Bed-wetting is also known as Nocturnal Enuresis. It is characterized by involuntary urination at night.
Enuresis is involuntary passage of urine past the age when a child should be expected to have attained bladder control. Because this is expected at age 2 to 3 years for daytime and age 4 years for nighttime, enuresis is said to occur a t approximately 5 to 7 years. Enuresis may be nocturnal (occurs only at night), diurnal (occurs during the day), or both. It is primary if bladder training was never achieved; acquired or secondary if control was established but has now been lost.
Functional nocturnal enuresis, no known cause, occurs in approximately 8% to 12% of children age 8 years or younger. It is found more frequently in boys than girls. It also tends to be familial (if it is present in a child, one of the parents probably experienced it too).
Bed-wetting before age 6 or 7 is not a cause for concern. At this age, nighttime bladder control simply may not yet be established.
Most kids are fully toilet trained between 2 to 4 years old. But there is no target date for developing complete bladder control.
What causes bed-wetting is unknown, but various factors may play a role:
A small bladder – the child's bladder may not be developed enough to hold urine produced during the night.
Inability to recognize a full bladder - if the nerves that control the bladder are slow to mature, a full bladder may not rouse the child from sleep, especially, if the child is a deep sleeper.
A hormone imbalance - some kids during childhood, don't produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production.
Stressful events – may trigger bed wetting such as becoming a big brother or sister, starting a new school or sleeping away from home.
Urinary tract infection - can make it difficult for the child to control urination. Signs and symptoms may include daytime accidents, bed-wetting, frequent urination and pain during urination.
Sleep apnea - bed-wetting is sometimes a sign of obstructive sleep apnea.
Diabetes - for a child who is usually dry at night, bed-wetting may be the first sign of type 1 diabetes.
Chronic constipation - sometimes children who do not have regular bowel movements retain urine as well, that can lead to bed-wetting at night.
If bed-wetting continues, treat the problem with patience, understanding and support. Bladder training, moisture alarms, limiting fluid before bedtime, or medication may help.
Toilet Training
Toilet training is one of the biggest tasks the toddler must achieve. There are many theories concerning toilet training and understanding the procedure thus becomes one of the biggest tasks of this period for parents. Most first time parents ask when to start, when the training should b completed and how to go about it.
The answer is that toilet training is an individualized tasks for each child. It should begin and be completed according to a child’s ability to accomplish it, not according to a set schedule. When it is started can be culturally determined.
Before children can begin to be toilet trained, they must have reached three important developmental levels, one physiologic and the other two cognitive:
1. They must have control of rectal and urethral sphincters.
2. They must have a cognitive understanding of what it means to hold urine and stools until they can release them at a certain place and time
3. They must have a desire to delay immediate gratification for a more socially accepted action.
Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myclinated to the anal level. A good way for a parent to know that a child’s develop0ment has reached this point is to wait until the child can walk well independently.
Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old. The markers of readiness are subtle, but as a rule children are ready for toilet training not only when they can understand what their parents want them to do but also when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers, they may bring a parent a clean diaper after they have soiled so that they can be changed.
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