Punishment can worsen bedwetting

Punishing children for bedwetting won’t solve the problem and may make it worse, researchers say.

In a new study, children who were punished for wetting the bed at night were more likely to be depressed and had worse overall quality of life overall compared to bed-wetters who were not punished.

Nighttime bedwetting, or “nocturnal enuresis,” affects about 15 percent of young children and is three times more common in boys than girls, according to the authors. Up to a third of parents punish their kids for bedwetting, they add.

While parents might think punishment will make bedwetting stop, they should know that punishment can actually make the problem worse, leading to more frequent bedwetting, more depression and a poorer quality of life for the child, the researchers wrote in the journal Child Abuse and Neglect.

Dr. Faten Nabeel Al-Zaben of the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia, and a colleague studied 65 children ages seven to 13 years old who wet their beds, and 40 healthy children without a bedwetting problem as a comparison group.

Next, the researchers divided the children with bedwetting problems into two groups, those who were punished for bedwetting and those who weren't.

On average, children who were punished for bedwetting at night wet their beds more often than the children who weren’t punished.

The punished kids also showed symptoms of depression that were more severe than the other two groups of kids.

The effect was worst when parents physically punished their kids, and the more often they punished their children, the more likely the children were to be depressed and have reduced quality of life scores.

“Urinary incontinence affects both the child and the family on several levels. It is often a source of shame and embarrassment for the affected child, and children who have experienced treatment failure have a lower self-esteem,” the authors write.

Dr. Max Maizels, a pediatric urologist at the Ann and Robert H. Lurie Children’s Hospital of Chicago who was not involved in the study, said that most healthcare workers would agree that punishment causes problems for kids.

“Most instances of bedwetting, whether they run in the family or not, have to do with heavy sleep and a sluggish coordination between bladder signals that say ‘take me to the bathroom’ and a deep level of sleep that prevents the signals from reaching awareness,” Maizels told Reuters Health in an email.

He said that if that coordination is sluggish then the bladder empties without the child's permission, so anything that can be done to accentuate the child's awareness will help reduce bedwetting.

“One common thing that can be done is called positive practice, where children lay in bed before they go to sleep and practice getting up and going to the bathroom,” Maizels said.

He added that reading children's books about bedwetting before bed also helps raise awareness.

A change of scenery or temperature may help too.

Maizels said that when families go on a vacation or to Grandma’s house, they’re startled when the bedwetting that happens with some regularity at home is reduced while they're away.

“Cold seems to set up bedwetting. Some families have a child's bed adjacent to an exposed wall and by moving the bed away from the cold wall it seems to reduce wetting,” Maizels said.

Maizels also said that some dietary changes may help.

“Keep things that may irritate the bladder away from the diet while the bedwetting is resolving like carbonated beverages, citrus, melons, caffeinated foods,” he said.

Maizels also explained that constipation can be a big factor in bedwetting when the over-full bowel puts pressure on the bladder.

“Try laxatives, milk of magnesia or any of the common laxatives, prune juice, or apple juice works to help with evacuating,” Maizels said.