Tuesday 17 October 2017

Ask the expert: My seven-year-old still wets the bed. Does he need help?

If parents are concerned about bed-wetting they should discuss it with their GP.
If parents are concerned about bed-wetting they should discuss it with their GP.
Illustration by Maisie McNeice
David Coleman

David Coleman

The parenting expert on how to help a child who still wets the bed

Question: Our son has just turned seven and still wets the bed every night. We limit drinks before bedtime, he wears pull-ups (which only partly work) and more recently we invested in a bed-wetting alarm. This alarm is triggered by the first drop of liquid and is loud enough to wake the dead, but doesn't disturb my son! Currently, my husband lifts him at 11pm and he does a substantial wee, which sometimes is enough to get him through the night, but not always. Please can you advise if this is normal or should we be seeking medical help at this stage?

David replies: Yes it is very normal and no you don't need to get medical help at this stage. That said, you could go and talk to your GP if you wanted.

Almost half of all children will wet the bed up to the age of three years; 10pc of children are still bed-wetting at age seven and between 1pc and 3pc of children still wet the bed at age 11. Bed-wetting is twice as common for boys as for girls.

There also seems to be a strong genetic or family component to bed-wetting since about three quarters of children whose parents both wet the bed as youngsters will do the same.

Bed-wetting seems to be most strongly associated with a physiological immaturity rather than any psychological problem. Most children who wet the bed can't help it.

Staying dry at night is difficult for children to control, as it depends on how deeply they sleep. Sometimes they may not get the message from their bladder that it needs to be emptied. This certainly seems to be the case for your son, since he didn't wake even with the noise of the bed-wetting alarm.

Some children develop the capacity to hold their wee, and so, despite not waking, they stay dry through the night. Getting the 'I'm bursting to go' feeling alerts other children, such that they wake up to go to the loo.

I could imagine that your son gets that bursting to go feeling, but doesn't respond to it because it doesn't yet override his continued sleep.

It is a shame that the bed-wetting alarm hasn't been successful. In many cases, the alarm system does help the child to become more aware of that feeling of needing to go, because they are awoken at the point that their bladder is full.

Sometimes, even in sleep, we do ignore certain sounds because, subconsciously, we figure they are not relevant to us. This is what allows lots of children to sleep even when their parents are talking, or there are the usual noises of family life in the background.

It might be worth a renewed effort with the alarm, and do check the instructions that came with it. Even if you are the one awoken, you can then go, wake your son, and get him to the toilet.

This reminds him of how important the noise of the alarm is and, hopefully, will increase the likelihood that he will learn to respond to the alarm, and in time respond to his body signals.

Being in the pull-ups may also reduce his motivation to stay dry. Part of the reason he has a fully soaked pull-up may be because he can afford to wee in his sleep with little or no consequences.

You may want to consider putting him back in pyjamas, or the pants that come with the alarm.

Don't worry too much about the practice of lifting your son. 'Lifting' in this context, is actually a process of waking them enough to get them to walk out to the toilet. Waking your child to get them to wee, which saves on more bed linen washing, is probably worthwhile, especially if you have stopped using pull-ups.

Like I suggested at the start, while you don't have to consider your son to have a medical problem, there are also pharmaceutical treatments available and your GP may be able to advise if your son is a candidate.

The other real benefit of taking him to the doctor is to rule out any other physical issues. By ensuring his 'plumbing' is all in working order you can be reassured that it is just about waiting for his physical maturation.

Because sometimes it is only patience and positive thinking that sustains us until our child's body matures and they get the dry nights that then come with that maturity.

Our two-year-old son has started hitting out  at us since his little sister was born. Any advice?

Question: My wife gave birth to our daughter 10 weeks ago and since then our two-year-old son's behaviour has changed. He has started slapping my wife and the baby. We tell him that slapping is bold and to go to the corner, but he could repeat it within five minutes. He just doesn't seem to understand that slapping is bold. My wife had an emergency Caesarean and was in hospital for five days. His attitude changed since my wife went away and came home with a baby. How can we get through to him that we still love him and that slapping is not acceptable?

David replies: I'd say your son's whole world has been turned upside down in the last 10 weeks! From his perspective he has experienced two very significant shocks and it sounds like he is showing you, in his behaviour, just how upsetting it has been for him.

The first shock may have been the five-day separation from his mother. Five days is a long time for a two-year-old to be away from his mum. He may even have felt abandoned by her.

If the departure was sudden, and the duration of separation unexpected, then he may have been left with a lot of anxiety about whether he would ever see her again. That is a big deal for any of us, and especially for a two-year-old who is trying to deal with it on an instinctual level.

The second big shock to his system was the arrival of his sister. Her presence has changed his relationship with his mum. She is, naturally, less available to him physically and emotionally as she is taken up with caring for his little sister too.

That change in his relationship with his mum may be really upsetting and frustrating for him. I wonder if his hitting out at his mother and his sister are a signal of that frustration. Maybe he is just showing you how unhappy he is that the status quo has been disrupted.

His world has changed. He probably wasn't ready for it and probably doesn't like the new world order. It will take some time and understanding from you and your wife to help him adapt to the change and to cope with it.

He needs lots of empathy and lots of consistency to realise that you are emotionally and practically available to meet his needs, as well as his sister's needs.

So, talk with him about how hard it can be when your mum has to go away and how worrying it can be if you don't know when she is coming back.

Talk to him about the stress of having to share his space and his life with a new baby.

Talk to him about how he might miss having all of your attention and how it can be really difficult to have to wait.

Because he is so young he is unlikely to respond to these kinds of empathy statements by talking. But they can still be really effective, because they show him that you can understand that the last few weeks have been really difficult for him.

When he realises that you might understand just how hard it has been for him, he is less likely to keep using his behaviour to show you how upset he feels.

I could imagine that you will see a reduction in his hitting out over time.

If he does still hit out, you need to deal with it in a very understanding way. Give him a single clear verbal message that slapping is not allowed and then move him out of reach of the person he has slapped. Be firm, but kind about making sure he can't hit.

He can't yet understand the moral rights and wrongs of hitting out. So for now it is simply about the behavioural messages you give him that hitting isn't allowed.

Balance the need to be firm about hitting, with lots of positive attention for positive things. Literally, catch him being good so that he experiences your praise and positive attention.

Take other opportunities, perhaps capitalising on any time when his sister is asleep during the day, to have special time with him.

So, for example, you could look at his baby photos with him, reminding him of what a lovely baby he was and telling his little sister about how lucky she is to have such a great big brother.

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