NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 6-YEAR-OLD’S ‘DOUBLE DILEMMA’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.
Q. Our 6-year-old is a happy-go-lucky boy. But he has potty accidents at school about once a month and wets the bed up to three times per week.
My instinct tells me that sometimes he is too exhausted to sense his need to go to the bathroom. I give him a change of clothes and some suggestions. I am careful not to shame him.
Also, our boy can’t sleep through the night.
We listen to CDs like “Indigo Dreams” and his favorite story, “The Velveteen Rabbit.” We say a good-night prayer. We make sure he has a few of his “friends” – stuffed animals.
He insists on a light in the hall in addition to his night-light. During the night, he will come into our bedroom and want to crawl into our bed.
We are consistent and firm and take him to the bathroom, then to his bed.
This pattern happens every night two to four times, and it is wreaking havoc on our sleep lives. What can we do about this double dilemma?
A. About 15 percent of 5-year-olds and 5 percent of 10-year-olds still wet their beds. Let your child know that you understand that the bedwetting happens while he is asleep, that it is not under his control, and that you don’t mind helping him change and wash his pajamas and sheets.
Set up a routine for handling the “accidents” that cuts down on tension and embarrassment. You can restrict fluids from suppertime on and remind him to urinate twice before he goes to bed.
I have found that if parents wake up the child before they go to bed it gives him another chance to empty his bladder and may help prevent bedwetting.
As for the middle-of-the-night awakenings, you can insist that his room is the limit: You will come to him but he can’t come to you. Then be sure you respond when he calls.
You can sit by his bed without lying next to him, reassuring him that you are there. The combination of bedwetting and awakening raises a possibility that might explain both: obstructive sleep apnea, or another related form of sleep disturbance.
OSA occurs when breathing during sleep is briefly but repeatedly interrupted by a blockage. Fortunately, people with this disorder wake up to get themselves breathing again – at the cost of poor sleep quality and lower oxygen levels.
The most common sign of OSA is snoring, although many children who snore don’t have this condition. At age 6 or 7, the tonsils and adenoids are largest relative to the size of the airway and therefore likelier to obstruct it.
Not all children with OSA wet their beds, but some do. Along with snoring, other OSA symptoms include breathing pauses, restless sleep, difficulty awakening in the morning, daytime sleepiness and behavior problems.
To make the diagnosis, a sleep study – which measures heart rate, breathing and sleep cycles – can be performed. However, the test may not detect a few related disorders (for example, Upper Airway Resistance Syndrome).
Asthma and allergies may also disrupt sleep. We suggest you consult your pediatrician.
For more information: “Take Charge of Your Child’s Sleep,” by Dr. Judith A. Owens and Jody Mindell, Ph.D. (Marlowe & Co. 2005), and “Solve Your Child’s Sleep Problems,” by Dr. Richard Ferber (Simon & Schuster, 1985).
Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.
Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.
Reprinted with permission from the authors.