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SouljahOfAllah
05-12-2009, 07:19 PM
Assalamu Alaykum Wr Wb
How do you talk to an 8 year old which still wets her bed - every single night. what do i say or ask her and how can i rid her of bedwetting? Her attitude after wetting her bed is apauling as she does not care, as she knows her mum will change her sheets and provide her with cean cloths and fresh bed for the up coming night.

Any advice?

Waiyyakum
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جوري
05-12-2009, 07:51 PM
The problem might not be psychological rather physiological.
Under any light you need to see a physician for the problem..
There are some methods that are employed from using a bell to medications like imipramine.. but the etiology of her problem needs to be ascertained first before you try any method..

Has she always been a bed-wetter? or this is a recent thing? if it is, you need to assess what new changes are causing her anxiety or to lapse into regression.. Are there any changes at home? new baby, parents divorcing or not getting along? something going on at school? etc

she needs to see her pediatrician..

and Allah swt knows best


:w:
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Raudha
05-12-2009, 07:57 PM
^ you're a med-student :p


was going to say something similar

:peace:
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SouljahOfAllah
05-12-2009, 08:25 PM
format_quote Originally Posted by Gossamer skye
The problem might not be psychological rather physiological.
Under any light you need to see a physician for the problem..
There are some methods that are employed from using a bell to medications like imipramine.. but the etiology of her problem needs to be ascertained first before you try any method..

Has she always been a bed-wetter? or this is a recent thing? if it is, you need to assess what new changes are causing her anxiety or to lapse into regression.. Are there any changes at home? new baby, parents divorcing or not getting along? something going on at school? etc

she needs to see her pediatrician..

and Allah swt knows best


:w:
its always been a case she has never come out of "nappies" at night time ever since she was born, and it not a case with just her but also with her younger siblings. there has always been a new baby in the family every single year but i dont see how it can effect her when so many have come after her? Allahu Alam but its really depressing seeing an 8 year old peeing her self in at night... imsad
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ayan333
05-12-2009, 10:40 PM
:sl:

i know of a 14 and year old who still does!

:w:
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جوري
05-13-2009, 12:13 AM
I have gotten you a scientific article on the matter...

pls pls know that this is only meant for your general knowledge, it is my strong recommendation that you take your child to see a doctor. I don't want this article misused as I can lose my privileges of my subscription with them.

Also, I don't understand why this problem is depressing? Sis all people have all kinds of problems.. al7mdlilah bed-wetting is one of those that can be managed...

:w:

Management of nocturnal enuresis in children

Authors
Naiwen D Tu, MD
Edmond T Gonzales, Jr, MD Section Editors
Jan E Drutz, MD
Marilyn Augustyn, MD Deputy Editor
Mary M Torchia, MD



Last literature review version 16.3: September 2008 | This topic last updated: March 17, 2008 (More)


INTRODUCTION — Urinary incontinence is a common problem in children. At 5 years of age, 15 percent of children remain incompletely continent of urine. Most of these children have isolated, or monosymptomatic, nocturnal enuresis.

Monosymptomatic nocturnal enuresis is usually divided into primary and secondary forms: Children who have never achieved a satisfactory period of nighttime dryness have primary enuresis. Children who have had a period of dryness, usually for at least six months, before the onset of wetting begins have secondary enuresis.

Primary monosymptomatic nocturnal enuresis has a high rate of spontaneous resolution (approximately 15 percent per year [1,2] ), and is thought to be related to one or a combination of the following: delayed bladder maturation; small functional bladder capacity; diminished vasopressin release; and poor arousal from sleep.

Secondary nocturnal enuresis often is thought to be caused by a period of unusual stress (eg, parental divorce, birth of a sibling) at a time of vulnerability for developmental of bladder control in the child's life. However, the exact cause of secondary enuresis remains unknown. The management of secondary nocturnal enuresis involves addressing the underlying stressor if one can be identified, although most children with secondary enuresis have no identifiable cause and are treated in the same manner as those who have primary enuresis.

The management of children with primary nocturnal enuresis will be presented here. The causes and evaluation of nocturnal enuresis in children are discussed separately. (See "Approach to the child with nocturnal enuresis").

GENERAL PRINCIPLES — The age at which enuresis is considered to be a "problem" varies depending upon the family. If both parents wet the bed until late childhood, they may not be concerned that their seven-year-old wets the bed. In contrast, parents may be concerned about a four-year-old who wets if he has a three-year-old sibling who is already dry. For the child, nocturnal enuresis usually becomes significant only when it interferes with his or her ability to socialize with peers [3,4] . As a general rule, children younger than 7 years of age may be managed expectantly, including reassuring parents that monosymptomatic nocturnal enuresis will resolve spontaneously in the majority of these children.

When necessary, treatment of primary nocturnal enuresis is empiric; it is based upon many years of observations, and attempts to address the factors that are thought to play a role in the etiology. Before beginning therapy, the pediatric healthcare provider should carefully define the expectations of the parents. Some parents may simply want assurance that the enuresis is not caused by a physical abnormality, but are not interested in initiating a long-term treatment program.

Parents must clearly understand that nocturnal wetting episodes are completely involuntary on the part of the child. Between one-fourth and one-third of parents punish their child for wetting the bed, and sometimes this punishment is physically abusive [4-6] . The video "Bedwetting: Jasper to the Rescue" is an excellent tool in helping parents and patients to understand enuresis [4] . It is available from Disney Educational Productions (800-295-5010) in a number of languages.

The pediatric healthcare provider should stress to the parents and child that a carefully constructed enuresis treatment program usually involves several methods of treatment (eg, motivational therapy, fluid restriction, enuresis alarm). The treatment may be prolonged, often is associated with relapses, and may fail in the short term. The parents must be willing to participate, and the family environment must be supportive. Therapy should be goal-oriented, and follow-up should be consistent [7] . The frequency of follow-up varies, but is usually approximately every four months.

It is important to determine whether the child is mature enough to assume responsibility for treatment. Treatment probably should be delayed if it seems that the parents are more interested in treatment than is the child, and the child is unwilling or unable to assume some responsibility for the treatment program. The child must be highly motivated to participate in a treatment program that may take months to achieve successful results.

Overview of treatment — Treatment may involve one or a combination of the following nonpharmacologic and pharmacologic modalities: Motivational therapy Bladder training Fluid management Behavioral alarms Pharmacological agents

As described above, treatment of nocturnal enuresis is rarely indicated in a child younger than 7 years of age. When the parents and child are interested and motivated to work toward long-term management, nonpharmacologic therapies (eg, motivational therapy, bladder retention exercises, fluid management) are usually tried for three to six months. More active intervention (eg, arousal alarm systems, pharmacotherapy) should be considered as the child gets older, social pressures increase, and self-esteem is affected. Pharmacologic agents can be effective in the short-term (eg, for sleepovers or camp attendance), but enuresis alarms are the most effective long-term therapy.

NONPHARMACOLOGIC THERAPY

Motivational therapy — Once the child agrees to accept responsibility, he or she can be motivated by keeping a record of progress. Successively larger rewards, agreed upon in advance, are given for longer periods of dryness (eg, a sticker on a calendar for each dry night, a book for seven consecutive dry nights).

Motivational therapy leads to significant improvement (decrease in enuretic events by ≥ 80 percent) in more than 70 percent of patients [8] . It is estimated to be successful (14 consecutive dry nights) in 25 percent [8,9] . The relapse rate (more than two wet nights in two weeks) is approximately 5 percent [10] .

Motivational therapy is a good first line of therapy for primary nocturnal enuresis, particularly in younger children [7,11] . In a systematic review of simple behavioral interventions for nocturnal enuresis, reward systems (eg, star charts), were associated with significantly fewer wet nights, higher cure rates, and lower relapse rates compared to those of controls [11] . However, these results were based on single small trials. If motivational therapy fails to lead to improvement after three to six months, other methods should be tried [7] .

Bladder training — Most children with nocturnal enuresis have a functionally small bladder capacity. (See "Approach to the child with nocturnal enuresis", section on Small bladder capacity). Bladder retention training exercises may be undertaken to increase bladder capacity in these patients (eg, those whose usual voided urine volume is less than the bladder capacity expected for age) [4] . Bladder capacity in ounces (one ounce = 30 mL) can be estimated in children by adding 2 to the child's age (in years) until 10 years of age [12] . Bladder training requires a highly motivated child and is a common component of multimodal therapy programs.

Bladder retention training involves asking the child to hold his or her urine for successively longer intervals ("as long as possible") after first sensing the urge to void. The volume of voided urine should be recorded once per week in a follow-up diary to evaluate success. The target volume is based upon the calculated bladder capacity for age [4,12] .

Bladder training is effective in increasing bladder capacity [13,14] . However, it is not clear that increasing bladder capacity affects nocturnal enuresis or response to treatment with an enuresis alarm [13,14] . In some review articles, bladder training therapy has been reported to lead to significant improvement (decrease in enuretic events by ≥ 80 percent) in as many as 60 percent of patients [10] , and has been estimated to successfully curb nocturnal enuresis (defined as 14 consecutive dry nights) in 35 percent [15,16] . However, subsequent randomized trials have found that increased bladder capacity was not related to treatment response (defined as ≤ 1 wet night in previous 28 days) [13] , nor to improved response rate to subsequent treatment with an enuresis alarm [14] . A systematic review of simple behavioral and physical interventions for nocturnal enuresis in children found there was not enough evidence to evaluate bladder retention used either in isolation or in addition to other interventions [11] .

Nonetheless, a trial of bladder training exercises is recommended before alarms and pharmacologic agents are tried, because the latter methods may be more demanding and have adverse effects [11] .

Fluid management — Asking the parents to record a fluid intake diary can help to assess the balance of fluid intake throughout the day. For those patients who are found to consume a disproportionate amount of fluid in the evening hours, a different schedule can be recommended [4] . Some authors recommend that their enuretic patients drink 40 percent of their total daily fluid in the morning (7 AM to 12 PM), 40 percent in the afternoon (12 PM to 5 PM), and only 20 percent in the evening (after 5 PM); beverages consumed in the evening should be caffeine-free [4] .

This fluid maintenance program differs from isolated fluid restriction in the evening hours, which is often attempted by parents to control enuresis. Isolated nighttime fluid restriction, without compensatory increase in daytime fluid consumption, may prevent the child from meeting his or her daily fluid requirement, and is usually unsuccessful. In contrast, the fluid management program described above permits the child to drink as much as he or she wants throughout the day. Ample consumption of fluid in the morning and afternoon reduces the need for significant intake later in the day. In addition, it increases daytime urinary flow and may assist in bladder training to increase functional bladder capacity [4] . (See "Bladder training" above).

Enuresis alarms — Conditioning therapy using an enuresis alarm is the most effective means of controlling nocturnal enuresis [3,17] . Enuresis alarms are activated when a sensor, placed in the undergarments or on a bed pad, detects moisture; the arousal device is usually an auditory alarm and/or a vibrating belt or pager (show table 1) [4,7,18] .

The alarm works through conditioning: the patient learns to wake or inhibit bladder contraction in response to the neurologic conditions present before wetting. At the initiation of therapy, the child may occasionally fail to awaken; this can be ameliorated if the parents wake the child when the alarm sounds.

The family should be instructed that the child is in charge of the alarm [19] . Each night before he or she goes to sleep, the child should test the alarm; with the sound (or vibration) in mind, the child should imagine in detail, for one to two minutes, the sequence of events that occur when the alarm sounds (or vibrates) during sleep. The sequence is as follows [19] : The child turns off the alarm, gets up, and finishes voiding in the toilet (only the child should turn off the alarm). The child returns to the bedroom. The child changes the bedding and underwear. The child wipes down the sensor with a wet cloth and then a dry cloth (or replaces the sensor if it is disposable) The child resets the alarm and returns to sleep.

Changes of linen and clothing should be kept near the bed. The parents may need to help the child wake to the alarm and should supervise the changing of bed linens. A diary should be kept of wet and dry nights. Positive reinforcement should be provided for dry nights as well as successful completion of the above sequence of events.

The alarm should be used continuously until the child has had between 21 and 28 consecutive dry nights [10] . This usually takes between 12 and 16 weeks with a range of 5 to 24 [10] . The child should be seen in follow-up one to two weeks after starting the alarm and then at the end of an eight-week trial [19] . Therapy with the alarm can be reinitiated for relapse (more than two wet nights in two weeks).

Approximately 30 percent of patients discontinue the alarm for various reasons including skin irritation [20] , disturbance of other family members, and/or failure to wake the child [10,18] .

In a systematic review, compared to no treatment, approximately two thirds of children became dry for 14 consecutive nights during alarm use (RR for failure 0.38, 95% CI 0.33-0.45) [17] . Nearly one-half of children who continued to use the alarm remained dry after treatment, compared to almost none in the no treatment group (45 versus 1 percent). Alarms appeared to be less immediately effective than desmopressin, but more effective in preventing relapse. Alarms were more effective than tricyclic antidepressants during and after treatment [17] . Treatment with desmopressin and tricyclic antidepressants is discussed below. (See "Pharmacologic therapy" below).

Relapse can occur after the alarm unit is discontinued. However, the relapse rate after discontinuation of therapy is much lower with alarms than with desmopressin (RR 0.11, 95% CI, 0.02-0.78).

Children who relapse after discontinuation of the alarm usually can achieve a rapid secondary response due to preconditioning as a result of the first treatment program [21-24] .

Alarm clocks — It also may be possible to condition some children to wake to void by using an alarm clock [25] . In one study, 125 children with primary nocturnal enuresis were enrolled into two treatment groups and treated for four months [25] . Group I children were awakened to void when the bladder was full, but they remained dry (the waking time was determined individually during a one- to three-week trial period); Group II children were awakened after two to three hours of sleep (whether they were wet or dry). One-third of the patients stopped using the alarm within one month. Among those who continued, initial success (14 consecutive dry nights) was obtained in both groups (77 percent in group I and 62 percent in group II). The relapse rate six months after stopping therapy was 24 percent for group I and 15 percent for group II. The authors concluded that an ordinary alarm clock is a safe, effective, noncontact treatment strategy for enuresis that does not require an episode of bedwetting to initiate a conditioning response.

PHARMACOLOGIC THERAPY — Two pharmacological agents have been shown to be effective in the treatment of nocturnal enuresis: desmopressin acetate (DDAVP) and tricyclic antidepressants (TCAs). Indomethacin may be beneficial.

Desmopressin — The suggestion that many children with nocturnal enuresis have an abnormal circadian rhythm of vasopressin release led to the introduction of desmopressin acetate (DDAVP) as a treatment option for nocturnal enuresis. The mechanism of action for DDAVP in nocturnal enuresis is unclear. Successful DDAVP therapy in a boy with nephrogenic diabetes insipidus and a mutation in the vasopressin 2 receptor suggests that DDAVP acts on a different receptor, possibly the vasopressin 1b receptor in the brain [26-29] .

Desmopressin is administered in the late evening to reduce urine production during sleep. The drug is given orally (the intranasal formulation is associated with increased risk hyponatremic seizures and is no longer indicated for the treatment of enuresis) [30] . Compared to other modes of therapy, desmopressin is relatively expensive [7] . A normal functional bladder capacity is necessary for response to desmopressin [31] . Desmopressin should not be used in children with hyponatremia or a history of hyponatremia [30] .

The dose of oral desmopressin is usually titrated to best effect, increasing the dose every 10 days to the maximum recommended dose; the process usually takes a total of 30 days [3] . The oral formulation is administered at 0.2 mg initially (one tablet) and may be increased to 0.6 mg (three tablets) as needed over a two-week trial period. A "trial run" of desmopressin is recommended if the child plans to use it for overnight camp; the trial should take place at least 6 weeks before camp in order to adequately titrate the dose and make sure that it will be effective. Certain precautions should be taken to prevent dilutional hyponatremia. (see "Adverse effects" below),

Twenty-five percent of patients achieve total dryness using desmopressin, with perhaps another 50 percent exhibiting a significant decrease in nighttime wetting [3,32] . However, similar to TCAs, discontinuation of the medication is associated with high rates of relapse (60 to 70 percent) [33] . A systematic review of 41 randomized trials involving 2760 children comparing desmopressin to other drugs or alarms in the treatment of nocturnal enuresis was performed [34] . The findings were as follows: Compared with placebo, desmopressin reduced bedwetting by 1.34 nights per week (95% CI 1.11-1.57). Compared with placebo, children treated with desmopressin were more likely to become dry (ie, no episodes for 14 nights) (RR 1.19, 95% CI 1.10-1.27). In contrast to arousal alarms, treatment effects were not sustained after discontinuation of therapy. Comparison between oral and nasal desmopressin could not be performed because of insufficient data. Desmopressin and TCA appear to be equally effective.

Adverse effects — Adverse effects of desmopressin therapy are uncommon. The most serious adverse effect is dilutional hyponatremia, which occurs when excess fluids are taken in the evening hours [35-37] .
In December, 2007, the U.S. Food and Drug Administration (U.S. FDA) issued an alert that the intranasal formulation of desmopressin is no longer indicated for the treatment of enuresis [30] . The alert was prompted by review of 61 cases of hyponatremic seizures associated with desmopressin; two cases resulted in death. Thirty-six of the cases occurred with intranasal formulations; 25 of these occurred in children with enuresis being the most common indication.

To prevent dilutional hyponatremia with oral desmopressin, it is recommended that fluid intake be limited to eight ounces (240 mL) on any evening that desmopressin is to be administered [34] . Fluid intake should be limited from one hour before to eight hours after administration of desmopressin. Treatment with desmopressin should be interrupted during episodes of fluid and/or electrolyte imbalance (eg, fever, recurrent vomiting or diarrhea, vigorous exercise, or other conditions associated with increased water consumption) [30] .

Tricyclic antidepressants — The tricyclic antidepressants (eg, imipramine, amitriptyline, and desipramine) have been recognized as a useful adjunct in the treatment of enuresis since 1960 [38] . Although imipramine is the drug most often used, other TCAs are also effective. TCAs decrease the amount of time spent in REM sleep, stimulate vasopressin secretion, and relax the detrusor muscle.

The dose of imipramine is 0.9 to 1.5 mg/kg per day, administered at bedtime. On average, the bedtime dose is 25 mg for children 5 to 8 years of age and 50 mg for older children. The dose should not exceed 50 mg in children between 6 and 12 years of age and 75 mg in children ≥ 12 years of age. The therapeutic effect of imipramine is quick if the dose is adequate. Imipramine should be discontinued if there is no improvement after a three-week trial (at an adequate dose); it may be discontinued abruptly. A "trial run" of imipramine is recommended if the child plans to use it for overnight camp; the trial should take place at least 6 weeks before camp in order to adequately titrate the dose and make sure that it will be effective.

Adverse effects of TCA therapy are relatively uncommon. Approximately 5 percent of children treated with TCAs develop neurologic symptoms including nervousness, personality change, and disordered sleep. Imipramine, amitriptyline, and other TCAs are required by the United States Food and Drug Administration to carry a black box warning regarding the possibility of increased suicidality, particularly in individuals with preexisting depressive symptoms. The most serious adverse effects of TCAs, however, involve the cardiovascular system, including the risk of cardiac conduction disturbances and myocardial depression, particularly in cases of overdose [10] . (See "Tricyclic antidepressant poisoning").

The success rate of therapy with TCAs varies considerably. In a systematic review, compared with placebo, treatment with tricyclic or related drugs was associated with a reduction of approximately one wet night per week, and approximately one-fifth of children became dry (14 consecutive nights) during therapy [39] . TCAs and desmopressin were similarly effective during therapy. However, the treatment effect was not sustained after discontinuation of either of these drugs [34,39] . Approximately 75 percent of children treated with TCAs relapsed when therapy was discontinued [40] .

Indomethacin — Although rarely used, one small randomized controlled trial found that indomethacin suppository versus placebo significantly increased the number of dry nights in children older than six years with primary nocturnal enuresis who were treated for three weeks (9 versus 4 dry nights) [41] . No adverse effects were reported. Possible mechanisms of action include removal of the normal inhibitory effect of prostaglandins on the response to vasopressin [42] and improvement in bladder function [41] . (See "Chapter 6E: Prostaglandins and the kidney", section on Antagonism of ADH effect).

Other drugs — Anticholinergic drugs, such as oxybutynin, are not effective in treating monosymptomatic nocturnal enuresis [43] . However, these agents may be useful in children who also present with significant daytime urgency. The combination of anticholinergic therapy and desmopressin may be used in these children in an attempt to increase bladder capacity during sleep.

Other drugs, including phenmetrazine, amphetamine sulfate, ephedrine, atropine, furosemide, diclofenac, and chlorprotixine have been tried. A systematic review of randomized trials of drugs other than TCA and desmopressin in the treatment of nocturnal enuresis found that although indomethacin and diclofenac were better than placebo, none of the drugs was better than desmopressin [44] .

COMPLEMENTARY AND ALTERNATIVE THERAPIES — A review of complementary approaches such as hypnosis, psychotherapy, and acupuncture finds limited evidence to support the use of such modalities for the treatment of nocturnal enuresis [45] .

INFORMATION FOR PATIENTS — Educational materials on this topic are available for patients. (See "Patient information: Bedwetting in children"). We encourage you to print or e-mail this topic review, or to refer parents to our public Web site, www.uptodate.com/patients, which includes this and other topics.

SUMMARY — Monosymptomatic nocturnal enuresis is a common pediatric disorder with a high spontaneous resolution rate. Most treatment is delayed until the child is at least 7 years of age.

Multiple treatment options are available and no single treatment option is highly effective in all cases (reflecting the multifactorial pathogenesis). (See "Approach to the child with nocturnal enuresis"). All treatment must begin with the child's willingness to actively participate and the parents' understanding that the episodes are completely involuntary on the part of the child. Treatment should be tailored so its potential adverse risks do not outweigh its benefits.

Simple behavioral methods (eg, motivational therapy, bladder retention exercises) are usually tried first, but more active intervention should be considered as the child gets older, social pressures increase, and self esteem is affected. Arousal alarm systems are the most effective long-term therapy. Fluid management and bladder training may be helpful adjuncts. Pharmacological agents can be effective in the short term, allowing the child to plan age-specific social activities, such as camp attendance or sleepovers with friends.

RECOMMENDATIONS — The following recommendations are made regarding the management of children who have primary monosymptomatic nocturnal enuresis: Among children younger than 7 years of age, who may not be mature enough to play an active role in treatment, therapy should consist primarily of reassurance that spontaneous resolution is likely. Once the child is able to be partially responsible for treatment, motivation and simple behavior therapies are recommended. These include reinforcement for dry nights (eg, a sticker calendar), bladder training exercises, and fluid management, as described above. A combination of these therapies may be useful. Enuresis alarms or pharmacologic therapy should be considered in children who have failed to improve after three to six months of behavioral interventions. Enuresis alarms are preferred to pharmacologic therapy because their effects are sustained after discontinuation and because they are associated with fewer adverse effects. Oral desmopressin is an effective short-term alternative to the enuresis alarm in patients who are unresponsive to the alarm. It may also be used as an adjunct to the alarm and as a short-term solution for camp attendance or sleepovers. Fluid intake should be limited from one hour before to eight hours after desmopressin is administered. Similar to desmopressin, TCA are an effective short-term therapy for nocturnal enuresis. However, their high relapse rate and potentially severe adverse effects make them less appealing than alarm or desmopressin therapy [19] . Nocturnal enuresis can usually be managed effectively by the primary care provider. However, children with refractory nocturnal enuresis may benefit from referral to a pediatric urologist.


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Cochrane Database Syst Rev 2002; :CD002112. Bamford, MF, Cruickshank, G. Dangers of intranasal desmopressin for nocturnal enuresis. J R Coll Gen Pract 1989; 39:345. Schwab, M, Wenzel, D, Ruder, H. Hyponatraemia and cerebral convulsion due to short term DDAVP therapy for control of enuresis nocturna. Eur J Pediatr 1996; 155:46. Bernstein, SA, Williford, SL. Intranasal desmopressin-associated hyponatremia: a case report and literature review. J Fam Pract 1997; 44:203. MacLean, R. Imipramine hydrochloride (Tofranil) and enuresis. Am J Psychiatry 1960; 117:551. Glazener, CM, Evans, JH, Peto, RE. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev 2003; :CD002117. Fritz, GK, Rockney, RM, Yeung, AS. Plasma levels and efficacy of imipramine treatment for enuresis. J Am Acad Child Adolesc Psychiatry 1994; 33:60. Sener, F, Hasanoglu, E, Soylemezoglu, O. Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandins. Urology 1998; 52:878. Berl T, Raz A, Wald H, et al. Prostaglandin synthesis inhibition and the action of vasopressin: Studies in man and rat. Am J Physiol 1977; 232:F529. Persson-Junemann, C, Seemann, O, Kohrmann, KU, Junemann, KP. Comparison of urodynamic findings and response to oxybutynin in nocturnal enuresis. Eur Urol 1993; 24:92. Glazener, C, Evans, J, Peto, R. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev 2003; 4:CD002238. Glazener, CM, Evans, JH
Reply

syilla
05-13-2009, 12:59 AM
:salamext:

Lots of kids bedwetting till they're teenagers. And when they're use to it, they start to get fed up with themselves and will show attitude of 'i do not care'.

You probably need a good advice from the doctors.

My son bedwet too... :'(. My way of doing it is try to minimize the accident that may happen. First avoid them from drinking alot of water at night. Make it a routine every night to empty the bladder before they sleep. In the middle of the night try to wake them up and bring them to the rest room. Don't ever let them wake up late because it will only encourage them to bedwet.

Sometimes it doesn't work...but it will minimise the incident. :)
Reply

ragdollcat1982
05-13-2009, 03:23 AM
My son just turned 6 and still does it occassionally. Some childrens bodies grow faster than their bodies. I would not have her mom change the sheets for her. I would make her help and teach her how to use the machine so she can wash them herself. I would see a doctor and see what could be causeing it.
Reply

Ummu Sufyaan
05-13-2009, 07:16 AM
:wasalamex
format_quote Originally Posted by SouljahOfAllah
Assalamu Alaykum Wr Wb
How do you talk to an 8 year old which still wets her bed - every single night. what do i say or ask her and how can i rid her of bedwetting? Her attitude after wetting her bed is apauling as she does not care, as she knows her mum will change her sheets and provide her with cean cloths and fresh bed for the up coming night.

Any advice?

Waiyyakum
i haven't read all the posts in this thread so i may be repeating myself lol...if her attitudes bad, get her to help her mum clean/wash her bedsheets :D
Reply

amazing2009
05-14-2009, 05:47 PM
Assalamualaikum,
Better wakeup at night & make pass urine Inshallah the problem will be solved
JazakALLAH Khairan
Reply

AnonymousPoster
05-14-2009, 10:18 PM
:sl:
Does this child have enough attention from the mother considering there are younger siblings?
If the problem is not anything else its possible that s/he is lacking the sort of love she can feel and identify.
I hope this matter is dealt with kindness and compassion as some children can be more sensitive to emotional pain than others even if they are in the same family.

Although responsibility can be taught at the same time -that s/he needs to help with the sheets- BUT you'll help him/her to get through this and that they are still loved regardless of the bed wetting.

Try also not to show your disappointment and give encouragement when accidents happen instead.... hope you remember an 8yr old is still innocent according to Allah swt...if He shows Mercy on us older guilty ones we must at least be forbearing and gentle on our little ones.

May Allah grant you patience and a swift remedy for your child...Inshallah you will be rewarded for your kindess and effort and patience you endure in raising your children. Ameen.
:w:
Reply

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