Enuresis (Bedwetting)
The child is unable to control urination and thus voids in the bed, pants etc. Usually bedwetting occurs during night when the child is asleep. A neonate is a natural enuretic and only by the age of 2-3 years is the child able to have some control over his voiding of urine. As the child masters it, he wakes up at night whenever he has the urge to pass urine. Such a child, by and large, is day and night-time dry and only occasionally, he may pass urine in his pants e.g. when he is busy playing or is in a deep sleep. Such rare occasions are normal.
Medical intervention is required only if the child is bedwetting after the age of 5 years. So if your child is bed-wetting say at the age of 4 years, it may just be that he requires some more time to be able to control it. Don’t worry about it, as most likely the child will outgrow it with time. Above 5 years, for a bedwetting child, the doctor may prescribe some simple tests like urine examination and culture to rule out any disease of the urinary tract and if none is found (as usually is the case), the child is said to be suffering from “Psychogenic Bed*wetting”.
This is the commonest type of bed*wetting and is usually due to conflict and stress during toilet training. For example, if a child of 3 years is unable to control voiding and wets his pants regularly, the parents may scold and humiliate him, undermining his confidence. This adverse psychological effect on the child leads to his being a bedwetter. It is important for the parents to realise that the child is not wetting deliberately.
He wants to co*operate and would give anything to overcome the problem. But he has little control over the unconscious feelings that produce the wetting in his sleep. What he needs is more confidence in his ability to control the wetting and this can only be gradually built up with patience and help from the parents. All negative remarks and attitude of the parents should completely stop. Instead the general attitude should be one of encouragement. They can explain to the child that quite a few children have this problem but that practically all of them overcome it with time.
They can express their confidence in their child, that he, too, will also surely overcome it. The child should be praised and encouraged if he doesn’t bedwet one night or if the frequency of bedwetting is reduced. A chart can be maintained on a “to be reviewed weekly” basis and improvement found during one week over the preceding week should be lauded. The child can also be rewarded by giving him some coveted article like toy etc. on showing improvement. Intermittent failures should be ignored.
Making the child drink less fluid after evening may be of some help. Waking the child up every night from deep sleep and making him urinate is of dubious benefit. Drug therapy for this condition is not satisfactory. The medicine may be able to control the bedwetting, but obviously the medication cannot be given for an indefinite period and so when it is stopped, the child again starts bedwetting. Some conditioning alarms are available that ring a bell when the bed is wet and are effective in some cases. Usually within 6 months of seeking medical opinion, the child is cured irrespective of the type of therapy.
What was discussed so far was about a child who never was able to control bedwetting (called “Primary Enuresis”). What about those children who had achieved control satisfactorily and now again have started bedwetting (called “Regressive or Secondary Bed Wetting”)? In these cases, the usual cause is some change in the lifestyle and routine of the child or some emotional trauma to the child. Examples are like shifting to a new house, birth of another baby in the family, some tragedy in the family, the child starts his schooling etc. A secondary bedwetter is easier to treat and the problem is usually transient.
Eye problems
Four common types of eye problems are discussed below.
i. Squint: A condition in which the child appears cross eyed should not be taken lightly, particularly if the child is older than 6 months. If corrected early the results are excellent but if delay occurs, the child may continue to focus and see objects preferentially with one eye in order to avoid the discomfort of double vision. With time the non-used eye may become functionally useless (“blind”) with a poor outcome and slim chances of restoring vision in that eye. So parents should always take squint seriously.
ii. Myopia: Also called as “short-sightedness”, the child can see nearby objects but finds it difficult to focus on far objects, which appear blurred. The first inkling often comes during school going when the child may not be able to see the blackboard clearly, particularly if he is seated some rows behind. The child because of shyness and shame may not complain. So all parents should make it a point to periodically check whether the child’s vision is good. Asking the child to read something written on the TV. (for e.g. “Cartoon Network”) at a distance that the parents can just read it clearly can be done at home also.
If in any doubt, get the eyes tested. The child may feel ashamed to put on spectacles, as very few children in school wear them and so he is the “odd one” out. His classmates may pass comments that his eye sight is not good, he looks funny in the specs etc., all of which may lead to a sense of inferiority complex in the child at a tender age. Parents should be aware of this and anticipate it. The child should be given reassurance i.e. with specs you look good and grown up, that many adults including the highly successful one and celebrities also wear specs to look elegant.
iii. Foreign body in the eye: The eye should be washed copiously in running tap water, which may remove small foreign particles. If the foreign body is visible and on the white (sclera) of the eye, parents may try to remove it by swiping it away with a moistened cotton applicator. If the foreign body is on the cornea (i.e. the black/brown central part of the eye), do not touch it and seek medical help. If some chemical like acid or alkali or hot oil etc. falls into the eye, the parents should wash the eyes copiously with tap water and seek urgent medical help.
iv. Night blindness: If the child sees less at night but well in the day time, it may be due to deficiency of Vitamin-A. The child should be shown to a doctor.
Malingering and hysterical conversion reaction
There is a slight difference between the two. In malingering, the child makes up some complaints like stomach ache, headache etc. to escape from a stressful and unpleasant situation e.g. going to school.
In hysteria, the patient may have abnormal behaviour, may be breathing fast and/or may act out a disease she/he has witnessed before e.g. Paralysis (as if the limbs are not moving), fits etc. This is done because the person is either psychologically disturbed or to achieve secondary gains like gaining love, sympathy and attention of the near and dear ones. The person usually feels neglected emotionally and so can have a hysterical conversion reaction.
Parent should be aware of these not so uncommon entities, so that they are not taken by surprise if the doctor tells them so.