Strategies to protect children's self-esteem.

Useful strategies

Be optimistic and avoid scolding the child.

Children are often scolded because we don't understand what really causes bedwetting .

It's a common misconception that something is wrong with a child who has primary bedwetting, but that's not true. The child doesn't feel the urge to go while sleeping, and it's not because they're lazy or naughty, says Dr. Frederick Kaskel, a professor of pediatrics at Montefiore Children's Hospital in the Bronx, New York. The family needs to come together and not try to relieve frustration by lashing out at the child. Such abuse, both physical and emotional, does occur. Dr. Cynthia Ferrell, an assistant professor of pediatrics at Doernbecher Children's Hospital in Portland, Oregon, says that actually, expressing frustration by scolding the child can damage their self-esteem. Remember that bedwetting is embarrassing enough for the child without the need for reprimands. Scolding children or making them feel self-conscious doesn't improve things and can even worsen the self-esteem issues these children are already facing, says Dr. Ferrell. Dr. Nagaraju says such punishment can even lead to problems worse than incontinence. Children develop dysfunctional elimination, he says, which often results in bedwetting occurring 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 bedwetting-free. Alyson, the mother of 8-year-old Ryan, who struggles with bedwetting, realized this was causing problems between her son and his little sister. Her daughter often reports that Ryan wets the bed, but only to be helpful, not mean, Alyson says, and never in front of anyone outside the family. He gets angry with her, she says. The American Academy of Pediatrics (AAP) guidelines for bedwetting suggest that parents ban teasing within the family. Don't let family members, especially siblings, tease a child who wets the bed. Explain to them that their brother or sister doesn't wet the bed intentionally, the AAP advises. If the problem is genetic, it may be helpful to explain to them that mom or dad 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 out of it, the bigger a problem it becomes for him, " Alyson says. Ryan's parents explained to him that it wasn't his fault and that, in their case, it's genetic. Alyson's husband, brothers, and nephews have all wet the bed. The AAP recommends handling the situation like Alyson and her family. Don't make a big deal out of bedwetting every time it happens. Make sure the child understands that it's not his fault and that it will get better with time, says the AAP. Let him know that most children outgrow bedwetting and, as the AAP says, the majority of cases are due to a delay in the maturation of bladder control mechanisms. He needs time to develop a little more, but it's perfectly normal.

Avoid medication unless absolutely necessary. “I don’t like to use [medication] before trying other types of therapy,” says Dr. Nagaraju. Other possible interventions include restricting fluids and waking the child at night to take them to the bathroom. According to Dr. Mark Stein, director of the Department of Psychology at Children’s National Medical Center in Washington, one reason to avoid medication too early is the high relapse rate.

Even if medication temporarily stops bedwetting, it does not solve the underlying problem, whether it be sleep problems, an underdeveloped nervous system, etc.

Side effects are another reason to avoid medication for as long as possible. Here are some side effects of the most commonly used medications for controlling bedwetting:

Chills, weakness, dizziness, headaches, nausea, constipation, high blood pressure and, more seriously, attacks, shortness of breath and heart attack.

Regardless of how you choose to manage your child's bedwetting, be attentive to their feelings and discuss the issue with your pediatrician. With a little research and reflection, you'll know you're making the best decisions for both you and your child.