Medline ® Abstracts for References 9-11
Jalkut MW, Lerman SE, Churchill BM
Pediatr Clin North Am. 2001;48(6):1461.
The authors do not have all of the data about enuresis, and many children are subject to relapses or failure of treatment. There is no cause for despondency, however. Enuresis is no longer a mystery. Good data exist about the natural history, epidemiology, and etiology of enuresis. In addition, multiple treatment modalities are available to practitioners. This article has sought to review the scientific literature and to relate the authors' experience with enuresis. The authors recommend a treatment program for children with monosymptomatic nocturnal enuresis that includes removal of caffeine from the diet. Enuretic children do not consume enough fluid, and the authors recommend that the daily fluid requirement be divided during the day: 40% in the morning, 40% in the afternoon, and 20% in the evening, with no restriction of fluid. Normalization of small functional bladder capacities may help to cure enuresis and has an effect on the efficacy of other therapies. Treatment of enuretics with antibiotics is effective in children with UTI, bacteriuria, or cystitis cystica. DDAVP has been shown to be effective in the treatment of enuresis, especially in children who have achieved a normal functional bladder capacity. Bladder alarm systems also offer a potential cure of enuresis, are inexpensive, and show a low relapse rate.
Division of Pediatric Urology, University of California Los Angeles School of Medicine, Division of Pediatric Urology, Clark-Morrison Children's Urological Center, University of California Los Angeles Children's Hospital, Los Angeles, California, USA.
Enuresis: a contrast of attitudes of parents and physicians.
Shelov SP, Gundy J, Weiss JC, McIntire MS, Olness K, Staub HP, Jones DJ, Haque M, Ellerstein NS, Heagarty MC, Starfield B
Questionnaires were used to survey 1,435 parents and 446 physicians in order to determine and compare attitudes and beliefs about enuresis. Although both groups thought that bed-wetting is a maturational problem, the parent group thought emotional causes were important and were less likely to accept small bladder size as an etiology. Parents thought that children should be dry at a much younger age than did the physicians (2.75 vs 5.13 years, respectively). Only 63% of parents thought that medical intervention is a good way to deal with a child's bed-wetting, yet 87% of the physicians suggested medical evaluation. A comparison of the various methods used to stop bed-wetting indicated that parents use waking the child, reassurance and talking with the child, restricting fluids, and punishment significantly more often than physicians. Although many physicians prescribe medication, only 6.6% of the parents thought that medicines are a "very good way" to treat enuresis. When developing a treatment plan for a child with enuresis, the physician should recognize the wide differences between parental and physician attitudes toward this common problem of childhood.
Seven deadly sins of childhood: advising parents about difficult developmental phases.
Child Abuse Negl. 1987;11(3):421.
Seven of the more difficult developmental phases for any parent to deal with are colic, awakening at night, separation anxiety, normal exploratory behavior, normal negativism, normal poor appetite, and toilet training resistance. For the child living in a high-risk family, these innocent acts can trigger dangerous or even deadly abuse. The two behaviors most commonly associated with fatal abuse are colic and toilet training. When we recognize a child who is going through a provocative phase, we should be prepared to advise the parents on some practical alternatives to a physical response. Such advice is welcomed by most types of families. Any treatment plan for an abusive family that fails to include this type of problem solving may be inadequate.
University of Colorado School of Medicine, Denver.