drtanvir
Forum Senior
Topics: 21
Posts: 96
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Knock
Introdyction
Tell me more about it?
When did bed wetting start?
Has the child always wet the bed or it began recently? Or Has your son ever been dry at night before? Or Has he started bed wetting after being dry for a long time?
Is there any particular time when these episode come out?
Does he have any day time wetting? does he wet his pant during the day? Or Is your child dry during the day?
How often does your child child wet the bed?How much volume of urine does he void during each episode?large or small
How many times in the day does he void urine?What is the quantity of urine during each void?
What is the average quantity of his fluid intake during the day?
Does he drink excessive amount of fluid before going to bed?
does he hold urine until last minute? And Does he ever have to run to the bathroom?
Does your child complain of pain or other symptoms when urinating?
Does he experience any difficulty in initiating or stopping the stream?
Does he ever complain of dribbling or burning while urinating?
Does he complain of a feeling of incomplete emptying of bladder?
Does the bed-wetting seem to be triggered by certain foods, drinks or activities ?
Does the bed wetting increase in the time of stress?
Is anything that reduces the problem?
How is his sleeping habit? does he snore?
Does he have any problems with bowel movement?
Does your child have any fever/ belly pain/ back pain?
Have u tried any intervention or drugs in the past? ( Rewards/ diaper/ alarm system/ periodic waking/ restricting fluid)
PMH: Does he ever have Sleep apnoea
does he ever had any type of Neurological or gait abnormalities., DM,Sickle cell disease
Does he suffer from repeated UTI?
Is your child currently taking any medication?
All HO:
Is he allergic to anything?
PSH & Hospitalization: Does he have any surgery or experience an injury to Nervous system?
Birth HO: Did your child have any problem at birth?
FH: Is there any family history of bed wetting?Did you or your husband have the problem of bedwetting as a child? I am asking this because it tends to run in family.
Social HO:
Children often tend to wet the bed as a result of some stressful event in their lives. Is your child facing any major life changes or other stresses?
• Are you aware of any incident that could be causing these symptoms in your child?starting a new school, problem at home?
• Would you describe your child as playful and social or shy or quiet?
Could you tell me how this problem has affected you and your family?
How is the bedwetting treated within the family?
Does the bedwetting cause shame?
How many children do u have? What are their age?
If you're divorced, does your child live in each parent's home and does the bed-wetting occur in both homes?
How much drinks (like juice ) does he take before bedtime?Does his drink contain caffeine or alcohol?
Immunization HO:
Last time check up:
Growth & Developmental HO:
Investigation
UA and Urine culture
first morning urine gravity
ultrasound kidney,bladder
Xray kidney
Closure
Miz xyz, I believe your son’s condition is probably an isolated symptom but I would like to run some test to make absolutely sure he does not have an underlying infection or a more serious medical problem, we can then discuss his treatment option after the test result..
In the mean time I recommend u two things
1- to limit fluids before bedtime and encourage double voiding — urinating at the beginning of the bedtime routine and then again just before falling asleep — may help.
You may want to encourage your child to delay daytime urination as well. If the bladder isn't completely full, the urge to urinate may fade within a few minutes. With practice, this simple "stretching exercise" may help your child's bladder hold more urine at night.
2-Help child to cope and support him.
Children don't wet the bed to irritate their parents.. Because your child's bed-wetting is involuntary, it's illogical to punish wet nights or reward dry nights. Try to be patient as you and your child work through the problem together.
DO u have any question for me?
What Causes bed wetting?
No one knows for sure what causes bed-wetting, but various factors may play a role.
Most children outgrow bed-wetting on their own — but some need a little help
What are the complication Complications? Does it pose any health risk?
Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however..
Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime
Treatments and drugs
Most children outgrow bed-wetting on their own. If there's a family history of bed-wetting, the child likely will stop at the age the parent did.
If your child is still wetting the bed by age 7 — and is motivated to stop — we recommend more aggressive treatment.
Moisture alarms
These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.
If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, and they may provide a better long-term solution than medication does.
Medication
If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:
Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray. As of December 2007, however, only the pill form is approved to treat bed-wetting. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids.
Change a child's sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has few side effects for bed-wetters. Caution is essential, however. An overdose could be fatal.
Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin, Levsinex) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.
Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped.
Alternative therapies
Therapies such as massage, acupuncture and hypnosis have been touted as helpful treatments for bed-wetting. More research is needed before such therapies can be proved effective, however.
Adopt good habits. Limit your child's fluid intake during the evening.. Make sure your child urinates before going to bed — and perhaps again when you turn in for the night. Remind your child that it's OK to use the toilet during the night if needed. Use small nightlights so that your child can easily find the way between the bedroom and bathroom.
Be sensitive to your child's feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past.
Put your child to bed earlier. Perhaps surprisingly, an extra 30 minutes of sleep a night helps some children stop wetting the bed.
Plan for easy cleanup. Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy.
Enlist your child's help. Perhaps your child can rinse his or her wet underwear and pajamas, or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
Celebrate effort. Don't punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents.
With reassurance, support and understanding, your child can look forward to the dry nights ahead.
DD
A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep — especially if your child is a deep sleeper.
A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production.
Stress. Stressful events — such as becoming a big brother or sister, starting a new school or sleeping away from home — may trigger bed-wetting.
Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination and pain during urination.
Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness.
Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
Chronic constipation. Sometimes children who don't have regular bowel movements retain urine as well. This can lead to bed-wetting at night.
Anatomical defect. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.
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