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| |    Daytime Wetting in Preschool Children by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. One of the most gratifying things about writing for the Web is the chance to get immediate feedback from our users and find out what parents really want to know. In one recent case, a mother wrote to ask about a four-year-old girl who had begun to wet herself several times a day over the past month. The answer to this question helps explain how a pediatrician might approach daytime wetting. Initial considerations regarding daytime wetting There are many reasons why a preschool-age child might begin wetting her pants during the day. The approach I am going to describe is based on an important assumption: that the child in question has had healthy physical, mental, and emotional development up to this point. I'm also assuming that she had been dry during the day for at least three or four months before beginning to have accidents, so that her wetting represents a true change, not just toilet training in progress but not yet mastered. In doctor lingo, daytime wetting is called "diurnal enuresis", while bedwetting is "nocturnal enuresis." When the wetting problem has been there from the start, it's "primary enuresis;" when the wetting begins after a period of dryness, then it's "secondary enuresis." When a child has secondary diurnal enuresis, as this one did, the first thing I want to know is, What could have changed to make her lose the control that she had? Physical causes Quite often, a child's medical history and a physical examination can provide helpful clues. I'd begin by asking her parents a series of questions related to her general health, diet, and toilet habits, including the consistency of her bowel movements. I'd also do a thorough medical examination, looking especially for signs of constipation or any unexpected weakness or abnormality, and I'd run a urine test to check for an infection of the bladder or kidneys and (far less likely!) diabetes. Most children with enuresis do not have urinary tract infections, but for the few who do, it is very important to diagnose and treat them to prevent possible kidney damage. Psychological causes At the same time, I would also consider psychological causes. Is there a new baby in the family? A new school (perhaps one in which she doesn't feel comfortable using the bathroom)? Any other sources of stress, even if they seem remote--a parent with a new job, a grandparent who is now ill, any family tensions? I'd ask the parents if she is showing any other signs of stress, such as poor sleep patterns, reluctance to go to school, or unusual quietness or tantrums. If a source of stress is identified, healthcare professionals often can help a child handle it in a more comfortable way, and the wetting goes away. When no cause is found Despite these efforts, I would not be too surprised if I were left with a little girl who seems healthy, happy, and calm, but is still wetting. Sometimes, for reasons we never really understand, a young child who was dry begins to wet; then, again without explanation, she learns to stay dry again. An attitude of encouragement and support is usually the most effective. It often helps for a parent or teacher to remind the child to go to the bathroom every couple of hours, stretching out the time as much as possible, and to praise her (mildly-you don't want to make too big a deal of this situation) for doing so. Parents can offer reassurance that they know their child will be dry again, even if they're not sure exactly when that will happen. If there isn't progress within two to four weeks, I would want to see the child again to make sure there is no new problem and to repeat the examination and think again with the parents about possible sources of stress. Often a problem or solution that wasn't clear at first becomes obvious the second time around.
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