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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. |
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