Soaking overnight is perfectly normal. By the time. According to experts, such an “accident” can happen only to those children who are not yet 5 years old. Otherwise, a visit to the family doctor or pediatrician is necessary. Although the problem seems trivial at first glance, it cannot be underestimated. Even the Ministry of Health made a significant change to the provision in the “Guidelines for diagnostic and therapeutic treatment of a child wetting at night”. So, when does a nighttime accident become a medical accident?
Bedwetting is a situation when a child of five years or older, who does not have a birth defect or acquired a disease of the nervous or urinary system, involuntarily urinates during sleep and it happens more than twice a week – explains Dr. Grzegorz Paruszkiewicz, MD. pediatric surgeon, a doctor who has been dealing with the diagnosis and treatment of bedwetting in children for over twenty years.
Children affected by this problem, feeling the fear of embarrassment among their peers, isolate themselves and have low self-esteem. Fearing the reactions of their surroundings, they do not take part in group trips associated with an overnight stay. Soaking is a problem not only for the baby, but also for the parents. Due to the lack of knowledge and shame, parents ignore the symptoms, close themselves to the problem and cannot talk about it. They do not know how to deal with a child, they are frustrated, irritable and starting to lack patience. A large number of children come to the doctor too late or do not see him at all, they are stuck in an unresolved and growing problem.
The problem is in the head?
Specialists emphasize that bedwetting is usually a cause and not a result of emotional disorders, so if your child is 5 years old and still has a problem with bedwetting, it is not worth waiting and going to the GP or pediatrician. Specialists also admit that the problem is often underestimated by the doctors themselves.
Prolonged enuresis increases the parents’ sense of helplessness, which may also adversely affect the child’s mental state. Tired of additional duties and increased expenses resulting from the disease, they tend to be more prone to react to their own frustrations with the child. Then they reveal attitudes of rejection and intolerance. A vicious circle is created and without outside help such a dysfunctional family will not cope. I emphasized the effects of bedwetting in children, because this problem is underestimated by the majority of society, including, unfortunately, some doctors. You have to be aware of it and speak out loud about it that even if the enuresis subsides spontaneously after many years, the mental losses cannot be “made up” – emphasizes Prof. related dr hab. med. Danuta Zwolińska, National Consultant in the field of Pediatric Nephrology.
Dr. Paruszkiewicz explains that there are various causes of bedwetting – it can be, for example, one of the symptoms of urinary tract infection, urinary tract defects, diseases of the nervous system, kidney diseases, and diabetes. The consequences of ignoring the problem of bedwetting in children can have serious psychological and health consequences for the child, increasing the risk of missing urinary tract malformations. The only possibility of a normal life is early diagnosis and proper therapy. The diagnosis of psychogenic enuresis can be made only after excluding the organic causes of enuresis: anatomical or functional – emphasizes the doctor.
Need a change?
Guidelines for diagnostic and therapeutic management of a bed-wetting child (created in 2012) are a very helpful document for doctors who see patients with bedwetting. It is the basic diagnostic and therapeutic guide. According to him, the diagnostic process as well as supportive and motivating proceedings have so far lasted 3 months. It is far too long, bearing in mind that the vast majority of parents have already implemented many of the recommended non-pharmacological methods.
Those who came to the doctor for the first time, very diligently keep records in the diary and follow the guidelines in the first month, but not seeing the effect, they get discouraged, as evidenced by a significant decrease in the number of patients at follow-up visits in the second month, and a drastic decrease in the third month therapy. This often results in a complete abandonment of the child’s treatment. Therefore, the Ministry of Health changed the provision, shortening the supportive and motivating period from three to one month. According to the declaration submitted by the deputy minister – Marek Tombarkiewicz – from January 3 there was an amendment to the reimbursement record of the desmopressin preparation. The changes to the enrollment will enable all children with bedwetting to receive appropriate assistance in the shortest possible time, in accordance with applicable international standards.
Data from clinical trials indicate the effectiveness of behavioral therapy in children in the first (3-4) weeks of its duration, in favor of shortening the period. However, in the following cases, the therapeutic effect remains at a similar level. This means that for patients in whom supportive treatment in the first weeks did not reduce wet nights, it will also not be effective over a longer period of time. Therefore, it is not surprising that the 3-month period of preliminary proceedings seems too long for the vast majority of parents. Discouraged by the lack of results, they break up their cooperation with the doctor, exposing the child to the lack of proper help and further permanent stress along with the escalation of negative consequences.