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Family Life: We're at our wits' end over daughter's bed-wetting habit

Q WE have three children. Our eldest is five and a girl, our second is aged four and a girl and our third child is aged two and a boy. Our problem has only started since our two girls went to different schools.

Our eldest started national school and the four-year-old went back to the pre-school last September that they had both attended together since January of last year. The problem is that the four-year-old has started bed wetting every night since September.

I lift her before I go to bed but it makes no difference. I've stopped drinks from six o'clock. I've also spoken to her teachers at school and she is her normal bubbly self there, as she is with us. I had her urine tested in case it was a UTI but test results came back as clear as a whistle.

I'm at my wits' end and she knows that she shouldn't be doing this and feels really bad about it. What can we do?

A PROBABLY the most important thing you can do is to take the pressure off your daughter. She really shouldn't be feeling bad about the bed-wetting as it sounds like it is completely unintentional. Both you and she need to understand her bed-wetting as accidental and understandable.

Bed-wetting is officially called nocturnal enuresis. Most bed-wetting occurs as a result of a very natural physical immaturity. After children initially toilet train by day they usually become dry through the night within about six months.

For some children, however, it takes a bit longer. Indeed, it can take several years for some children's bladders to reach the maturity to contain the wee all through the night. When children have not yet gained the ability to stay dry it is called a primary enuresis.

However, in your daughter's situation it sounds like she had already achieved the maturity to stay dry at night. From what you describe, she had been fully toilet trained by day and night for at least a number of months or a year or so. If this is the case, then her bed-wetting is considered a secondary enuresis (ie, she has started wetting the bed after achieving a significant period of settled, dry nights in the past).

Most commonly, secondary enuresis is the by-product of some kind of anxiety, worry or stress that a child has. Any kind of significant emotional upset can lead children to start wetting themselves, by day, or, more usually, by night.

If you apply this thinking to your daughter's circumstances then it seems likely that the change in her situation at the pre-school may be linked to her starting to wet the bed. I wonder if her initial sense of security and comfort at the pre-school was bolstered by her older sister also being there.

Despite continuing to appear bubbly I wonder if she now feels a bit less secure there.

If the two of them started together back in January of last year then she may have assumed that they would always be together in the same school and class. The change (and loss) of her sister to a new school is possibly enough of a destabilising factor for her that she has started to wet the bed.

The good news, however, with any secondary enuresis, is that once you have a good idea about the likely cause of the anxiety they are often easier to resolve than a primary enuresis.

If you can help your daughter to deal with her stress, or worry, about being on her own in the pre-school then I think the bed-wetting will stop.

To do this you will need to help her to acknowledge, first, that she does indeed find it harder to be in the pre-school without her sister and that she is missing her sister being around during the day.

She is too young to expect her to be able to describe this spontaneously. Four-year-olds rarely have the vocabulary or the emotional understanding to be able to articulate their feelings. So you need to articulate those feelings on her behalf.

This involves talking to her about what it is now like in the pre-school without her sister and suggesting to her, in an enquiring manner, that she misses her sister being there and that you wonder if it might be harder for her now without her sister around. You can also guess that she might be worried or upset that her sister isn't there.

In many ways you are filling in the blanks for her. When you use emotional words to describe what you think she might be feeling then she can make the connections between her experiences and the actual feelings that describe those experiences.

Finding a fit between feelings and experiences allows us to process and deal with those feelings so that they don't get stuck. Essentially, by naming the emotions you think your child might have you allow him or her to sort out the feelings and to move on.

So, although your query is, on the face of it, about bed-wetting, the solution is more likely to come from emotionally supporting your daughter to adjust to the change brought about when her sister moved from the pre-school.

While she does this emotional work you need to stay patient with the bed-wetting and give her a strong message that such accidents don't matter and that you are confident that in a short while she will regain her dryness at night.

I also believe that you can be confident that as she accommodates to her sister not being with her and learns to cope and feel confident on her own in the pre-school that she will indeed stop wetting the bed and will continue to grow and blossom.

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