Dr. Peter Nieman: My eight-year-old daughter still wets the bed

Question: My eight-year-old daughter still wets the bed. What should we do?

Answer: Close to 5 per cent of children wet their bed at this age. About twice as many boys than girls wet have this problem. The longer this situation continues the more likely it is that the child may be bothered by low self esteem.

Bedwetting, known medically as nocturnal enuresis, is frequently associated with the child being a deep sleeper. A family history of this condition is also common.
In addition, constipation and a small bladder volume may predispose the child to enuresis. A normal bladder volume for an eight-year-old is close to 10 ounces (300 millilitres) One can roughly calculate a bladder volume by adding two to the child’s age. (In this case, eight years plus two gives 10.)

I suggest you start a diary to record when your daughter wets her bed (early or later during the night), the frequency of enuresis, if there is an association between the bedwetting and constipation, how hard it is to wake her up and if there are any urinary tract concerns.
This approach may help identify factors that contribute to bet wetting. Adding fibre to the diet, for instance, may reduce constipation. Or, limiting fluids after a certain time of night could be helpful.

If there is a medical abnormality, such as an infection of the urinary tract or blood in the urine, then further testing is required. But the vast majority of patients with bedwetting have no related medical condition such as urinary tract abnormalities or diabetes.

Treatment options include a device which sets off an alarm when the child voids. The device is strapped to the child’s arm at night and is connected to a pad that is placed in the underwear; this pad picks up the urine flow and starts the alarm. The aim is to condition the brain not to sleep so deeply. Hopefully, over time, the child becomes a lighter sleeper and wakes when there’s an urge to urinate.

There are also several medications that doctors sometimes prescribe for bedwetting, including DDAVP tablets (desmopressin acetate), which act like a hormone to reduced urine production, and Ditropan (oxybutynin) which relaxes the bladder wall.

More and more parents are interested in solving this issue naturally, without resorting to medications. If that’s your inclination, you may want to check out a recent book “Stop Washing The Sheets” by Calgary pediatrician, Lane Robson, one of Canada’s foremost experts on bedwetting. It’s an extremely comprehensive and easy-to-use book for parents. (Visit www.stopwashingthesheets.com)

Most pediatricians tend to reassure families that the majority of children will outgrow bedwetting. Dr. Robson, who is sometimes referred to as “the professor of pee,” goes a step further by offering useful ideas that will help both parents and children deal with enuresis.

Dr. Peter Nieman: When should I start testing my kids for allergies?

Question: When should I start testing my kids for allergies?

Answer: Even among allergists there is a debate about the usefulness of doing skin testing prior to one year of age.That’s because the child’s immune system is still developing and the information gathered from these tests may not be very reliable. After age one most allergist seem to agree that skin testing can be done in a useful manner, identifying the underlying cause of allergies.

If there is a serious underlying allergy to eggs or peanuts or if there was an episode of anaphylaxis it is critical to see an allergist. Anaphylaxis can result in the sudden onset of various symptoms including an itchy rash, throat swelling, and low blood pressure. In extreme cases, it can be fatal.

In Canada, there is a national shortage of allergists which can lead to a wait of up to a year for an appointment.

Another option is to use blood tests to search for some allergies. (These tests are known as RAST testing.) This may be an option while waiting to see an allergist. However, it is ideal to see an allergist as soon as possible if the allergy was complicated enough to visit a hospital emergency room.

For patients with a history of serious, undiagnosed allergies the primary care doctor will prescribe an adrenaline kit with instructions on how to use it appropriately. Pharmacists will reinforce the correct use. The more educated parents are in the appropriate use of these kits, the less likely it will be that they may panic or use it incorrectly at a time of need.
Once the adrenaline kit is used, the patient should be seen also in the ER because there could be a further reaction.

In less serious cases, such as the only symptom being red itchy eyes upon exposure to an animal, the long wait of a year will not harm the child.

If a child has asthma, allergy testing is required sooner than later. An allergy may aggravate asthma symptoms and make it harder to breathe. When asthma is well controlled – usually with the appropriate use of medications – it means a child sleeps well at night, does not miss school, can continue to be physically active and does not end up with frequent unexpected visits to the doctor.

Dr. Peter Nieman: My Child is a Sore Loser

 

The question: My child can’t handle losing. I’ve noticed that when she’s playing games with others, if she doesn’t win the game, she gets all sulky and moody. How can I teach her that losing is part of life?

The answer: Losing is indeed part of life and for that reason a child should learn that lesson early – ideally by the time she starts school. It has been found that sore losers have more trouble than other children, as they get older, when it comes to making and sustaining friendships.

Some children are born with a temperament or personality where they need to always be in charge, which may mean winning. Toddlers are normally self-centered and at this age it may in fact be normal to insist on always getting one’s way. However, as the child gets older, it becomes less appropriate to insist on being the winner 100 per cent of the time.

An innate temperament that is easily frustrated can be managed over time in such a way that the child learns to lose graciously. It takes much patience and begins with the parent.
The way parents handle their own frustrations serve as a role model. Overly involved parents can make matters worse; setting unrealistic expectations for your child may contribute to the problem and focusing more on the outcome than the effort may also add fuel to the fire.

Start by acknowledging her feelings. It is fine to get frustrated, but at the same time, losing does not mean that she is an inferior person. Praise her for her effort. Point out that she is constantly improving and that even the best athletes have off days. Use sport events on TV as a tool where she can see that even first ranked teams or players do not always win.

Unfortunately, we live in a culture where winning and being highly competitive have become the norm. Some coaches are guilty of focusing on winning more than effort or simple participation. Competition is good, but when winning becomes a superior way of saying, “We are better than those other bunch of losers,” then it may frustrate a child when she loses.