Friday 9 December 2016

My seven-year-old son still wears training pants at night

Published 18/08/2015 | 02:30

Illustration by Maisie McNeice
Illustration by Maisie McNeice

Advice from the clinical psychologist on what to do when your seven-year-old son is still wearing pull-ups at night and on dealing with a claustrophobic relationship with your sister.

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Question: My seven-year-old son is still wearing those pull-up nappy things at night as he would wet the bed on a regular basis if he went without them. This doesn't overly concern me; I know some children are later than others to gain night-time continence, so I just expect things to fall into place at some point. But he was invited to a sleepover recently and didn't go. I think he was too embarrassed to accept because he wears the pull-ups and was afraid his friends would see them. I hate to see him being held back like this. What should I do?

David replies: Yes, it does sound like your son may, indeed, be embarrassed by his night-time wetting. Properly, this is called nocturnal enuresis and is really common, especially among boys.

Some estimates suggest that about 30pc of boys still wet the bed at age 4, dropping to about 2-5pc of boys wetting the bed age seven.

Typically, for those boys who become dry at night, it isn't even a skill that needs to be taught. Mostly it is simply maturation of the urinary system.

For most children, around the time that they are trained to use the toilet, they naturally fall into the practice of staying dry through the night too.

For those whose night-time bladder control doesn't mature, it can be tempting to keep them in nappies, or as you have done, transfer over to the under-pyjama pants when they get a bit bigger and feel self-conscious about still wearing nappies.

However, by their design, the night-time pants will lock away the moisture, such that children don't even feel the wet when they involuntarily wee at night. Because of that, they get no physical feedback from damp clothes or sheets to let them know that they have wet themselves.

While I don't wish the extra hassle of cleaning up a wet bed on anyone, I do question the long-term impact of under-pyjama pants. I wonder if they actually slow the learning for some children in terms of gaining bladder control at night.

Your son is aware of his night-time wetting, in as much as he is afraid to go to his friends' houses, overnight, in case his protective pants are seen. Presumably, if he didn't have the pants, he'd be as anxious, staying over, in case he wet the bed.

Given that his enuresis is now affecting his social life, and possibly his self-esteem (as a consequence) it may be time to just tackle the night-time wetting.

Your first step should be to get rid of the under-pyjama pants. Then, when he is going to bed in just his pyjamas you can try some other strategies.

Certainly, limiting the amount of liquids he has in the evening is worth doing. You can ensure that he does a big wee before he goes to bed. You can also choose to lift him to the toilet in the middle of the night (whenever you are heading for bed, typically).

It might help him to understand the way his bladder and urinary system work. It is helpful for children to notice the "full" feeling, before they do a wee in the daytime. So, when you see him heading for the loo, do remind him to pay attention to the pressure he feels and the urgency.

Those same physical sensations are present at night, but, as yet, they don't breach his unconsciousness strongly enough to be responded to. By paying attention to the "full" feelings in the day, he may be more attuned to them at night.

But, aside from all the small things that you can do, to help children that wet the bed, the most successful strategy, in my opinion, are the alarm systems.

You can find them online, including an Irish supplier. The priming for the alarm is usually sewn into a pair of underpants, that the child wears to bed. As soon as any moisture hits the lining a shrill alarm goes off, waking your child.

When they wake, they go to the toilet to finish off the wee. Usually, at his age, the alarm systems are an effective way to train a child, at night, within about four weeks.

It costs a bit of money, but you'll be saving on not having to buy the under-pyjama pants. Most importantly, however, your son will feel so much more confident once he has this night-time bladder control.

My sister suffocates me, copying everything I do. I worry that her son is now smothering my son too

Question: I have three children age three, five and seven. My sister, who lives beside me, also has three children of similar ages. My sister is suffocating, always trying to copy me, aping everything I do. This makes me want to scream. Her son also tries to swamp my son at school. They are in the same class and her son is very annoying and needy, constantly following mine around, blocking him from making other friends. I am really tempted to move my son to another school so that he can break free of his cousin. Is that too drastic?

David replies: I think you have two issues. You have to resolve your relationship with your sister and you have to deal with how your son and his cousin get on. Of those, however, your relationship with your sister seems, to me, to be the more important issue to sort out.

You sound very upset about the fact that your sister is so close by and seems to copy everything you do. To describe her as "suffocating" suggests that she is always popping in, always commenting on your life or always turning up to the same events that you do.

You sound like you would like a bit of physical and emotional distance from her. Have you ever asked for that? She may not even be aware that you feel her presence so strongly.

Naturally, if you live beside each other, it is tempting to move in and out of each other's lives. I presume that the cousins, also being so close, may feel like they are part of one big extended family.

That might suit your sister very well, but it sounds like it is a bit claustrophobic and restrictive for you.

If this is the case then you need to talk to your sister about it. This is not about blaming her for "aping" you and giving you no space. But, you do have to explain to her that you find the proximity overwhelming at times.

You have to remember that, unless she too is looking to pull away, that some of her needs may be met by the same proximity that bothers you. So, when you ask for more space she may find that hard to achieve.

She may also really admire you, or even feel a bit jealous of you, and this might lead her to try to be like you.

However, once you have explained what your needs are (more distance, less involvement with the extended family) then you can be more direct with her when her behaviour imposes on you.

So, for example, if she turns up at the same location as you have gone for a family day out, you can explain to her that this is an example of her encroaching on your family time.

I think it is fine for you to want time for yourself and your own family, that doesn't involve the extended family. But often we have to be direct (and a bit blunt) in asking for that.

If there are other issues about the way she copies or "apes" you then you need to give her the examples of where that happens and how you feel when it happens. Your sister may just be unaware, or unconcerned, about the impact of her behaviour on you.

The best way to make her aware is to tell her about how you feel whenever you feel overwhelmed and "suffocated" by her. You may like to talk to a therapist, in your own right, about your family dynamic, and about your experiences growing up with your sister and other siblings. .

When it comes to your son, it does sound a little drastic to move him to another school. Alongside your son's perception of things, have you checked with their teacher about what he or she percieves about their relationship?

I presume the boys are in your local school and so moving him might disadvantage him in terms of his connection to the local community.

Alongside your discussion with your sister about your own relationship you can talk with her about the situation between the two boys and explain that you are encouraging your son to make lots of new friends in school.

Then you can teach your son some assertive skills, to be able to be direct with his cousin if his cousin is bothering him and to feel confident enough to make those new friends.

dcoleman@independent.ie

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