Treatment
Home Up Bed-wetting Treatment Success Clinical Services Manual

 

Ramsey Coote provides an outline of treatment on this web page. 

Treatment has seven main stages:

preparatory education of parents;
medical examination.
interview of child and parents.
becoming dry with treatment.
being dry for 14 continuous nights.
over-learning (not always required by practitioners).
follow up.

Preparatory Education of Parents.  The practitioner provides an educational package for parents. It  should tell you about bedwetting, the course of treatment,  explode any myths and bring to an end any practices such as restriction of fluids and lifting, and stopping any punishment. Some practitioners may offer parents training in groups providing this education and opportunity to ask questions. An example of a "package" is the manual, "Bedwetting, A Manual for Parents".

Medical Examination. Children require a medical examination where the treatment is not being supervised by a medical officer. Practitioners other than medical officers would ask whether the child has had a medical examination for bedwetting. Your general practitioner may have a standard referral form.

Interview of child and parents. 

Practitioners mostly see children in their clinic for the first interview. These practitioners will provide supervision by further visits to the clinic or by telephone calls. Some practitioners visit homes for both the initial interview and follow on supervision. Typical time for this interview is 50 minutes.

We refer to this interview as a "child-centred consultation". That is the client or patient is the child, not the parents. Typical content is:

the child - enabling the child to talk about this private matter.
the family - background, and any other bed-wetters in the extended family.
medical background - general health and any conditions with medication.
any previous attempts at treatment; any home remedies.
bedwetting - explanations and roles; becoming dry; successfully dry.
bell-and-pad - explanations; placing the bell unit; child in command.
role play - shows an understanding of what to expect and do.
layout of the house - access to toilet; adequate lighting.

It is an educational interview. In a short time, the practitioner has to teach the child about his/her role and the parents about their role. After finding out what has been learned from the preparatory education, the practitioner will demonstrate the setting up of the alarm and will show the child how to operate it. There will be role play to test and improve the child's understanding.

Not every possible occurrence can be discussed during the interview. There is more than enough to learn without canvassing every  possibility. Should the unexpected arise, your supervisor will be a telephone call away to explain and advise.

The practitioner will go through the way that treatment will progress and show what records are to be kept.  These records are important in obtaining success; they are more accurate than recall of memory, and help to assure progress.

The practitioner will encourage the child to report progress and have the parent confirm the child's report. 

At the end of the interview, the child takes possession of one of the two parcels: the boxed bell alarm or the rolled bed-pad, with one parent taking the other one. 

"From tonight, you will no longer wet the bed. You will wet the pad. That will help you learn to be dry" are motivating last words of the practitioner.

Becoming Dry with treatment.  

In becoming dry,  parents and children are applying a therapeutic procedure in the home away from direct supervision. To assure success, there has to be adequate external supervision by the practitioner.

There are many patterns of progress. The common pattern is to continue wetting each night at first. Parents observe that the wet patches on the bed-pad become smaller. Smaller patches means the child is responding more quickly to the bell.  Then the child will have a dry night, or wake up and go to the toilet. The dry night will be followed by one or more wets, then several dry nights. This progress goes on for about four weeks when the child begins to have continuous dry nights.

Children may wake up themselves, that is without the alarm sounding, during the night and go to the toilet.

Practitioners supervise the child's progress by providing assessments of progress, monitoring roles, and checking adherence to instructions. They will offer encouragement along with other guidance and further instruction to handle occurrences not covered in the interview or earlier supervision.

The usual outcome is for the child to go through the night and wake up at the normal time with an urge to go to the toilet.

The average time to complete the treatment is six weeks. 

14 Days Continuously Dry.  When the child has had 14 nights dry continuously, the child is considered dry. This is the measure of successful treatment. To emphasize this, should the child have a wet night on the 13th night, the counting starts all over again.  Parents can now expect the child to remain dry at night. The child can remove the bell-and-pad from the bed.

Over-learning. Some practitioner include this further stage where extra fluid is taken to reinforce what has been learned. The extra fluid will bring about further instances of bells ringing and giving the child more learning. When the child has had 14 continuous dry nights, the child can remove the bell-and-pad from the bed.

Follow Up. Practitioners will follow up at three, six and twelve months to check that the child remains dry at night. They will remind parents about possibility of relapse and importance of immediate remedial treatment.

 
Younger Than Primary School Age  

Parents that have confidence in their children's ability to learn and do enable them to learn, have got their children dry by doing the following list of things:

obtain information - make contact with your local provider of bed-wetting treatment to obtain educational material about parenting of the younger bed-wetter.
observe - make a record of your child's bedwetting; then when you follow this list of things you will be able to tell whether its working for your child. You will have a written record to talk to later should you have to consult a practitioner. Doing bed checks may tell you something you don't know - your child is wetting more than once per night.
drinking - increase intake of fluid; more drinks stretches the bladder so it holds more.
nappies and pullups - remove nappies or pullups where the child shows awareness of wetting. There are under-lays to absorb the urine and keep the bed clothes dry.
encourage - the child that wakes when wet; praise dry beds.
rewards - where the child has some dry night; this has to be a unique reward only available for dry nights; you need some prospect of success for rewards to have any meaning.
 
Here is a not-to-do list:
 
punishment - to punish or embarrass will not help; it can bring about continued wetting.
drinking - do not restrict fluids.
lifting  - do not lift the sleeping child and take that child to the toilet during the night.

Your local practitioner can assist you further where you have any difficulties following through with these suggestions.

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