instead of having an annoying alarm do this. Some of these alarms can be fairly costly, and have varying degrees of claimed success.
Bill Krill is a guest writer and a Child and Adolescent Mental and Behavioral Health professional trainer. You can read more about his services on his parent education, support, and coaching