~..... ' • 1·: ,. : < ";:~:r:'~':. .BEtjAVIQR .' 1 GUIDELINES " '::-.::..~ FOR PARENTS r ,I" ) be avoid~d:;'.·):'.' mptationpe~i '.,. however),i~{ tj :eething lay more illi~'i. fussy ba~y~,. ," caused by'?~'/ n otitis mi.':; ::," , ....;·tti~~-:tachycardi:J.:~;·· '.,.'.' . ,'·::,,"7.b~ ·THE PROBLEM J What to do a'bout i~~r::;-,. frequent daytime urination By Barton D. Schmitt, MD lux, or .eveti'j\ ',., ' .. disease,l~;Lth ~Some young ~hJ1clrel:su~ldenly devel.op the habIt of SI'ael 'f'ev~(iP' ," ·JfrequcntdaytIme urmatlOn, They 11l1nate every ten ; be attri~itt}~~~ ;,1630 mmutes and as often as 30 to 40 tunes a day . ., ,;~~~ ~rheypass small amounts of m'ine each time. The uriit wori't1b~~·k:ilationh, not painful. These children have been toilet 3tifyteeth@~i: i~ained and do not wet themselves duril1g the day. ~so, w~·h!~i~ ~~h.eydo ~ot drink excessive amounts of fluid. The of conditlohSI',';P.r9blem dIsappears when they are asleep. The peak a .os¢di~d~\' W~~fo1' daytime urinary frequency is 401' 5 years, but ~ar~i~~;W; '_~~,~can occur as l~te ~s 12 years of age .. , gmilestoH~~::f.i.Frequent unnatJon usually reflects the spIllmg < , I" in those few children \vho also have small bladders' anel wet the beel. •• ~ ..'::~.t~~~:~?-!~r of emotional tension, It simp~y not means ~our child ;;',r'~~~~'"!,~.¥nderpressure. The symptom]s delIberate, It i1)S~ally begins within one or two days of a stressful ::1~~~nt such as a death or illness in the family, a move :;Wa new hotise, or the start of kindergarten. ~'Physical canses are rare, but your child should be ':~ed by a physician. 'The only test that is usually ~eededis a check of the mine .. ;wIJ.f parents worry needlessly about disease, they ilUJiy actually increase stress on the child and make '~I!!~ probkm worse. Punishment, criticism, 01'teasing It.: •• W·SibJi~lgR als.o worsens the sy~np.tom. ,.~aytllne ul'lnary frequency IS,its ]tJ general, a harm:.~'."condition that goes away on own. If the cause :lhechild's st.reSR is identified and dealt with, the '1fIptolngenerally stops in one Lofour weeks, WiLhany intervention, it usually disappears spontane- !r in two or three months. It may recur, hO\vever, :0---,:/. !~_~fvlllT is director'of general consultative services, The " e~ s Hospital 01 Denver. and professor of pediatrics, ~~;Iy 01 Colorado School of Medicine, ~~~oard .. of Contemporary PediatJics . He is a member of the THE SOLUTION The following tips can help your child overcome daytime ulinary frequency: Reassure your child that hc is physically healthy. He may fear that something is wrong with his body because people have been concerned about his frequent urination. 'Tell him that his body is fine, and reassure him once or h•.. ice that he is in excellent health. We will do the same, Reassure your child that she can lem'n to wait longer to w·inate. Assnre her that she won't .•.. yet herself if she waits, which is a common fear. If she has wet herself previously, encourage her to talk about her embarrassment, and reassure her that it happens to many children occasionally. Tell her that she will graduaJly get back to urinating every two to three hours, or \vhatever her previous pattern was, ] f frequent urination has been quite stressful for you and YOllr child during shopping trips or other outings, avoid taking her with yon to public places temporarily. Try to idcntify specific st1'esses on YOUI' child. Try to pinpoint a stressful event 01' situation that may have occurred one or two days before the urinary frequency began. Ask other family members and school or day-care staff for ideas. Some common stresses include: • a death in the family OCTOBER 1992 83 •• ': .> •• FREQUENT URINATiON 1'· --::",., :: ~ ••..•. '!", "..• ~__ u II an accident or other life-threatening event tension in the parents' marriage &I illness in a parent, sibling, or other close relative &I starting schoo] for the first time, or 'changing to a new schooJ . III III excessive II wetting worry about staying dry at night himseJf in theJ}resence of other chiJdren. If you identify a !1tress, talk to your child about it, . and try to help him overcome it. If YOlt need help with this, can our office. wheJher his c?ndition the same .. is improving or staYiryg: ;/;1 .... " Make sure that none of your child's caretakers Of! teachers are punishing or criticizing him about fr~: quent urination. Stop all family conversation aboutid and remind ~iblings not to tease. The less that is said . I~ the Jess your'child ,\ill worry. If your child brings up.;; the topic, reassure him that he wil1 gradually getbet-i: tel' but that it may take a few weeks. : ,0:; ":'1" >; ~•. ;./\~, Help yonr child 'reia;'!; in general. Frequent urination can be a barometer of inner tension. Make sure your chi1c1 has free time and fun time every day. If she is overschedllled with activities, try to lighten the load. Maintainin'g 01' increasing harmony \\ithin YOllr home will usually help restore your child's sense of security. Enlist the cooperation of school or day-care staff t.o reduce any tensions there, sllch as restrictions on the use of the bathroom. Children over 8 years of age may benefit by learning reJaxation exercises. Atloid bubble bulh and other irritants. Bubble similar symptoms. As a further precaution, haveyou/~! child wash the geni tal area with \vater, not soap~~ ! prior to puberty since young children may besensi~~ 'j tive to soap .. : ; ;:;,::~~! .:·":;:~~~ Call our office during regular hours if: Ignore frequent nrination. toilet mind you. watch When your child uses the often, don't comment on it. Comments only rehim t.hat the symptom is bothcdng or worrying Don't ask him about his symptom, and don't him urinate. If you have been keeping track of the amount or frequency of urination, stop doing it. Don't collect urine samples 01' measure the amounts, and dou't time the intervals bet.ween trips to the bathroom. Your child does not need to ten you when he has urinat.ed; you wiJJ have a general impression about bath,. can irritate the opening of the urinary tract and cause; frequent urination in children, especially girls. Tak~:!. ing a bath in water that cont3ins shampoo can causf • .~.: :.o;;f'i .. ~ ,.~ ~1·· Adapted from Schmi!! BO: Your Child's Health ec!2. New York, Bania'!) Books. Inc .. 199 f. ' ... ' ::::i ·t~·, ~ 'ik This parent information aic! on frequent daytime urir.alion may be .. photocopiec! arKI distributed 10 parents without permission of the PU,.':.,," /-!!). ...•.•... d I 84 CONTEMPORARY PEDIATRICS M • Your chiJd's frequency of daytime urination is nO,t; J back to normal ~fter using this program for ..~.~~,;~ ,~ ·;;;;.',~t:.:~ month .. .. .,.,'1;. • Urination begins to cause pain or buming .. ':"i~i:'!' • Your child begins to wet himself during the d?~r~r. • Your child begins to drink excessive fluids :";, &I You have other questions or concems ;:iJ~