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He explained that it was not intentional for children, especially older ones, to suddenly wet their beds and stressed that parents needed to understand that fact and have patience as the children learnt to control their ability to pass urine.

“Punitive measures have never helped at all. To punish a child for something they have no control over heightens the child’s anxiety. It is misplaced to beat up a child for bed-wetting and that indicates that you the parent or guardian do not truly understand what is going on with the child. It is not intentional the child is bed-wetting. There are issues that need to be investigated and the children need our support to address those issues,” he stated.

Highlighting some punitive measures parents and guardians give their older children who bed wet, Dr Owusu Sekyere emphasised that “parading children who bed wet across the street while carrying their wet bed is traumatic psychologically and it is not something that is advisable at all. This is surely not the way to go because they worsen the ability of the child to overcome that problem.”

Dr Owusu Sekyere in a telephone interview with The Mirror said usually between four and five years old, many children would have stopped bedwetting but there are some children (generally about five per cent of the population) who would continue to wet their beds beyond the time that they are expected to have attained bladder control.

The Consultant Paediatrician said instead of beating such children, parents should take them to the hospital for their cases to be investigated “and where it is a condition that is causing it, the necessary treatment will be given.”

Causes of bedwetting in older children
He mentioned the four causes of bed-wetting in older children to be primary, secondary, psychological and organic and explained that the primary category were children who had never learnt to control passing urine, while the secondary category were those children who by age four or five years stopped urinating in bed but something happened and so by seven, eight or nine years, they started to urinate on bed again.

“The secondary one is the type that turns out to have an underlying cause because the child has learnt to control the bladder so why is the child now wetting the bed again?”

For the psychological one, which he said was normally seen in children from the secondary type, “something might have happened in the family, for example divorce. The child is being abused or bullied in school and so they express what they are feeling through bed-wetting”.

For such cases, he said, the children were referred to a clinical psychologist to helped them deal with the problem.
With respect to the organic one, Dr Owusu Sekyere explained that where there was a problem with the brain, children were unable to control urine.

Children who fall into this category include those with underlying conditions such as diabetes, urinary tract infections, kidney infections and those born with abnormalities. While some of the children with these conditions urinate a lot, others also urinate unknowingly, hence bed-wetting.

The consultant said genetics also had a role to play in some children bed-wetting at an older age.
He pointed out that that was normally inherited from the parents but commonly from the mother.

“If the mother learnt to control urine from 10 to 14 years, the child also tends to do that,” he said.
In Ghana, he said, most of the cases of bed-wetting seen in older children had to do with the primary one where the child had never learnt how to control urine.

Untreated conditions
For older children who bed wet because of an underlying condition, especially for the boys, Dr Owusu Sekyere said if the cases were not detected early and treated, they could develop complications.
He cited for instance that if conditions such as posterior urethra valves and urinary tract infections were not treated, the result could be kidney failure.
Those who are bed-wetting due to a tumour, diabetes or kidney stone blocking one of the passages of urine are also likely to have a problem with their kidneys if they are not treated.

Impact of bedwetting on older children
The Consultant Paediatrician explained the impact of bed-wetting on older children to include loss of their self-esteem and ability to integrate socially, adding that “the earlier it is seen and therapy given, the better.”

He said there were certain medications which could be administered to children who bed wet for an unusually long period and included medications which controlled the brain’s ability not to produce urine to enable the child to sleep through the night and medications targetting the bladder not to pass urine.

Tips for parents
On the type of support parents could give, Dr Owusu Sekyere said they could wake the children up at regular intervals to urinate, institute reward system anytime the children were dry and also provide them with a mobile toilet close to their sleeping area so that when they woke up at night to pass out urine, they could quickly do so.

Additionally, he said parents could procure a special alarm system which could ring at intervals to prompt the child.

The disadvantage with that, he said, was that it never worked with deep sleepers because “they won’t wake up even when the alarm rings.”.