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: Bedwetting: Do Diapers Help?

Dear DR. PAUL: My 4 and a half year old son has primary bedwetting. We tried the reward system as per our doctor's advice. After a week of very wet sheets and much frustration we "gave in" and let him wear a diaper every night. Do the diapers help or hinder his trying to stay dry at night?

PEDIATRICIAN DR.PAUL ANSWERS:The first thing I have to tell you is that many other parents experience the same frustration. The good news is that most children do outgrow this problem, as night-time bedwetting(nocturnal enuresis) is thought to be caused by a temporary immaturity of bladder control during sleep. The key is what do we do in the meantime? The answer depends entirely on the age of the child and the degree of frustration of all involved. The main goal of treating children with bedwetting today is making sure that they are not affected psychosocially. In other words, that their self esteem or image does not become adversely affected. In general, the older the child who wets the bed, the more his or her self esteem will be affected; As a result, the more aggressive we will be in our attempts to stop or reduce the frequency of the bedwetting.

Now to your specific question about diaper use. I do not usually consider diapers(or pull up panties) as a part of my treatment approach, although we are seeing an increasing number of advertisements promoting their use in children who wet the bed at night. As you can see from my stand described above, I strongly believe that if a child's self image is affected, can't participate in sleepovers, or if the family is at their wits end, then we should definitely try to help stop the bed wetting. However, diapers, unlike other approaches, do not stop the bedwetting, but rather hide it. My fear is that diaper use in nocturnal enuresis sends a "message of permission" to urinate at night. Although the bed and sheets may be dry, the child still has urinated at night, but into a diaper. Although this approach may temporarily spare the need to change sheets and stop the associated night time disruption, I believe that prolonged use of diapers may actually make the problem worse. In the short term, many will argue that diaper use will allow a child to participate in sleep-aways without the fear of embarrassment. But do not forget, that wearing a diaper (even a pull-up) may also be a source of ridicule by peers.

To conclude, while diaper use may temporarily give the family and child a break, I do not advocate their prolonged or regular use in the treatment of children with nocturnal enuresis. I prefer to use other proven and effective methods, ranging from behavior modification(rewards), to the alarm and in certain children, the use of medication such as DDAVP or desmopressin(spray or pill form). The specific treatment approach selected, depends of course on the age and individual situation.

The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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