He deals with all aspects of children’s medical problems including headaches, anaemia, paediatric asthma, chronic disorders, fits, faints and funny turns, gastro-intestinal disorders, abdomen pain, concerns regarding growth and development, and any other problems with newborns.
His special interest is in kidney and bladder conditions and he runs special clinics for urinary infections, incontinence and kidney andbladder abnormalities.
Here Dr Tewary answers some much asked questions on children and bed-wetting.
At what age are children usually expected to ‘sleep through’ without wetting the bed?
By the age of five children can usually expect to be ‘night dry’. If that doesn’t happen there is no need for panic but it would be sensible to take your child to a doctor or school health nurse to see if ‘interventions’ are necessary. I would advise parents to take action before the child reaches seven years old.
There will be some children who take longer than others to sleep through but at what age would you start looking at bed-wetting as a medical problem?
About 10% of children at age 10, and two per cent of pubertal age can still be wetting the bed at night. It is more common if there is a family history of a sibling or parent having the same problem as they grew up. It is important that a medical/urological cause needs to be ruled out if they are still wetting after the age of five.
Are there any ‘regular’ causes – something that parents can alleviate by making a few changes in their child’s eating/drinking/sleeping habits?
We encourage the child to stop or reduce drinking preferably two hours before going to bed. Regular bladder emptying, hygiene, and drinks routine does help to train the bladder. Poor or irregular habits can potentially delay being dry.
Should parents discuss the problem openly with their child?
Yes, we encourage parents to discuss the problem with the child in a positive and non-discriminating manner. They should explain that it is not the child’s fault and also discuss how the situation could be improved with certain interventions – if you are doing something different then it is important that your child knows why. Be positive and reassuring throughout the process and also encourage your child to take ownership of cleaning and changing bed linen under supervision and with support of parents.
What are the most common ‘successful’ treatments?
It very much depends on the cause. A simple 'lack of arousal' – the child waking up when they need to urinate may improve with general behaviour modification and encouragement, whereas lack of hormone to regulate night urine production, or bladder irritability may need medications. That is why it is important to visit your GP if the situation doesn’t seem to be improving.
Is surgery ever a necessary option?
Children do not need surgery unless there is a urological condition, such as double ureter or obstructions affecting the kidney or bladder and these are extremely rare.
What if your child stops wetting the bed for several months but then the wetting starts up again?
If the child is dry for six months and then start wetting again, this is classified as 'Secondary Wetting' and medical/urological causes need to be investigated. However it is often brought on by stressful situations. Again support and encouragement from parents can help.
If you have two or more children all at ‘bedwetting age’ is it best to deal with each one separately or try to make it a ‘group’ thing?
This very much depends on family dynamics. Group work may be helpful if there is a positive engagement/environment within the family and the cause of wetting is same. However, each child is an individual and, as such, even though they are all in the same family the causes and solutions may all be different.
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