Enuresis, or bed-wetting, is a problem that arises in the development and training of a child in about one out of ten cases. One out of three or four households is, therefore, disturbed by it. It may be of all grades of severity and may cause every grade of worry to the parents. The amount that the parents worry quite as frequently determines the severity of the condition as the other way round.
The child should have control of the urine in the day time by 2 years of age. If not established by 21 years, the condition should be regarded as abnormal. Control at night should be accomplished by the end of the third year. If it is not, it is time to do something.
A certain number of cases are due to lack of training. Training should be begun at the age of 10 months and the child should learn to void regularly during the day and before going to bed and upon getting up in the morning.
In the past, emphasis has been placed upon the psychological and emotional basis for the habit, but of late a number of studies have been directed toward the possibility of physical abnormalitiessensitivity of the bladder, its capacity, the amount of liquid it will hold, and the amount of pressure which it will stand. Undoubtedly in certain cases there is some organic condition to account for the habit.
Most cases, however, are of the functional kind due to bad habits. These are by all odds the most difficult ones to cure. To show how much of the condition is psychologicalit is very frequently observed that while a child will wet the bed at night sleeping at home, when he sleeps away from home, visiting another child or taken to the hospital, the habits stops entirely. When he returns home again it is resumed. When control is accomplished it appears to be as much due to the subconscious determination of the child as to any treatment that has been imposed by the parents.
All sorts of plans have been used in treatment. Encouragement and co-operation will usually be effective when the trouble is functional. Dr. M. F. Campbell wisely says, “The bed-wetting problem should not be permitted to constitute the child’s entire horizon.” … “Remonstrances, cajoling, whipping, and otherwise punishing the patient serve only to furnish a satisfactory alibi for continuing the practice.” Nearly all of them get over it anyway and in only a very few instances does it persist into adult life.
The two best schemes for treatment seem to be, first, to prevent the child from lying on its back by tying a towel or some other object on the back so that it will be more comfortable for it to lie on the side. The second scheme is to get the child out of bed frequently during the night, allowing it to void at that time. Most children wet them-selves about two hours after falling asleep. Hence the child should be awakened about one-half hour before the expected accident.