Winter – the season for wet beds

“Oh no it’s going to rain, hail and the temperature’s not going to get over 12 C for the next 5 days – how on earth am I supposed to get all these sheets washed and dried……..”

Sound familiar?

Winter is the time of year when wet beds really become noticeable and often frustrating for parents. All that extra washing and trying to get sheets dry.

What is the answer?

Keep buying more sheets?

Continue to keep your child in pull ups?

These are just bandaid solutions.

Meanwhile, your child comes home from school worried, with a notice for camp at the end of term 3 and flatly says they won’t be going.

It’s time to do something about bedwetting.

Our bedwetting program usually takes between 6 & 8 weeks and requires an initial intake interview with parents and the child. In this interview the child is set up with an enuresis alarm, encouraged that they are the only ones to turn it off when it rings  and need to manage the accidents.

The program is closely managed and monitored, with the child phoning in to me weekly for updates on their progress. These weekly phone calls are essential for helping to support the child and parent, particularly in the early stages of the program when they may encounter difficulties such as not waking to the alarm.

Despite modern medicine and technology the bell and pad alarm is still the most effective evidence-based method of helping children get dry at night. At the end of the program, when the child has successfully achieved two consecutive weeks of dry beds, a final session is held in order to celebrate the child’s achievement.

Many parents at the concluding appointment report that they wished they had done the program sooner and if they have another child bedwetting enrol them immediately.

Parents often also report that although they never made a big deal of their child’s bedwetting –  they realise now how it must have been troubling their child, as they notice a new sense of confidence and happiness now that their child is dry at night. Some parents have even commented that other adults such as teachers and sports coaches have noticed an increase in confidence in their child.

After helping children become dry at night for over 17 years now, I still find it extremely rewarding and satisfying, knowing that for many children and families it has been life changing.

It is a well known fact that certain foods containing high levels of sugar can hinder a child’s ability to be dry at night. Much of the literature on bedwetting and advice from specialists suggest that limiting soft drinks, cordials and juices is a good idea in helping a child to be dry at night. A good piece of advice I have for children who have wet beds and their parents is the “After 5pm rule”. This involves a child just drinking water from 5pm onwards, so if they are wanting juice or milkshakes etc….to have these straight after school and then just water (as much as they need to) from 5pm.

Recently, I had one of my clients return to me as he had relapsed after having been dry for almost 9 months. Master B who was 14 had taken approximately nine months to become dry and then nine months later began wetting again. At first it was only a couple of times a week, but after a month or so his mother called me very concerned as it had become every night again. Master B was naturally becoming despondent and anxious as he had an impending school camp.

Upon assessment in trying to ascertain what had caused the relapse, Master B’s mum reported that he was going through ‘a growth spurt’ and that “it was impossible to fill him”. Master B reported that he loved apples and would eat up to 5 a day! His mother concurred that he did eat vast quantities of apples and on most nights had recently begun having an apple as he went to bed in order to try and quell his hunger. As apples are naturally sweet and contain fructose and other natural sugars I suggested before trying the bell and pad alarm again that Master B reduce the quantity of apples he was consuming to perhaps two a day and no apples after 5pm.

Interestingly, within days of Master B taking on this advice he began to be dry again at night and continues to be so.  (more…)

World Continence Week June 24 – 30

“Talk about Incontinence: A problem in anyone’s language” is the topic for this year’s World Continence Week.

The focus is on better educating Australia’s ethnic communities about incontinence, as it is a well-known fact that seeking help for continence-related issues can be very difficult amongst our diverse communities.

The Continence Foundation is launching bilingual fact sheets and web pages on their website, www.continence.org.au and are encouraging people with continence problems to access its online forum.

As part of World Continence Week –  we will be offering a FREE talk to parents of children who wet the bed.

If you are interested please email bec@drjanethall.com.au for details or alternatively phone Rebecca on 9419 3010.

I have your book Easy Toilet Training and have found it very useful. My son started toilet training when he was 2 1/2 years. We had been really successful, no poo accidents till this weekend and a wee accident maybe every 3rd day usually when he was too busy and forgot.

He started a kinder program a few weeks ago and since then we have had accidents every day including one poo and he tells me he will just do it in his pants, stickers and treats have stopped working and I am not sure what to do.

Interestingly, he has been to kinder twice now and held on for 3 1/2 hours, no wees while he was at kinder, but can’t even make an hour at home without weeing and he has stopped telling me.

We are not sure what to do, apart from keep persevering and asking him every hour if he needs to go but how long should we do this for? Any thoughts comments would be greatly appreciated.

Also we do undies at home and pull-ups when going out, hope this is okay, but recently I have gone back to pull-ups at home because of all the accidents.

I saw the mother and the little boy on one occasion and set them up with a toilet plan. In the session, we discussed the confusion that can arise when having children in undies at home and then pull-ups when going out. Like in many areas of parenting, it helps a child if you are consistent in whatever approach you take. The mother emailed me a few weeks later with this response.

I have been waiting a couple of weeks to see what happened but he finally toilet trained (during the day, still wet about 4 nights out of 7). After seeing you we asked him occasionally if he needed to go without forcing the issue or putting him under pressure.

Two weeks after his birthday just before going to kinder he said he wanted to wear his ‘Buzz’ undies. I told him he had to tell me when he needed to go and in the first 2 weeks I think he had only 3 accidents, which were when he was too busy playing. We still do the odd sticker and chocolate when he asks, but we are so happy. Thanks for you advice during our visit.

Initial Email Enquiry from our website:

Master 12 is a chronic bed wetter and always has been.
We have never made an issue of his bed wetting, certainly praise him lots if he has a fairly dry night and great celebrations if he is dry. In the last 6 months he would have had 2 dry nights by himself.

When he was 8, we saw a paediatrician, and he wasn’t at all concerned as children grow out of this and I know they can, but he doesn’t appear to be doing so now that he is 12 and off to secondary school within 6 months. We were referred to the hospital sister who worked with us using a bell and pad. We did this and I was very thorough. We had the alarm pad for about 3 months and not once did the noise of it wake him, although I was getting up an average of 3 times a night to the alarm. In the end, it clearly wasn’t working.

At various times over the years, we have used reward systems – stickers, special times, Beanie Kids etc. Master 12 is always excited about these, but it doesn’t make a difference.

We have also tried Minirin. It works quite well the first night, the second night has limited success (usually wets but a little less) and from then on has no effect. We use Minirin as an emergency if a friend stays or if on a camp, or if he is at his friends house.
Currently he wears pull ups to bed and 19/20 days has wet right through these in the morning.

He is a great kid and loves to be dry! He really does try, but this is something that’s just incredibly difficult for him. As he’s getting older it is becoming a bigger problem and unfortunately one which is getting in the way for him socially. He begins Secondary School next year and has a 4 day camp which all children attend within the first few weeks– as things are, he cannot possibly go as the ramifications of bed wetting socially would be a disaster.
Please help us!

Master 12 joined our Boss of the Bladder program and at first consultation presented as a quiet and reserved boy who was very embarrassed about his condition, but also very motivated about beginning the program and wanting to be dry at night.
Treatment involved being placed on our “Boss Of The Bladder” program which incorporates the use of a bell and pad alarm system, rewards, phone and one-to-one consultations and encouraged responsibility to manage the night wetting. He was also encouraged to drink more fluids during the day and before bed.

After only three consultations and over a period of three months, he had been dry for one whole month and was extremely pleased with his success. Both he and his mother were extremely happy with this outcome and he was given a certificate and bookmark to celebrate his wonderful achievement. There was a significant change in his demeanour from the initial consultation. He appeared much more confident, talkative and excited about beginning secondary school. He phoned three weeks later upon returning from his year seven camp to inform me that he was dry throughout the camp, had had a fantastic time and had been dry at night since.

Master 4 first presented to our clinic as a delightful, quiet and co-operative boy, who was toilet trained for wees, but refused to sit on the toilet when needing to poo. When his parents tried to encourage him to sit on the toilet, he would become increasing agitated and anxious and would hold on for as long as he could, before hiding behind the couch and pooing in his pants.

As part of therapy to overcome his anxiety, a behavioural modification program was established in the first session. Master 4 was required to sit on the toilet to do “practice poos”. The emphasis to him and his family was practice, so that there was no implication of pressure to pass a bowel motion as that would only increase his anxiety. He was also set up with a reward system for complying with the practices and a reward system for achieving his goal.

After only two consultations over a period of six weeks, he was pooing in the toilet routinely with no distress. His mother was extremely pleased with his success, but still concerned that he would only pass a bowel motion in her presence and in his own toilet. After introducing incentives to try other toilets and gradually exposing Master 4 to many other toilets, he began pooing in other toilets and without the presence of his mother. It was recommended to continue using rewards and incentives until he was confidently using toilets for one month and then to gradually phase them out.

Upon follow up, his mother reported that he continued to use the toilet successfully with no accidents and had “not looked back”. She felt that there had been a significant improvement in other areas of his life as well, including eating better, being less anxious and more settled. His mother emailed me this final correspondence;

“Rebecca, thanks again for all your help. It was a pleasure meeting you and watching Master 4 form such a strong (and immediate) bond with you. Thanks for not only helping him, but for allowing me to see some of the ‘mistakes’ I was making with him as he was growing up (overall – not only in relation to his toilet training issues). I have highly recommended you to all my friends. And we may be in touch again as he and his sister both grow up….”

CONTINENCE AWARENESS WEEK AUGUST 3 -9

As part of Continence Awareness Week August 3 – 9, this year the Continence Foundation is focussing on children and women, with the title, “Life’s Little Spills”.

A testimonial to the “How You Can Be Boss of the Bladder” Book and our email service!

My Mum and I are writing to you to see if you might be able to help me with bed wetting.
I am 8 ½ years of age. I wet the bed most nights. I have 2 brothers aged 11 and 5 and neither of them wet the bed. We were wondering if your program might be able to help me.
Mum and I both read the article in Saturday’s Herald Sun. We already do all of the suggested tips you mentioned for a dry bed.
Thankyou.

Our response:
Thanks for your email and especially thank you for taking the responsibility to email us yourself when you are only 8!!
My name is Rebecca Gilmour, I am a psychologist who manages the Boss of the Bladder clinic for Dr Janet Hall in Richmond. There are some steps you can take before embarking on our program.
1.) Firstly, we would strongly suggest you read Dr Hall’s book “How You Can Be Boss of the Bladder”. It is an excellent resource for both parents and children to read. The book is available through our website or from most bookstores. This is usually the first step we take in trying to get children dry, as often just by reading about what is happening can be enough to get them dry as knowledge is power!

2.) The next step is whether or not you are still wearing nappies or pull ups to bed. If you are then we suggest removing these to see whether there is a chance you can become dry by yourself and allow this to happen for a couple of weeks. It is a much different sensation waking up in a wet bed as opposed to a wet pull-up.

3.) If you are still not dry, then a bell and pad alarm in conjunction with regular coaching from a psychologist is the best intervention method and generally is 90 per cent effective.

The costs involved with our program are subject to individual circumstances, and whether or not you have a MEDICARE referral from a GP. Under the medicare scheme (brought in November 2006) enuresis (either bedwetting or day time wetting) is considered a psychological item that can be rebated through Medicare. If you chose to go through Medicare, your child will be entitled to 6 sessions in which you will receive $75 back on each session. If you would like to consider this option, please let me know so that I can send you some documents which you can print out and give to your GP in order to make it easier for him/her in writing the GP Health Care Plan for your child. Please go to our website and follow the medicare link for further information on this. If you have private health insurance you may also be eligible for a rebate.

Following response received from 8 year old:
Thank you for writing back.
We ordered the book and it arrived today. I am reading it first and then Mum will read it.
I am going to try to go without pull-ups over the school holidays. Hopefully after reading the book I might be successful. I will write to you again after the school holidays to let you know how I go. If it doesn’t work, Mum will then make an appointment.
Thankyou.

Parent’s response:
My daughter and I wrote to you regarding a bedwetting issue. You advised that she should try to go without pull-ups for 2 weeks. She did this over the school holidays and continues to go without pull-ups.
She had about a 50% success rate. This really is a big improvement on what was previously occurring. There doesn’t seem to be any patterns as to whether she will be dry or not. Sometimes 3 or 4 dry nights followed by 3 or 4 wet ones. There have even been instances of more than one accident during the night. She doesn’t seem to be waking during it, just waking after it has happened. Probably because she is cold? She also does not wake needing to go to the toilet. She either sleeps right through successfully or wakes up wet.
Do we continue with what we’re doing as I can see some improvement or do you think the bed alarm might be our next step?
Thanks for all of your help so far.

Within a month they emailed again with:
I think we have turned a corner. It has been a long process but I would now safely say that my daughter no longer has a bedwetting problem. It all slowly got better and better. Had about 1 to 2 accidents a week and it has now been nearly 2 weeks of dry nights.I really can’t thank you enough. I don’t think we would have gone down this path had we not spoken to you. The article in the Herald Sun came along at just the right time. I was quite happy to let her grow out of it. After reading the article, she was very keen to give it a go. Thanks again Rebecca.

BEDWETTING AND PULL UPS!!

Frequently, we receive enquiries from parents with young children (aged between 3 and 5) who want to know what the first steps are they can do to help their child have dry beds.

The following is just one of the many email responses we receive when I offer the advice from last weeks blog, that is, read the Boss of the Bladder book with your child and remove pull-ups or nappies.
A couple of months after emailing the advice, I sent the following:

Hi There,
Just a quick email to check in with you and see how your daughter was going with achieving dry beds at night. When you emailed me almost a couple of months ago now,  she was tired of the pull ups and I advised to take her out of them and see whether she had any success being dry on her own. You also enquired about our program and the costs involved, were you still interested in possibly going on our program.
Look forward to hearing from you soon.
Warm regards,
Rebecca Gilmour
Psychologist M.A.P.S
Boss of the Bladder Manager

To which I received the following response:

Hi Rebecca
Thank you for following us up.
We took Miss 6 out of the pullups and she was dry straight away. In her first two week period she only had one wet night. We than went on holidays and stayed at several different places. She went pretty well whilst we were away however she did have several wet nights. I put this down to late nights different locations and a change in routine. We have been back from holidays for 3 weeks and she has only had one wet night!!!

After reading the Boss of the bladder book we started getting her to find her way,  in the dark, to the toilet with a torch, prior to going to sleep. She now is very confident in getting up and going to the toilet and does so most nights.

At this stage we will not need the program. Since we have started talking to other parents about her wetting we have discovered other parents with the same difficulty and we have been suggesting they start with the boss of the bladder book. They seem to be like us and doing all the wrong things like getting her up to go to the toilet and restricting drinks.

Once again thanks for your help and giving me the confidence to remove the dreaded pullup.
Regards.

Knowledge is Power: The benefits of reading How You Can Be Boss of the Bladder.

Dear Dr. Janet Hall,
I am the mother of a five year old who is still in night nappies. I have been told conflicting advice, but have left him in nappies because he has only had one dry night that I can recall and I thought wet beds every night would not be fun!
I am writing to request information about the resources and services you offer. I live in rural Victoria, north of Shepparton, about 3 hours from Melbourne, and am able to come to Melbourne for a consultation. I would appreciate your thoughts on useful ways for me to proceed.
Thank you for your time.
Shepparton Mum

Response:

Thanks for your email.

My name is Rebecca Gilmour and I manage the Boss of the Bladder program.

Have you and your son read Dr Janet Hall’s book “How You Can Be Boss of the Bladder”? If you haven’t, then this is the first step you need to take (you can purchase the book from our website or from most good book shops). The book is an excellent resource for parents and kids, helping to demystify the myths about bedwetting and allowing children to see that they are not the only ones who do it, and it can be something that they can control. There is a specific section for children to read.

The next step is to remove the nappies/pull-ups/dry nites and see whether he can obtain some dry nights on his own. as he may never learn to be dry. I’ve treated 14 year old boys who have been wearing pull-ups, whilst they are in nappies, they may never learn to be dry at night. Nappies/pull-ups act as a security for children and it is a much different sensation to wetting in a nappy as opposed to a wet bed. You need to remove nappies for at least a few weeks to see whether there is some chance that your son can achieve dryness on his own.

I know obviously it is very difficult though dealing with up to 3 wet beds per night every night. We have a couple of contacts here in Melbourne who have websites and have developed a special absorbent mat to put on children’s beds to assist them in achieving dryness on their own without resorting to pull ups and nappies. Their websites are www.conni.com.au and www.slumberdry.com.au

A month passed, so we followed up with this email:
Just emailing to check in and see how your 5 year old was getting on with achieving dry nights!!! You emailed us in early September, and I recommended taking him out of pull ups and reading Dr Janet Hall’s book How You Can Be Boss of the Bladder as the first step.
Look forward to hearing from you.

And the response back was fantastic news!!
What great service and we haven’t even been to your clinic yet! Thank you for following me up. We got a copy of Janet’s book, we borrowed it from the library,it’s a fairly old copy, so I don’t know if it’s been updated or not.
Anyway, we read it and that night he decided he would try to be “Boss of the bladder” and have no nappy (we had recently put him back in cloth nappies, which can’t have been very comfortable). Anyway, that night he woke up at 2.30am and did a wee and had a dry night, the next night he woke up at 9.30pm for a wee and had another dry night (we were So amazed!). The next 2 nights he wet his bed and was discouraged so the two nights after that he wanted to wear a nappy again. I let him, because of that thing ‘he has to want to be dry’, after that he decided that he would do ‘one night nappy, next night no nappy’, but it hasn’t worked out like that and he hasn’t been back in a nappy. Last night was dry, and he was happy with himself. He said “you know what I think is really helping me is reading that book about being boss of the bladder!!!”. Before last night he’d been wet about 4 nights in a row. If he wets his bed he never wakes up, he just keeps sleeping.

Well, what a long winded answer! The language we are using with him if he’s feeling discouraged is that his brain is still learning to wake him up when his bladder tells it it needs to go to the toilet, and sometimes it doesn’t manage to wake him up, that just
means it needs more practice and will get really good at it soon enough, and that it takes time to learn something new.
I don’t know if we’ll need to come and see you or not, we’ll see how it goes.

Thanks again for your email, I have been recommending your clinic and Janet’s books all over the place!!!!

After 6 months we followed up again and received this great response:

Hi Rebecca,
I have been really thankful for your advice 6 months ago and I have recommended “Boss of the Bladder” to so many parents and children (most who have been dissatified by the response from doctors and maternal and child health nurses who say there’s nothing to do for a five year old who hasn’t had a dry night, and to they’ll look into it when the child is 8 or 9). I tell them my story and your advice. Our son is now permanently dry, he’ll wet the bed occasionally- when he’s particularly tired or something. He sometimes gets up to go to the toilet but mostly hangs on. After a few months of being dry he wet the bed a couple of nights in a row and he initiated reading “boss of the bladder” again.

My 4 year old daughter has just stopped wearing night nappies in the past few weeks and is pretty happy telling everyone she is “Boss of the Bladder!” So there’s no nappies in our household for the first time in 6 years!!! We are so pleased and grateful for all your help.