Bedwetting: Exploring Behaviour Modification Options

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• Bedwetting: How to Help Your Child

By Sara Dimerman

If your child is still bedwetting beyond the age of six, you may have explored options such as the urine alarm system or medication as a way of helping him stop. However, most literature supports an approach that includes some behaviour modification - either on its own or in conjunction with other methods. Teaching a child new skills and techniques that support his staying dry, along with employing other interventions, often has longer lasting effects than when only one approach is employed at a time.

Some behavioural interventions include cleanliness training, positive practice, reinforcement of dryness and retention control training, When a parent introduces the urine alarm, for example, it is suggested that it be accompanied with Cleanliness Training methods. This requires that the child go to the toilet, clean him or herself (with some assistance if needed), help to strip and clean the bed, remake the bed and help to reset the urine alarm. Although the vast majority of children do not consciously wet their beds, it is still suggested that they assume some responsibility for their behaviour. They may actually prefer to actively help rather than passively watching a parent go through the motions of clean up as the latter may make them feel worse. According the Child Clinicians Handbook on Elimination Disorders "in some cases, children's bedwetting behaviour is subtly reinforced when the parent strips, cleans and remakes the child's bed while having a pleasant interaction with the child. Parents should be neutral rather than punitive" during Cleanliness Training.

Positive Practice involves the child by having him repeatedly walk to the bathroom and go to the toilet. There are several ways in which psychologists have suggested this be acted out. One approach includes the child counting to 50, then getting out of bed, going to the bathroom and trying to urinate. This process is carried out about 20 times. It is suggested that this approach is not very effective when used on its own but may be a good complement to other approaches.

The Reinforcement for Dryness approach is one in which the parent praises or rewards the child for having a dry night. It is suggested that the child check the sheets and then report to the parents. However, if it is difficult for the child to get through an entire night without wetting, it is suggested that the child be woken up at specific intervals to check the sheets and be rewarded or praised then. This method, like Positive Practice is rarely used alone.

Retention Control Training is based on the belief that children with enuresis may not be able to hold as much urine for as long as their peers. As a result, it is suggested that these children may not be able to retain their urine throughout the night. The goal of this method is to increase the bladder's capacity to hold more urine over longer periods of time. This approach suggests that children drink fluids and delay urination for increasing lengths of time. In one study conducted in 1986, children drank eight ounces of water and practiced postponing urination for 45 minutes. Following each three minute period during which they postponed urinating, they received 5 cents (which was probably good money to a child in the late '80's but may not be powerful of a motivator today!!). The child was considered to have reached adequate functional bladder capacity when he was able to postpone urination for the entire 45 minutes.

All of the methods described above are best not done in isolation and should be considered and carefully understood before pursuing. It may be best to work with a behaviour modification therapist who has experience with these methods before embarking on them