roseola If a trained child suddenly begins bedwetting, the cause may be physical. If bed wetting develops a year or more after night training has been established, or if a child wets himself both day and night, a physical disease is likely. However, most cases of bedwetting are not caused by an identified physical disorder. Some cases seem to be hereditary, with brothers sisters, and parents also having been bed wetters. Some are caused by overemphasis by the family on toilet training. Others are caused by taking children out of their night diapers too soon or by waking children to urinate in an effort to train at night. Some children have emotional problems that cause bedwetting. Still, the cause of many cases of bedwetting remains unknown. PatiV.°C?0rncis no Physical cause for bedwetting, the best home care nce calmness, and understanding. SIGNS AND SYMPTOMS A child who frequently and consistently wets the bed after age five has a bedwetting problem. HOME CARE Before beginning any home treatment of bedwetting, see your doctor. The doctor can perform tests to determine whether bedwetting is being caused by a physical disease, such as a urinary infection or diabetes. If the doctor finds no physical cause, the best home treatment is to ignore bedwetting as much as possible and to try to avoid it. Do not take a child out of night diapers until the child consistently remains dry. Do not make a big fuss about daytime training. Do not try to shame a child into remaining dry at night. Do not use devices that awaken the child as urination starts. Withholding liquids during late afternoon and evening hours is not usually successful and may seem like punishment to the child. Behavior modification techniques (rewarding success and reacting neutrally toward failure) rarely work. Rubber sheets and plastic pants are helpful until the child stops bedwetting. Until then, patience, calmness, and understanding may be the best treatment. PRECAUTIONS • Do not let a minor problem like bedwetting become a major destructive factor in your relationship with your child. Anger and frustration between parent and child are more costly than extra laundry. • Do not allow other children to taunt a bed wetter. MEDICAL TREATMENT Before planning treatment, your doctor will conduct a physical examination and order a urinalysis. The doctor may suggest xray studies of the urinary tract or consultation with a urologist. Drug therapy may be started: imipramine (an antidepressant) may be given by mouth at bedtime for a trial period, or dextroamphetamine, phenytoin, or caffeine may be prescribed on a temporary basis. A program of behavior modification maybe recommended. Although these treatments are not always effective, they may be worth a try. RELATED TOPICS: Diabetes mellitus; Urinary tract infections guick Reference Birthmarks SYMPTOMS • Red, purple, or salmoncolored marks • Blueblack marks on back or buttocks • Brown or black moles HOME CARE • In most cases, birthmarks need no treatment • Protect strawberry marks from rubbing or scratching. roseola