The transition from kindergarten to primary school is a significant milestone for children, marking them as "big boys and girls". However, if a child aged five or above wets the bed more than twice a month at night, it may not simply be a matter of slower development, but could indicate nocturnal enuresis. Paediatric specialist Dr. Tsui Chi Kwan points out that while most cases of nocturnal enuresis improve with age, parents who simply wait for the problem to resolve on its own may overlook the psychological impact it has on children, and it could even have a domino effect into adulthood. At the same time, parents can also experience stress and a decline in sleep quality, and may even damage their parent-child relationship by scolding their children.
Boys have a relatively high chance of suffering from nocturnal enuresis, and delayed treatment may see them accompanying this condition into adulthood.
Nocturnal enuresis is common among children in Hong Kong. According to a study by the Faculty of Medicine at The Chinese University of Hong Kong, approximately 2 to 5% of children aged between 3 and 19 suffer from nocturnal enuresis,with 5-year-olds accounting for around 16 per cent and 10-year-olds for 31 per cent, the majority of whom are boys.
As children grow, nocturnal enuresis will gradually improve and eventually resolve, but this is not something that happens overnight. Dr Xu points out that nocturnal enuresis may cause children to feel ashamed, inferior or lacking in self-confidence, affecting their ability to make friends and even their psychological development, with repercussions extending into adulthood.“In a study conducted by the Chinese University of Hong Kong’s Faculty of Medicine, 1.5% of 19-year-olds still suffered from nocturnal enuresis, demonstrating that if the condition is not properly addressed during childhood, its effects can continue to persist,” Dr Xu added.
Many parents, in an effort to prevent their children from wetting the bed at night, may wake them up in the middle of the night to use the toilet. However, this method does not solve the root problem and, in the long run, can directly affect the sleep quality of the entire family. Lack of sleep can reduce concentration, memory, and focus, which in turn can affect children's academic performance and parents' work performance.
Drug therapy is highly safe and works best in conjunction with behavioural therapy.
Therefore, early intervention and treatment are important steps. Dr. Xu said: "If parents have enough perseverance and patience with their children, behavioural therapy can be carried out early, such as improving lifestyle habits and using enuresis alarms; however, if you want to achieve results in the short term, medication is more suitable." Current drug treatment mainly works by supplementing antidiuretic hormone to reduce urine production at night. However, many parents avoid it due to concerns about side effects for their children, hoping for a "natural cure" instead. But Dr. Xu said that current medications are highly safe with a low chance of serious side effects, and a combination of drug and behavioural therapy can achieve better results.
Encourage rather than punish to improve parent-child relationships.
Dr. Xu also advises parents to provide encouragement and avoid punishment. For example, parents can create a record chart with their children. If their child doesn't wet the bed, or manages to avoid drinking water and eating for two hours before sleep, they can earn a sticker. Collecting a certain number of stickers can then lead to a reward. This approach not only strengthens the parent-child relationship and encourages children to face the challenge together, but also makes the treatment a positive experience.
Dr. Xu shared that an 8-year-old girl suffered from nocturnal enuresis, wetting the bed 2 to 3 times a week in severe cases. Her mother believed the problem would resolve with time and only engaged her daughter in behavioural therapy. However, as the daughter slept too deeply at night, the behavioural therapy had little effect. It wasn't until the daughter was preparing to attend a summer camp before school that both mother and daughter became concerned about the embarrassment of wetting the bed at night, and thus sought medical advice. After undergoing drug treatment, the girl no longer experienced bedwetting. She is currently continuing to take medication and her condition is being monitored, with the hope of permanently curing her nocturnal enuresis.
The above information was provided by Dr. Tsui Chi Kwan.
Source: Health Institute (8 November 2023): https://bit.ly/41aABaU
