Is it possible that I could have a role?

Yes, dear caregiver, you are the one who plays the greatest role in treating your child's enuresis (bed-wetting), particularly if it goes back to psychological causes.

Below is an outline of your role as clarified by physicians:

- To habituate your child to depend on himself from an early age until he gets accustomed to facing problems and tries to solve them under the supervision of his parents. A child who is habituated to depending on himself from a very early age rarely suffers from this problem.

- Habituate the child, from a very early age, to use the toilet correctly. These days, thanks to easy-to-use diapers, mothers slacken in training their children to use the toilet at an early age.

- Do not rebuke or beat your child as this may lead to negative reactions on the child’s side, or, perhaps, his insistence on wetting his bed as an objection to the rebuke and hitting. So, it is important to stop punishing the child and showing anger to him because of his bed-wetting problem, since showing anger because of this leads to tension and trouble, with which the enuresis continues.

- To accept this behavior as being natural and explaining it to the child gives him a feeling of security. Parents should alleviate the negative feelings about that condition and convince him that he is not the only one and that many children do the same, and that soon he will get over it.

- To provide the child with warm feelings, compassion and support. The parents should tell the child that they love him and by no means should they be angry with him.

- To encourage and even praise the child whenever he is able to control his urination.

- To put a monthly table and mark with red stars the nights on which he could control his urination. This way motivates him and helps him evaluate the situation and endeavor to overcome the problem with eagerness to receive the reward in the event of success.

- Serve dinner to the child at an early time and do not give him drinks after six in the evening, i.e. 2 to 3 hours before he goes to bed -- especially drinks that contain caffeine because it is a diuretic; however, do not leave the child thirsty.

- Do not give him foods that contain large amounts of water; such as watermelon, cucumber, and so on, before going to bed.

- Help the child have enough sleep during the night, and have an hour of sleep during the day, as this will help overcome the problem of deep sleep.

- It is necessary for the child’s food to be healthy and free of excessive spices, salts and sugars.

- Get the child to go to the toilet to urinate directly before sleep and awaken him during the night to go to the toilet for the same purpose.

- To observe the times at which the child urinates in bed and awaken him from sleep some minutes before those times to urinate. In this respect, the parents have to make it easy for the child to go to the toilet to urinate by keeping the toilet light switched on and making the child’s room near to the toilet, if it is possible. At the same time, this procedure should not be made a burden on the child. An adult should accompany him to the toilet if he is afraid of going alone at night.

- Switch on a faint light in the child's room to help him go to the toilet or change his clothes at night.

- Do not talk about the child’s problem with others in the child’s presence and do not make a comparison between him and his peers who do not face the same problem.

- Do not attribute to the child characteristics which he does not like and tackle the problem in secret.

- Be keen on the child's cleanliness and urge him to take a bath and change his clothes.

- It is better if the child sleeps alone on a separate bed.

- It is better to put bedding to absorb liquids, so that the child would be more comfortable.

- See a doctor to be sure whether this problem goes back to physical causes, and abide by the guidelines of the physician with regard to taking the medicine regularly at its due time.

- Train the urinary bladder to increase its capacity by getting the child to drink great quantities of liquids during the day and asking him to defer urination for some time, with increasing the time for which he should hold urine throughout many weeks, during which he would become able to control urination in a better way.

- If the child wakes up wet and weeping, the parent should change his clothes quietly, calm him and embrace him and sit by his side until he goes back to sleep.

- Provide a good family atmosphere for the children, and good communication. Parents should not quarrel in their children’s presence, and the children should feel they live in a house full of happiness and love.

- Boost the child's self-confidence by saying that the problem will inevitably get better with time; and if we succeed in solving it, the results would be better.

- Do not let the child listen to disturbing news particularly directly before bedtime.

- Limit the time the child sits in front of the TV and choose the programs he watches.

- Read relaxing stories to children before sleep to calm them.

- Alert his older siblings not to ridicule him because of this habit since this harms him and complicates his situation.

- Give the child the freedom to discuss his status with his physician if he is capable of doing so.

- Provide coverings and underclothes near the child, and encourage him to change them by himself in case of involuntary urination so that he feels responsible for this problem.

- Make the child change his bedsheet every time he fails to control urination.

- The family should ensure a quiet atmosphere in the house, particularly before the child goes to bed.

If the involuntary urination is traced to a psychological cause, it should be identified. We have mentioned that the child's enuresis is an indicator of a problem from which he is suffering. So, it is of great importance to know the specific nature of that problem. Knowing the cause that lies beyond his feeling of annoyance, depression, terror, and so on, helps us treat the causes of our children's displeasure. In this way, we would obtain a radical solution for the problem.

A lot of parents are mistaken when they think that the treatment of the children's enuresis is only to habituate the child to control urination. Whoever thinks, or does so, will not solve the root of the problem. Bed-wetting, as we have previously clarified, indicates a problem, and its disappearance does not mean that the problem itself has disappeared; in so much as it means that only its outward symptoms have disappeared. Some specialists say that it is true that the child may stop bed-wetting, but unless the problem underlying his annoyance is principally solved, he will express it through other abnormal behaviors. In this way, he only replaces one means of expression with another.

For example, he may become more introverted, more secluded, achieving less at school, to the end of this chain of undesirable behavior. Hence, the parents should look for the causes lying behind their children's suffering and try to improve the psychological atmosphere in which they live. It is of no use to order them to stop bed-wetting, while the family quarrels or their persecution remain the same, given that if these problems are solved, the bed-wetting would automatically diminish and it will be easy for us to try to stop it completely.