By Steve Hodges, M.D.
Let’s say your child has a cold. Would you reward her for every hour she doesn't sneeze?
Of course not! Because no child (or adult, for that matter) can control when a sneeze comes on.
Likewise, no child can control bedwetting or daytime accidents. Yet parents are often advised to reward children for staying dry.
A mom recently emailed: “Our pediatrician suggested we offer our 9-year-old son extra screen time every time he has a dry night. Is this a good idea? He’s wet almost every night.”
A recent newspaper parenting column offered this advice to the mom of a bedwetting 7-year-old: Put a reward program in place. This can help in keeping him motivated. It doesn't have to be a huge endeavor but something small to possibly prevent him from becoming discouraged.
Unbelievably, even the American Academy of Pediatrics’ website recommends rewards. Its bedwetting section advises:
Be positive. Reward your child for dry nights. Offer support, not punishment, for wet nights.
I appreciate the advice to “be positive” rather than or shame the child. Certainly no child should ever be punished for wetting the bed. The problem is, rewards send the wrong message.
A reward implies the child has control over the situation. So when the child has an accident, which may well be every night, she feels like a failure.
Bedwetting is, pure and simple, a medical condition caused by chronic constipation. The stool-stuffed rectum presses against and aggravates the bladder, triggering hiccups. The bladder empties without warning, and there’s nothing the child can do about it — just as a child can’t prevent hiccups or a sneeze.
No amount of screen time or M&Ms will alter this scenario. These kids don’t need “motivation” to stay dry; they need to have their rectum cleaned out on a daily basis, ideally with an aggressive regimen such as the Modified O’Regan Protocol, aka M.O.P. (a combination of enemas and laxatives). Only then will the rectum have a chance to shrink back to size and stop bothering the bladder.
If parents want to reward kids for complying with M.O.P., that’s fine. Nightly enemas aren’t a heckuva lot of fun, and I’m in favor of anything that will make life easier for these kids. If playing 10 minutes of War Robots on the iPad make a kid more amenable to the regimen, go for it! (In fact, rewards are among the strategies recommended by parents in my blog post “11 Ways to Ease Your Child’s Fear of Enemas.”
But parents must be absolutely clear: the reward is for the child’s effort — not the outcome.
In addition, kids must understand they are in no way responsible for their condition. Toward this end, I have two recommendations:
•Confirm the constipation via X-ray.
In my blog post, “When to X-ray a Child for Constipation,” I explain the many benefits of X-raying kids with enuresis. Among these benefits: the family can see very clearly why the child has no bladder control.
As one mom in our private Facebook support group posted, “Seeing the X-ray really decreased our frustration with our 5-year-old son. We thought his accidents were a behavior or anxiety issue.”
After the X-ray, this mom stopped rewarding her son for dry underwear, and the boy stopped trying to hide his wet undies from his parents. “Now he doesn't have to feel disappointment for not earning a reward when he has no control over it. We all have better attitudes, as view the wetting as a medical issue.”
•Read Bedwetting and Accidents Aren’t Your Fault with your child.
I wrote this book because I could see how many of my patients felt shame for their accidents. They would hang their heads as they sat in my exam room. They still do.
Even when parents try hard to be supportive and project a “Hey, kid, it’s no big deal” attitude, the underlying message to the child is: You can control this. You just need to try a little harder.
In the book, Dr. Pooper explains to siblings Zoe and Zack that millions of kids all over the world have pee and poop accidents. He also tells them:
Sometimes adults wonder if kids have accidents on purpose. But kids don’t, of course!
Accidents are a little like sneezes. You know how, when your nose gets tingly, you can’t hold back that ah-choo?
Same with accidents: They just happen and fast!
Cristina Acosta’s amazing illustrations bring this idea to life and, according to parents, make kids feel a lot better.
As one amazon reviewer wrote, “Our daughter related to it and felt finally understood. It was a relief for me and her after years of frustration.”