The need to change wet nappies of infants is part of a parent's growing up years. If a child continues to bed wet after his or her second or third birthday, most parents start to panic. And, the worry is justified. Ideally, a normal child learns control over the bladder by the age of two. But in a not-so-perfect situation, there are reports of children as old as 12 years continuing to wet their beds.Bed wetting or enuresis, by itself, is not a disease. But if not tackled early, it can cause both the child and the parent a lot of anxiety. Once a day, we receive at least one case of bed wetting.Heredity, neurological disorders and psychological problems have been roughly identified as the chief sources of bed wetting. When a case is reported we generally try to find out if either of the parents learnt bladder control rather late when they were children. More often than not one of the parents confirms this suspicion. However, for most children, the cause of bed wetting is neurological disorders. Meningitis, for example, which is an infection of the brain, affects the nerves leading to the urinary bladder. As a result, the child cannot control his or her urinary flow. Besides neurological disorders, urinary lithiasis, commonly known as renal stone can also indirectly cause bed wetting. Indirectly, because the infection leads to pain while passing urine, due to which a child holds the urine back and passes it in bed when he or she is fast asleep - the pain is not felt then. The psychological reasons for bed wetting could range from anything like attention-seeking tendencies of a child to strained relations between the parents. The sudden occurance of bed wetting in an otherwise `dry' child is considered to be an immediate pointer to a psychological problem. But generally, psychiatric treatment is advised in extreme cases and psychotherapy on the part of the doctor usually helps.Parents resort to panicking, shouting at the child and at times even beating them to correct the disorder. It is precisely here that the problem aggravates. Parents should instead help the child gain or learn control over the bladder. What happens usually is that kids, in a hurry to go off to sleep, pass out only a few drops and come out. Parents should see to it that they empty their bladders completely. Besides this, children should be woken up once or twice at night and should be made to walk to the bathroom in an attempt to teach control. The child would be thoroughly roused and would remember the visit to the bathroom.The child should thus learn control, consciously.Dr Vinod Tibrewala is a Senior Consultant Pediatrician at Bombay Hospital.- As told to Anagha Sawant
