Bed Wetting

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Occupational English Test

Writing Test: Pharmacists

Time allowed: 40 minutes

Mrs. Gill, the owner of a daycare nursery, has previously invited you to deliver a lecture on bed-wetting to the young mothers whose children attend her daycare nursery.

Since you are overloaded with work these days, you decide to write them a letter on that topic instead. Mrs. Gill will read the letter on your behalf.

Please take into consideration the below information. Definition

Bed-wetting, also known as nighttime incontinence or nocturnal enuresis, isn't a sign of toilet training gone bad. It's often just a developmental stage.

Children who've never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.

Generally, bed-wetting before age 6 or 7 isn't cause for

concern. At this age, nighttime bladder control simply may not be established. If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.

Symptoms

Bed-wetting is characterized by involuntary urination at night. Most kids are fully toilet trained between ages 2 and 4 — but there's no target date for developing complete bladder control. During the preschool years, about 40 percent of children wet the bed. By age 5, bed-wetting remains a problem for only 10 percent to 15 percent of children.

Causes

No one knows for sure what causes bed-wetting, but various factors may play a role. ▪ A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night. ▪ Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep — especially if your child is a deep sleeper. ▪ A hormone imbalance. During childhood, some kids don't

produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production. ▪ Stress. Stressful events — such as becoming a big brother or sister, starting a new school or sleeping away from home — may trigger bed-wetting. ▪ Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination and pain during urination. ▪ Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may

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include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness. ▪ Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite. ▪ Chronic constipation. Sometimes children who don't have regular bowel movements retain urine as well. This can lead to bed-wetting at night. ▪ Anatomical defect. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

Risk

factors Bed-wetting can affect anyone, but it's more common in boys. It also tends to run in families. A child with two parents who wet the bed as children has an 80 percent chance of wetting the bed, too.

Medical

assistance Most children outgrow bed-wetting on their own — but some need help. In other cases, bed-wetting may indicate an underlying condition that needs medical attention. Consult the doctor if: ▪ Your child still wets the bed after age 5 or 6 ▪ Your child starts to wet the bed after a period of being dry at night ▪ The bed-wetting is accompanied by painful urination, unusual thirst. Depending on the circumstances, urine tests may be done to check for signs of an infection or diabetes. If the doctor suspects an anatomical abnormality or other problem, your child may need X-rays (radiographs) or other imaging studies of the kidneys or bladder.

Complications

The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem. Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime. Treatment

Most children outgrow bed-wetting on their own. If there's a family history of bed-wetting, the child likely will stop at the age the parent did. If your child is still wetting the bed by age 7 — and is motivated to stop — a doctor may recommend more aggressive treatment. Moisture alarms

These small, battery-operated devices — available without a prescription— connect to a moisture-sensitive pad on your child's pajamas. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms may provide a better long-term solution than medication does.

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Medication If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:

▪ Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray and should be taken at bedtime. DDAVP has few side

effects. The most serious is a seizure if the medication is accompanied by too many fluids.

▪ Change a child's sleeping and waking pattern. The

antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Side effects tend to be rare with correct dosage but include nervousness, anxiety, constipation, and personality changes. An overdose could be fatal. It may be combined with desmopressin if desmopressin alone is not effective.

▪ Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin, Levsinex) may help reduce bladder

contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.

▪ Desmopressin acetate (DDAVP) is a synthetic form of

antidiuretic hormone (ADH), a substance that occurs naturally in the body. This drug imitates ADH in the body, which is secreted by the brain; it increases the concentration of the urine and reduces the amount of urine. Its main use is for children who have not been helped by an alarm. It is also used as a stopgap measure to help children attend camps or

sleepovers without embarrassment.

▪ Oxybutynin (Ditropan) and hyoscyamine (Levsin) are

medications that reduce unwanted bladder contractions. They help relieve daytime urgency and frequency in addition to uncomplicated bedwetting. Their side effects include dry mouth, drowsiness, flushing, heat sensitivity, and constipation.

Treatment of uncomplicated bedwetting is not appropriate for children younger than 5 years.

Because a majority of children 5 years and older spontaneously stop bedwetting without any treatment, many medical

professionals choose to observe the child until age 7. Coping and

support Bedwetting is typically seen more as a social disturbance than a medical disease. It creates embarrassment and anxiety in the child and sometimes conflict with parents. The single most important thing parents can and should do is be supportive and reassuring rather than blaming and punishing.

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▪ Adopt good habits. Limit your child's fluid intake during the evening. Make sure your child urinates before going to bed. Remind your child that it's OK to use the toilet during the night if needed. Use small nightlights so that your child can easily find the way between the bedroom and bathroom. ▪ Be sensitive to your child's feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past. ▪ Put your child to bed earlier. Perhaps surprisingly, an extra 30 minutes of sleep a night helps some children stop wetting the bed. ▪ Plan for easy cleanup. Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy. ▪ Enlist your child's help. Perhaps your child can rinse his or her wet underwear and pajamas, or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the

situation. ▪ Celebrate effort. Don't punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents.

Home care ▪Reduce evening fluid intake. The child should try not to give any fluids, chocolate, caffeine, or citrus after 3 p.m. ▪ The child should urinate in the toilet before bedtime.

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elp the child understand that it is more important to wake up every night to use the toilet. ▪ A system of sticker charts and rewards works for some

children. The child gets a sticker on the chart for every night of remaining dry. Collecting a certain number of stickers earns a reward. ▪ Make sure the child has easy access to the toilet.

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ou should avoid using diapers or pull-ups at home because they can interfere with the motivation to wake up and use the toilet. ▪ The parents' attitude toward the bedwetting is all-important in motivating the child. ▪ Avoid blaming or punishing the child. The child cannot control the bedwetting, and blaming and punishing just make the problem worse. ▪ Be patient and supportive. Reassure and encourage the child. ▪ Enforce a "no teasing" rule in the family. No one is allowed to tease the child about the bedwetting. Do not discuss the bedwetting in front of other family members. ▪ Help the child understand that the responsibility for being dry is his or hers and not that of the parents. ▪ The child should be included in the clean-up process. ▪ To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers. ▪ One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night. ▪ The parent should awaken the child, typically at the parents' bedtime. ▪ When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms.

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Bedwetting alarms have become the mainstay of treatment. ▪ Up to 70% of children stop bedwetting after using these alarms for 12-16 weeks. ▪ About 20-30% start wetting the bed again later (relapse), but with persistence, this method works for 50-70% in the long run. ▪ These alarms take time to work. The child should use the alarm for a few weeks or even months before considering it a failure. ▪ There are two types of alarms: audio and tactile (buzzing) alarms. ▪ The principle is that the wetness of the urine bridges a gap in the sensor, which in turn sets off the alarm. ▪ The child then awakens, shuts off the alarm, finishes

urinating in the toilet, returns to the bedroom, changes clothes and the bedding, wipes down the sensor, resets the alarm, and returns to sleep. ▪ Alarms are preferred to medications for children because they have no side effects. ▪ It is generally believed that all children 7 years and older should be given a trial of an alarm. ▪ For the alarm to be effective, the child must desire to use it. Both the child and parents need to be highly motivated.

Writing Task

Summarizing the above information regarding complicated and uncomplicated bed-wetting, write a letter to the mothers at Mrs. Gill’s daycare (24, Royal Passage Close, Epsom, Surrey 2363) to provide them with information on bed-wetting.

Your letter should not exceed

200

words.

Figure

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