Thursday, January 29, 2009

Older Children,Bed-Wetting,and Self Diapering

In my readings on nocturnal enuresis I have come across the following situation and I decided to devote a whole article to this topic. I don't know how prevalent it is but I felt it needed to be addressed. This issue concerns me and that is why I felt it needed to be covered in more depth. On some incontinence forums I have read about some parents and babysitters diapering older children with bed-wetting problems. Some of these children are 9 or older. As we all know bed-wetting can be very stressful and in my opinion this stress can be exacerbated by parents not letting their child put on their own protection. By no means am I a childcare expert but my intuition tells me that above the age of 3 or 4 a child should be taught how to put on their own diapers.

Years ago I had a friend who had to babysit a 6 year old. She was telling me that she had to diaper the child before he went to bed. Due to his age I assumed he was potty trained and that the reason he wore diapers was because of a bed-wetting problem. She told me that he went running through the house naked and screaming and refused to let her put the diapers on him,which I can't say as I blame him.

I do believe that an older child,adolescent,or teenager should wear diapers to bed if all attempts to cure it have failed and if other garments such as pull-ups and "Goodnites" don't offer adequate protection but I also feel that the youngster should be responsible for putting on their own protection unless they have some cognitive and/or physical disability that makes it either difficult for them to do so or prevents them from doing so. Diapering an older child has the potential to drastically effect a child's psychological health for years to come.

There are certain tasks that can be accomplished by youngsters who aren't cognitively or physically impaired including tying one's shoes,putting on one's clothes,etc. Diapering one's self in my opinion would fit into this category also.

At this point I'd like to talk about disposable diapers. If the parents are concerned that the child might not fasten the diapers correctly thereby causing the diapers to leak the parents can show the child how to fasten the diapers correctly. One way of doing this is to lay the diaper on the bed,have the child sit in the diaper,and tell them how to fold and fasten the diapers properly. I wouldn't think the child would have much difficulty doing this. However,if the child is having any problems with fastening the diaper,the parents can talk them through this. After the child is done putting the diapers on, the parent can have him or her stand up to see if the diaper is put on correctly and if not they can have the child make any adjustments that are necessary,such as refastening the tapes,putting on the diapers again if it looks like they don't fit correctly(which could cause leaks),etc. I would do this when the child is young because the older the child gets the more embarrassed the child will feel. This is a very sensitive area for children. Many bed-wetting children feel self-conscious and embarrassed about wearing diapers to bed(although as I have pointed out many times they shouldn't be) and having their parents diapering them will make them feel even more self-conscious and embarrassed. Also bed-wetting makes many children feel helpless and by parents diapering the child it reinforces the feeling of helplessness. That is why children should be taught to be independent in this are as soon as possible.

As far as pin-on diapers are concerned some parents are afraid that the youngster might stick themselves with the pins. This is certainly a valid concern but if appropriate precautions are taken this shouldn't be an issue. I was talking to someone in customer service for a company that sells pin-on cloth diapers and plastic pants for older children and adults with bed-wetting problems to get her take on the situation and she told me that at the age of 7 or below the parents might need to fasten the diapers,above the age of 7 it would depend on the child's development. I believe the same steps taken with disposable diapers can also be taken with pin-on diapers. Again the parents should lay the diapers on the bed,have the child sit in them,and teach them the correct way to fasten the diapers. I can't emphasize this enough-children need to be taught at a young age how to be independent in this area. As I mentioned at the beginning of this article, my feeling is that beyond the age of 4, a child should be responsible for putting on their own diapers. Some children develop at a faster rate than others and some children might be savvy enough to put their own diapers on when they're 3. If the parents feel that the child might be capable of handling this task when they're this old the parents should let them. At this age they might need some supervision, but once the parents feel that the child has mastered this skill and can fasten the diapers correctly, the parents should let the child manage this task themselves. Like I said earlier children can be very sensitive about this issue and having a parent diapering them beyond the age that's appropriate will make the child feel like they're being babied by their parents. This in turn will make them feel embarrassed and self-conscious and will make them resistant to wear the diapers to bed.

Another idea I have as far as teaching youngster how to be self-sufficient in this area is the following. I don't know how feasible this idea is and I admit it's somewhat unusual but like the saying goes in many situations it's good to think outside the box. In many community colleges they use dummies to demonstrate certain medical techniques to nursing students. The parents could talk to the head of the nursing department at their local community college and see if they could borrow a dummy and then use the dummy to teach the child the correct way of fastening the diapers. If the head of the nursing department asks you why you want to borrow the dummy you can explain that you have a child who wears diapers for a bed-wetting problem and you want to use the dummy to teach them how to correctly fasten the diapers. If you are not able to borrow the dummy you can ask them if they have any suggestions about what to do in this situation. I suspect that purchasing something like this from a medical supply store would be expensive so the nurse at the community college might have ideas about alternative approaches to the situation. In addition you might want to call your local medical/hospital supply store and see if they have any ideas. about how to deal with this matter. As I mentioned earlier this is a very delicate situation that has the potential to do irreparable psychological harm to a child.

I wonder if some parents do this because on some level they might miss the closeness of the parent/infant relationship and this is a way to recreate this. Some parents either consciously or sub consciously want to keep their child at a certain level of development because the parents don't want to let go emotionally. It must be stressed that this is just speculation,and I'm not saying this is necessarily the case with all parents who put on their older child's diapers but the fact that this could be a factor with some people should be considered and if this the case it should be addressed with a mental health professional in order to prevent causing emotional harm to the child.

Unfortunately another reason some parents might diaper their older child that wets the bed is to humiliate them. Many parents try shaming their kids into stopping bed-wetting and this is one tactic that parents might use. I've read about one case where the parents diapered their child in front of the whole family in an attempt to get him to stop wetting the bed. There are many other things I've heard parents do to try to shame their children into stopping bed-wetting but out of sensitivity to my readers I won't mention them. Suffice it to say these practices are despicable and a form of child abuse. In terms of diapering older children that wet the bed it seems that the situations described above are atypical but even though this is the case,both my friend's experience and the situations I've read about on various incontinence forums concerned me and prompted me to write this article.

I hope people realize that this article is not meant as a criticism of anyone's parenting skills. It's meant to help people realize that children are very sensitive regarding these sorts of issues. Children need their privacy and independence in these areas and by not respecting this it makes them feel undignified. I hope this helps people look at this issue in a new light. As always I feel dialogue on these matters is very important and I welcome any constructive thoughts on this matter..

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