by Max Maizels, M.D.

Questions and Answers

Q: There's a lot of advice out there about bedwetting--from my mother-in-law to other bedwetting books to Internet Websites. What's different about the Try for Dry approach?

A. The approach we use in our practice, the same one offered in this book, distinguishes itself from existing treatments for bedwetting in at least four ways:

It is the only comprehensive, medically based, organized approach that deals with wetting problems by day, by night, or both.

The treatments we recommend are multi-modal; that is, they consist of several remedies working together. So wetting stops sooner and the effects last longer than when single modes of treatment are used.

The cost of treatment is minimized, because we focus on the use of a one-time-purchase enuresis alarm and inexpensive medication.

Articles describing the treatment success of our program have been published in medical journals.

How Children React to Their Wetting Problems

By age six, most children who wet realize that they are in the minority among their peers. By age seven, most have become certain that there are no other children in the world their age who still wet--and they do all they can to protect their secret. They become masters at hiding the problem from friends and, to some degree, family. Young and older children might try to hide their soiled bedclothes. Older children might go so far as to secretly wash their own sheets and pajamas. Children who wet during the day sometimes attempt to prepare for any future "accidents" by putting on dark pants and very long T-shirts when they get dressed in the morning. Some children will flatly deny being wet, even when their pants are obviously soaked. They will tell their parents and the doctors, "I don't know why we're doing this treatment. I don't have a problem."

Each child is an individual, and each responds differently to his or her wetting problem. Some appear indifferent, some depressed. All too often, they have just given up hope of getting dry, and may astound you with their seeming acceptance of the condition. To help you recognize your own child's reaction, here are a few common responses that children have to wetting.

Parents

There are two critical roles for parents to play: nurturer and coach. Much of what needs to be done to treat enuresis falls to your child to do herself, but she will need your understanding, encouragement, and at times firm insistence if she is to attain her dream of dry nights and dry clothes. This is not the time to chastise, scold, or punish, no matter how frustrated you become. Keep in mind that your child is frustrated, too. Dr. Stanford Friedman, an expert in the effects of corporal punishment on children, says that parents who use corporal punishment to address their child's bedwetting problem do so out of frustration with not being able to resolve the problem in any other way. Parents who use this severe treatment are in the minority, and we hope that, as successful methods of treating enuresis become more widely known, all parents will refrain from resorting to harsh punishment when dealing with their wet children.

Whatever treatments you decide to use, it is important that parents be unified in their support of the program. Today a child may live with one or two parents, biological, foster, or adoptive, in one or two households, as well as with stepparents or grandparents--under the influence of as many as four parental figures. For the sake of the child, all the adults involved must be informed and supportive of the chosen treatment plan. When parents openly disagree about a treatment plan, the child may get inconsistent messages about the importance of her compliance with the program, and she can also lose confidence in the treatment. Children may thwart otherwise good efforts by using their parents' disagreement over this issue to play one against the other. Because the child's ability to comply with the prescribed treatment plan is the essence of its Parents, as well, need support during treatment. They can help each other through the fatigue of interrupted sleep and the frustration of slow or little progress. Parents often find it helpful to take turns getting up with the child during the night, particularly when an alarm is being used.

There is a simple reason that we decided to call our program Try for Dry and to name this book Getting to Dry. We want to remind children and families alike that the "trying," the ongoing commitment to making a positive change, is fundamental. No treatment program for any medical condition can guarantee 100 percent success, but we believe that if you and your child maintain your optimism and stick to the plan, you will see results and get to dry.

To help you obtain an accurate record of your child's condition, in this chapter we will guide you through the following steps:

Step 1. Determine what type of wetting problem your child has.

Step 2. Consider any psychological complications.

Step 3. Measure your child's functional bladder capacity.

Step 4. Record how often your child urinates and moves his bowels.

Step 5. Consider whether your child may have any food sensitivities.

Why Hasn't The Alarm Been More Popular In The Past?

In the existing medical research, the enuresis alarm has consistently achieved the best success record in helping children get to dry. But paradoxically, using an alarm is the least popular approach. Here are some reasons why it is not used more widely, followed by explanations to counter such concerns.

Staying With It

Making sure that your child uses the enuresis alarm every night--and follows the other treatments you have chosen as well--can be challenging. From our experience, we have learned that the number one enemy of progress toward dryness is not being compliant with the program.

Most kids seem to hate routines that are imposed on them, especially if they don't understand the reason behind a new regimen. So make sure your child sees the connection between faithful use of the alarm and permanent dryness. Explain that, just like learning to play a musical instrument, she has to practice every day--even when she doesn't feel like it. If she wants to get dry, she needs to follow the schedule.

If your child has too many wetting episodes while tapering alarm use and has to return to step 1 in the alarm schedule, try to reassure her. Explain that starting over is not a punishment, but simply what needs to be done to make sure that the alarm is teaching her bladder control well. Beginning again at step 1 after weeks of progress can be the most difficult part of the process--for both children and parents. This is the time when a well-chosen reward or other motivational device can really do wonders by helping to prop up a child's sagging commitment (see Chapter 7).

Ultimately, your participation and faith in the program may be your child's primary motivation for staying with it. If your child balks at the program at first, you must resist the natural temptation to give up. Encouraging your child to continue is the most important part you can play in the successful resolution of this problem.

Reinforcement

One of the most difficult challenges for children undergoing treatment for wetting is merely sticking with a program. When progress is slow, when wetting shows no signs of remitting, children can lose heart and ask to stop treatment. On the other hand, when a child has made a great deal of progress but has not quite reached his goal, he may get impatient and want to quit. You, as the parent, need to be prepared to help your child overcome the doubts, the tedium, and the frustration that will come with treatment. In this section we'll explore the issue of reinforcement: giving rewards and other affirmative feedback in order to help kids stay on track.

[Click here for suggestions on using rewards.]

For the effects of this learning process to be long-lasting, treatment should be gradually phased out, or tapered, rather than stopped abruptly. Just as a child who fractures her leg wears a cast for a few weeks, your child "healed" her wetting problem with the help of a specific therapeutic device, namely, this dryness program. However, a child with a newly healed fracture only gradually goes from walking with crutches to walking with a cane, to walking unassisted, to running. Likewise, even though your child's wetting has now stopped, she needs to gradually resume her normal bedtime routine.

Based on our experience, we have devised a preferred order in which treatments should be tapered:

Step 1. Phase out the use of the alarm. (See the alarm schedule in Chapter 5 for details on
          how to do so.)

Step 2. Phase out using the medication.

Step 3. Phase out the bowel program, assuming that your child still moves her bowels daily.

Step 4. Gradually reintroduce any foods or beverages that you found contributed to your
           child's wetting.

Let's take these one at a time. During any of the following phase-outs, if your child has two or more wet nights over a two week period, go back to full treatment. After your child gets to dry again, try once more to taper the treatments. If the wetting relapses a second time consult our doctor.