The terrible case of a 10-year-old girl being forced to lick her urine as punishment for bed-wetting by the warden of her residential school in a small town in India set off a furore in the national media that flooded the news channels analyzing the case as torture and child abuse. The National Commission for the Protection of Child Rights decided to visit the school to investigate. But the complete silence by one and all on the medical aspects of the issue is no less appalling.
If the warden was aware of the girl’s bed wetting problem, why did she not summon the child’s parents before being so harshly punitive for a natural act over which the little girl had no control? If the parents were aware and did not take necessary action, then they are culpable too for what happened to the little girl. If her parents were ignorant about her bed wetting, then the warden is to blame for not drawing their attention to their daughter’s problem.
Why does a ten-year-old girl wet her bed? Is it normal? It is natural for a small child to wet his/her bed while sleeping. But most little kids grow out of the habit of their own by the time they are five or six. If the child continues to wet the bed, it becomes a medical condition called nocturnal enuresis or night-time incontinence, a general name that suggests the ailment but does not specify the cause. For very small children, bed-wetting is of no concern. But when it continues with the child’s growing up, it is not only a health issue for the parents to look into, but also a psychological issue because of the severe embarrassment it can cause to the child who really is not responsible in any way for the act.
This writer met at least one parent who tried to bring about a quick solution to her ten-year-old son’s bed wetting by taking him out of residential school to save him from embarrassment and humiliation. But she did not care to put him in a different school or seek medical and psychiatric help to find out what was wrong. The child grew up into a man, uneducated, unskilled, unemployed and frustrated and turned into an emotional wreck.
General practitioners and pediatricians truly do not have any ready-made treatments for children because the causes are often uncertain, varied and vague. Kevin Peterson, a health specialist, points out several causes of bed-wetting. These are – hereditary factors, too deep sleep, slow development in the central nervous system needed for bladder control, hormonal imbalance, irregularities in urethral valves in boys or in the urethra in girls, problems with the spinal cord and a small bladder.
More severe causes pointed out as ‘secondary’ that could lead to bed-wetting in older children are – (a) urinary tract infections, (b) juvenile diabetes, (c) structural or anatomical abnormality, (d) neurological problems (e) sleep apnea and (e) emotional problems. Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination. Emotional problems result from a stressful home life, such as constant conflict between parents or an ongoing divorce or a remarriage by one parent that could cause children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bed wetting. Children who are being physically or sexually abused sometimes begin bed wetting.
The normal age by which a child is able to control its bladder is around five or six which differs according to individual differences between and among children. No treatment is called for a child who wets the bed till six or seven and using force on the child to control could lead to disastrous results because it could create a severe guilt complex. If bedwetting continues after the ages of eight or nine, then it becomes a problem and it demands that parents take control. Little Punita of Patha Bhavan does not seem to have had any help with her problem.
An estimated five to seven million children in the United States wet their beds. One out of five 5-year-olds are affected by this condition. By age 10, only one in 20 have this problem. Some children could get very upset by their problem and can suffer from feelings of personal failure. They may fear sleep-overs and having friends find out about their bed-wetting. Effective treatment improves behavioral and emotional problems sometimes associated with bed-wetting.
A straightforward approach by parents of a bed-wetting child of nine or ten can often work wonders. They can explain the issue of bed-wetting to the child and elaborate how it will take care of itself in course of time and that it is not his or her fault.
Parents can explain the problem to the school authorities so that they are aware of the problem and treat the child with the empathy it needs. Discussion with other parents is also necessary so that friends do not make the child a butt of their jokes which could lead to severe psychological problems.
A bed-wetting child who suffers from attention deficit disorder may be somewhat less likely to respond to treatment than the normal child who wets the bed in sleep. An American study found a prevalence of bed wetting of 6.21% in boys compared with 2.51% in girls. There is also a strong genetic aspect to bed wetting, as a large British study found a significantly higher likelihood of bed wetting if a parent was a bed wetter.
Treatment varies from lifestyle modifications to medication and alternative therapies for which there is little evidence of effectiveness. Desmopressin, a medication that works on the kidneys to reabsorb urine, is successful in reducing bed-wetting at night. But the benefits disappear when medication is stopped. Tricyclic antidepressants can be effective in some children, but there are adverse effects and few parents choose this option.
Common bed-wetting is not a mental or learning problem, and punishing your child is never a solution. In fact, a child who is punished for wetting the bed can develop emotional problems. “The most critical aspect of treatment is reassurance for the child, who may experience low self-esteem,” writes Dr. Darcie Kiddoo, Divisions of Pediatric Surgery and Urology, University of Alberta, Edmonton, Alberta. “Parents must understand that, unlike daytime behaviour, nighttime incontinence is not within the child’s control,” he sums up.
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Written byShoma A. Chatterji
Dr. Shoma A. Chatterji is a freelance journalist, film scholar and author based in Kolkata. She has 20 published titles, has won the National Award twice and the Lifetime Achievement Award from the Rotary Club of Kolkata Metro. She has done her post-doctoral research on cinema and has juried at national and international film festivals over time