Bedwetting is a common problem but an upsetting one for both parent and child. It is so common that an entire industry has grown up around the problem including books, equipment and even medications that offer cures.

Research turned up the following practical and compassionate article on bedwetting from the website of Dr. Sears (Ask Dr. Sears.com), which is reprinted in its entirety.

William Sears, MD and his wife Martha Sears, R.N. come by their knowledge not only from 30 years practicing pediatric medicine but raising 8 children of their own.

Millions more have sought their advice through the 40+ pediatric books, articles in parenting magazines, and appearances on more than 100 television programs such as 20/20, Good Morning America, Oprah, CBS This Morning, CNN, NBC’s Today Show and Dateline.

Myths about Bedwetting

• Bedwetting is not a psychological problem. It does not mean that your child is too lazy to get up, is using bedwetting as a control issue, or is manipulating the family.

• Misunderstandings about bedwetting have kept it from being viewed as a legitimate medical problem. If the lungs malfunction, the child is medically and sympathetically treated for, say asthma. If the bladder malfunctions, the child is thought to be lazy, stubborn, and immature. You would certainly be sympathetic to an asthmatic child who wheezes at night because his lungs aren’t filling with enough air.
• Think of bedwetting as any other medical concern in which an organ of the body is malfunctioning. Bedwetting is a malfunction of the bladder-brain communication system. The child sleeps so deeply that bladder-overfilling and spilling occurs.
• It’s a myth that children don’t care. Really, what child would want to wake up in a wet, smelly bed every morning, and start each morning stripping the bed and carrying wet sheets to the washer?

Facts About Bedwetting

1. The medical term for bedwetting is “enuresis,” which refers to bedwetting that is not due to an abnormality of any portion of the urinary tract. Primary enuresis means the child has never been dry, whereas secondary enuresis is the term used for a child who has previously been dry but then starts wetting his bed. Bedwetting is sometimes referred to as “nocturnal enuresis” or “nightwetting.” Sometimes it’s called “sleep wetting,” since some children may also “nap wet.” Bedwetting really should be called “sleep wetting” because it occurs during sleep.

2. Fifteen percent of five-year-olds or around three to four children in a first grade class, are not dry every night. Eighty-five percent of children eventually outgrow bedwetting without treatment. In the teenage years, only two to five percent of children, or one child per class, continue to wet their bed. Bedwetting boys outnumber girls by a ratio of 4 to 1.

3. Bedwetting is not an emotional or psychological problem, nor does it reflect a dysfunctional family. It is a problem of sleeping too deeply to be aware of bladder function.

4. The genetics of bedwetting are similar to that of obesity. If both parents were bedwetters, the child has a seventy- percent chance of being a bedwetter. If only one parent was wet at night, the child will have a forty-percent chance of following his parent’s nocturnal habit.

5. It helps to first understand how children usually achieve bladder control. In early infancy, bladder-emptying occurs mostly by the bladder-emptying reflex. When the bladder reaches a certain fullness and the muscle has stretched to a certain point, these muscles automatically squeeze to empty the bladder. Sometime between 18 months and 2½ years, most children have an awareness of bladder fullness, the first step toward bladder control. Next, the child becomes aware that he can consciously inhibit the bladder-emptying reflex and hold in his urine. As a result of his urine-holding efforts, his bladder stretches and its capacity increases. When the child can consciously inhibit the bladder-emptying reflex, he achieves daytime bladder control. Nighttime control occurs when the child can unconsciously inhibit the bladder-emptying reflex.

6. Think of bedwetting as a communication problem: the bladder and the brain don’t communicate during sleep. The bedwetting child literally sleeps through his bladder signals. Delay in bladder control can occur if there is a delay in awareness of bladder fullness, a small bladder, or the bladder-emptying reflex continues to be strong well into later childhood. These components of bladder maturity occur at different ages in different children. Bedwetting is simply a developmental lag in the mastering of a bodily skill. There are late walkers, late talkers, and late dry-nighters.

7. Bedwetting is a sleep problem.

New insights into the cause of bedwetting validate what observant parents have long noted: “He sleeps so deeply, he doesn’t even know he’s wetting the bed.” These deep sleepers are not aware of their bladder sensation at night, let alone how to control it. In addition to bedwetters sleeping differently, the hormonal control of urination may act differently in some children.

8. Some bedwetters may have a deficiency of ADH (anti-diuretic hormone), the hormone that is released during sleep and concentrates the urine so that the kidneys produce less of it during sleep and the bladder doesn’t overfill.

9. Normally, bladder fullness works like supply and demand. The bladder fills with just enough urine at night so that it does not overfill and demand to be emptied. Bedwetters may overfill their bladder so the supply outweighs the demand, but because they are sleeping so soundly they just don’t tune into their bladder fullness.

10. A small number of children have small bladders that are more easily overfilled.

The following article is reprinted with the permission of Kelly Palmatier as it appears with the title of Volunteering with Children on the site, compassionatekids.com

Volunteering with children is a great way to help them learn about giving back. Children learn valuable skills while “on the job.” Home schooled students, who may have more time available for volunteering, could also enjoy the additional socialization opportunities presented through volunteering. Another benefit of volunteering is children learn about the concerns of the organization and what need it fills in the community. Consequently, the children also have an opportunity to remember what they have to be thankful for.

Work Together

It’s important to work side-by-side when volunteering with your child, since leading by example has been shown to be the most effective form of teaching. Children who see their parents volunteering are much more likely to believe in the value of working to help others.

Naturally, working side-by-side with your child will allow you to assist him/her when necessary, ensuring the child’s presence is a help, not a hindrance to the organization’s staff and other volunteers.

An additional benefit of working with your child as a volunteer is the bonding that occurs when people work together as a team. Also, when people are focused on a task, it sometimes fosters deep conversations that may not have occurred with more direct eye contact.

Consider the Right Opportunity

When choosing a volunteering opportunity, it’s important to consider the following:

• Your Child’s Interests
• Your Interests
• Your Child’s Abilities
• Your Abilities
• Location, Frequency, & Duration
• Staff Attitude

Your Child’s Interests

If your child is clearly interested in a subject, it may be possible to use that interest as a springboard into volunteering: Children who construct a lot of forts or buildings with blocks may enjoy helping out a construction organization such as Habitat for Humanity; children who love animals my enjoy volunteering with animal organizations such as the Humane Society.

Your Interests

It’s also important to consider your own interests. Children look to their parents to help them discern how to respond to new stimuli. If you are bored while volunteering, your child will associate boredom with volunteering. Alternately, if you are passionate about your actions, your child will respond to that passion.

Your Child’s Abilities

If your child is very young, it can be challenging to choose a volunteering opportunity that he/she can actually help with. Fortunately, there are opportunities available that even very young children can do with a little parental guidance.

I started volunteering with my children when they were three and six years old. My older child could follow basic directions well with a small amount of supervision. However, my three-year-old was an energetic little boy with a young child’s motor skills and attention span.

We were able to be successful volunteering at a local food pantry, where his sorting and counting skills worked quite well with close supervision and direction from me. I gave simple tasks such as taking two boxes of macaroni & cheese from a shelf and putting them in each grocery bag. He was able to complete these tasks easily, while I added all the remaining groceries.

Your Abilities

Just as your child will learn from your passion for volunteering, he/she will benefit from seeing you work well in your element. For example, if you are especially skilled at home renovations, you may find a community restoration project to work on. This would allow you to share your skills while demonstrating the relevance volunteering has to many different careers and interests.

Location, Frequency, & Duration

Of course, it’s important to consider the basic logistics of any volunteering opportunity. If the opportunity is close by, a commitment to help out on a weekly basis may be fine. If it’s farther away, you may need to commit to helping on a monthly basis instead. It’s fine to increase your volunteering later, after you’ve tried it out and you know it works well for you, but be careful not to over-commit initially. Remember your child is already learning work ethics from this experience. You’ll want to ensure you arrive in a timely manner when you’re expected, only canceling or rescheduling when you truly have valid reasons and can give plenty of notice.

Consider, too, the duration of each volunteer session. Older children may be fine with a few hours or more. However, younger children may need sessions to be kept short.

We found our one-hour volunteer session at the food pantry each week worked well during the first 30 to 45 minutes of fast-paced grocery bag-filling. However, the remaining 15 to 30 minutes of shelf-restocking were slow-paced enough that the three-year-old had trouble staying focused. It was an invitation for chaos. We handled it by simply leaving earlier until he was a little older and better-able to handle a full hour of volunteer work at a time.

Staff Attitude

The last item to consider is the attitude of other volunteers and the organization’s staff. Most people will appreciate your instilling a volunteer ethic in children at a young age, but you may find a few “sour apples” who focus more on the decibel level or other potential distractions. (In fact, many organizations may prohibit children under a certain age.)

To some extent, the mission you’re on is more important than any individuals who may not appreciate your child’s input. However, be sure to consider the effect others’ attitudes have on your child. If a child feels like a hindrance, volunteering will end up seeming like a chore rather than a joy.

Resources for Finding Volunteer Opportunities

There are many ways you can learn about volunteering opportunities, including the following:

• Check with Keep America Beautiful or other local organizations for community clean-up days.
• Consider raising vegetables or starting a canned food drive for your local food pantry.
• Check with local nursing homes for “toddler days.”
• Take on home baking projects for fundraising bake sales or meal delivery services.
• Ask your local Chamber of Commerce for information about local organizations that may have volunteer opportunities.
• Call non-profit organizations you like and ask what you can do. They may have needs/volunteer opportunities that you haven’t even thought of.
• Check for opportunities listed in national volunteer website databases such as VolunteerMatch.org (has a designation for kid-friendly opportunities) or Idealist.org (has designations for teen opportunities and under-age-12 opportunities).

As with most parental/educational pursuits, there are many factors to consider regarding volunteering with children, but a little effort can provide a lifetime of benefit for both the kids involved and for society.

“Can Do” Street now has a directory of Kid-Friendly Restaurants listing those that have a menu that appeals to adults while providing kids with a menu and features that make eating out enjoyable for both.

The “Kid Friendly Restaurant” Program’s purpose is to help parents find places where both they and their children can enjoy a quality meal out in a dining-in restaurant, not a fast food establishment.

Being listed in the Directory is free as is the decal each restaurant receives to display in their window alerting potential customers that they are rated as kid-friendly.

The selection criteria to be listed in the Kid-Friendly Restaurant Directory includes:

1)      Be a restaurant/diner – not a fast food type establishment.

2)      Have a website

3)      Have a children’s menu or pricing policy

4)      Have children friendly accessories i.e., crayons, games, children’s area

The Kid-Friendly Restaurants Directory is part of a new feature  in the “Can Do” Street Mall…The Chefs Club.

In addition to the Directory, there is the opportunity for each of the chefs from restaurants listed in the directory to share their favorite kid-friendly recipe. Also featured are kid-friendly recipes from staff and visitors to “Can Do” Street.

If you want to nominate your favorite Kid-Friendly restaurant, go the “Restaurant Recommendation” section of the Chefs Club and fill out the recommendation form.

We welcome your recommendations and comments. If you have questions, contact: johnd@candostreet.com

We hope that this directory will make dining out easier, not only in your home city or community but when you are on vacation.

So, check out the Kid-Friendly Restaurants Directory by going to the Chefs Club in the Mall. Each week there will be several new listings added from across the US, Canada and Europe.

Few things are as much fun for young children as water play.

Few things require the constant, undivided attention of parents and other adults as children playing in water whether it is in a backyard pool or public pool, a lake, the ocean, or even the home bathtub.

According to the American Academy of Pediatrics (AAP) water is one of the most ominous hazards your child will encounter. Young children can drown in only a few inches of water.

The AAP used to advise against swimming lessons for children ages 1 to 3 because there was little evidence that lessons prevented drowning or resulted in better swim skills, and there was concern parents would become less vigilant about supervising a child who had learned some swimming skills.  In light of new evidence showing  that children ages 1 to 4 may be less likely to drown if they have had formal swimming instruction, the AAP has changed its position and now recommends that parents should decide whether to enroll an individual child in swim lessons based on the child’s frequency of exposure to water, emotional development, physical abilities, and certain health conditions related to pool water infections and pool chemicals.

The AAP suggests following these rules when your child is near water:

1. Be aware of small bodies of water your child might encounter, such as bathtubs, fishponds, ditches, fountains, rain barrels, watering cans—even the bucket you use when you wash the car. Empty containers of water when you’re done using them. Children are drawn to places and things like these and need constant supervision to be sure they don’t fall in.
2. Children who are swimming—even in a shallow toddler’s pool—always should be watched by an adult, preferably one who knows CPR. The adult should be within arm’s length, providing “touch supervision” whenever infants, toddlers, or young children are in or around water. Empty and put away inflatable pools after each play session.
3. Enforce safety rules: No running near the pool and no pushing others underwater.
4. Don’t allow your child to use inflatable toys or mattresses in place of a life jacket. These toys may deflate suddenly, or your child may slip off them into water that is too deep for him.
5. Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive into the shallow end.
6. Backyard swimming pools, (including large, inflatable above-ground pools), should be completely surrounded with at least a 4-foot (1.2 meters) high fence that completely separates the pool from the house. The fence should have a self-closing and self-latching gate that opens away from the pool, with the latch at least 54 inches high. Check the gate frequently to be sure it is in good working order. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence. No opening under the fence or between uprights should be more than 4 inches (10 cm) wide. Keep toys out of the pool area when not in use so that children are not tempted to try to get through the fence.
7. If your pool has a cover, remove it completely before swimming. Also, never allow your child to walk on the pool cover; water may have accumulated on it, making it as dangerous as the pool itself. Your child also could fall through and become trapped underneath. Do not use a pool cover in place of a four-sided fence because it is not likely to be used appropriately and consistently.
8. Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.
9. Spas and hot tubs are dangerous for young children, who can easily drown or become overheated in them. Don’t allow young children to use these facilities.
10. Your child should always wear a life jacket when he swims or rides in a boat. A life jacket fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age five, particularly the non swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.
11. Adults should not drink alcohol when they are swimming. It presents a danger for them as well as for any children they might be supervising.
12. Be sure to eliminate distractions while children are in the water. Talking on the phone, working on the computer, and other tasks need to wait until children are out of the water.

During his preschool years, my younger brother would bite his brothers and sisters. He bit us when we wouldn’t give him what he wanted. Unfortunately for my parents, he also would bite the neighbor’s children, kids in the playground, and just about anyone  when he didn’t get his own way.

In those days, a biter was considered a troubled child whose parents did not know how to control him.  By the time he was three he had a reputation in our neighborhood. As he would approach the playground with my mother, other mother’s would grab their kids and move to a different play area.

My parents were mortified by his biting and at a loss to get him to stop. Our pediatrician was called into the situation and was also at a loss to know why this bright, friendly, otherwise likeable boy would resort to biting.  All kinds of behavior modifiers were tried, including making his brothers and sisters bite him back. Nothing worked. Then, he stopped. Just a month before he started Pre-K…he stopped biting and he never bit anyone again!

The other day I came across an article by Dr. Som, a pediatrician, whose posts I’ve referenced in past blogs. My mother and father would have been so relieved to have read her article about preschoolers and biting.

So…for all of you who may be worried about a preschooler who bites here is an excerpt from Dr. Som’s post that will put preschool biting in perspective and hopefully put your minds at ease.

Biting is very natural and all children around the age of 12 months begin to experiment with biting Mom or Dad. Then they might try biting siblings or friends. The behavior peaks around 24 months and then declines. Three year old children rarely bite because they have gained social competence and the language skills to mediate frustration.

Please know that all children bite. No matter how you handle the behavior, your child will outgrow it by three years old. How you react may affect how quickly the behavior stops.

To nip it in the bud

• A simple, “biting hurts” will do. Nobody should be called bad. No shouting.
• Give affection and attention to the child that was bitten.
• Briefly ignore the biter. Time out may not be necessary as ignoring the child sends a clear message that biting is an antisocial behavior.
• Let the biter say sorry or hug the person he has hurt.
• Anticipate biting and offer distraction or offer words that the child can use instead.
• If the skin is broken, see your doctor about the need for antibiotics or a tetanus shot. Usually soap, lots of water, and maybe a cool compress are all you need.
• Choose a daycare with good staffing ratios, at least one adult to four children for toddlers. A quality provider engages the children, minimizes boredom, recognizes fatigue and understands that biting happens.

Biting is almost never a sign of abnormal development in an otherwise normal child.

Visit Dr. Som’s site at   www.pensivepediatrician.com/