Strategies to protect children's self-esteem.

Bedwetting in children can be a delicate problem, especially as the child reaches a certain age. Therefore, it is very important to handle the situation properly to protect the child's self-esteem, avoid embarrassment, and help them stay dry. The techniques often recommended for managing bedwetting vary from doctor to parent, ranging from doing nothing to the extreme of administering medication. The same methods do not work for all families, so it is important for parents to discuss their situation with their pediatrician to determine the best treatment options. Useful strategies Be optimistic and avoid scolding the child. This is by far the most important thing to remember when your child wets the bed. Parents shouldn't scold or punish children, says Dr. Pradeep Nagaraju, interim director of the Department of Urology at Mount Sinai Hospital in Chicago. Children are often scolded because they do not understand what actually causes bedwetting . There's a misconception that something is wrong with a child with primary bedwetting, but that's not true. The child doesn't feel the urge while sleeping, and it's not that they're lazy or naughty, says Dr. Frederick Kaskel, professor of pediatrics at Children's Hospital at Montefiore in the Bronx, New York. The family needs to come together and not try to relieve their frustration by lashing out at the child. Abuse of this kind happens, both physical and emotional. Dr. Cynthia Ferrell, assistant professor of pediatrics at Doernbecher Children's Hospital in Portland, Oregon, says that expressing your frustration by scolding the child can actually hurt their self-esteem. Remember, bedwetting is embarrassing enough for the child without the need for scolding. Scolding children or making them feel bad doesn't improve matters and can even exacerbate the self-esteem issues these children already face, says Dr. Ferrell. Dr. Nagaraju says such punishment can lead to problems even worse than incontinence. Children develop dysfunctional elimination, he says, which often causes bedwetting to occur during the day as well. Avoid teasing When a child wets the bed and has a sibling who doesn't, they often get teased. This can be especially distressing if the sibling is younger and already self-controlled at night. *Alyson, mother of Ryan, an 8-year-old who struggles with bedwetting, realized this was causing problems between her son and his younger sister. Her daughter often reports that Ryan wets the bed, but to be helpful, not mean, Alyson says, and never in front of anyone who isn't family. He gets mad at her, she says. The American Academy of Pediatrics (AAP) guidelines for bedwetting suggest parents ban teasing in the family. Don't let family members, especially siblings, tease a bedwetter. Explain to them that their sibling isn't wetting the bed on purpose, says the APP. If the problem is genetic, it may be a good idea to explain to them that their parents also wet the bed when they were little. While you're dealing with bedwetting, it can be helpful to use disposable absorbent underwear. When children wake up dry, they feel less embarrassed. Show through your attitude that bedwetting isn't a big deal. The more I make a big deal about it, the bigger of a deal it becomes for him, says Alyson. Ryan's parents explained to her that it wasn't his fault and, in their case, it's genetic. Alyson's husband, brothers, and nephews have all wet the bed . The AAP recommends handling the situation the way Alyson and her family did. Don't make a big deal about bedwetting every time it happens. Make sure the child understands it's not his fault and that it will get better with time, says the AAP. Let him know that most children outgrow bedwetting over time and, as the APP says, the majority of cases are attributable to a delay in the maturation of bladder control mechanisms. He needs time to develop a little more, but he's completely normal. Avoid medication unless absolutely necessary. "I don't like to use [medication] before trying other types of therapy," says Dr. Nagaraju. Other interventions include limiting fluids and waking the child at night to take them to the bathroom. One reason to avoid using medication too early is the high relapse rate, according to Dr. Mark Stein, director of the Department of Psychology at Children's National Medical Center in Washington, D.C. Even if medications temporarily stop bedwetting, they do not address the underlying problem, whether it is sleep problems, an underdeveloped nervous system, etc. Side effects are another reason to avoid medications as long as possible. Here are some side effects of the most commonly used medications to control bedwetting: Chills, weakness, dizziness, headaches, nausea, constipation, high blood pressure and, more seriously, seizures, shortness of breath and heart attack. No matter how you choose to manage your child's bedwetting, listen to their feelings and discuss the issue with your pediatrician. With a little research and careful consideration, you'll know you're making the best decisions for both you and your child.