Urine trouble: a social history of bedwetting and its regulation.

Bedwetting has confounded the presumed boundaries of the human body, existing in a fluid space, between the normal and pathological, its treatment has demanded the application of a wide array of different technologies, each based on a distinct conception of the relationship between the body and personality, human organs and personal conduct. In tracing the social history of bedwetting and its regulation, this article examines the ontological assumptions underpinning the treatment of bedwetting and how they have changed over the past two centuries. Through the analysis of medical journals, newspaper articles and magazine advertisements, different topologies are identified which redefine the boundaries of the human body and its capacities. From 16th-century naturalism, in which the human body is subordinated to a cosmic totality, to the circumscribed space of 19th-century paediatrics and the expansive circuits of behavioural psychology and modern psychoanalysis, the body has become multiplied, differently enacted through the application of diverse technologies. It was be shown how coordinating the messy and divergent conceptions of the human body has posed an endemic problem for the human sciences, and how the enduring tension between object enactment and subject constitution is an expression of modern "baroque" subjectivity.

Cosleeping and its correlates in Saudi school-aged children.

BACKGROUND: There are cross-cultural variations in sleep habits among children. No previous study has assessed the prevalence of cosleeping in school-aged children in Middle Eastern countries. PURPOSE: To assess the prevalence of, and the factors associated with, cosleeping in Saudi school-aged children. METHODS: Questionnaires were distributed according to a specified sampling procedure, and parents were asked to rate each item that described their child's behavior within the previous 6 months. Cosleeping was defined as all-night sharing of a bed or room with a parent. RESULTS: Data were analyzed for 977 children (50.5% boys) with a mean age of 9.5 +/- 1.9 years and a range from 5 to 12 years. Cosleeping with parents was reported by 26% (95% CI: 23.2-28.7%) of the sample. According to a multivariate logistic regression model, a child's school level, enuresis, and nightmares were the only predictors of cosleeping. CONCLUSION: This study demonstrated that cosleeping is more common among Saudi school-aged children than has been reported for other countries. When assessing children's sleep, the practitioner should give special consideration to the child's needs, and his/her family's cultural background.

Primary monosymptomatic nocturnal enuresis in Singapore--parental perspectives in an Asian community.

Primary monosymptomatic nocturnal enuresis (PMNE) is often not openly discussed in Asian societies. We report the parental view of PMNE in Singapore, its impact on patients and their families and the traditional beliefs and its influence on subsequent management. A screening questionnaire was used in evaluating 30 children enrolled in a clinical trial on the use of oral Desmopressin for the treatment of PMNE. Primary monosymptomatic nocturnal enuresis was familial in 56.7% of patients. Fifty per cent of them were previously unevaluated. Earlier remedial attempts included bedtime fluid restriction and voiding (100%), incentive measures (43.3%), traditional practices (26.7%), punishment (20%), drugs (16.7%), psychotherapy (100%) and bladder training (3.3%). Perceived causes of PMNE were maturational delay (50%), deep sleep (50%), familial (43.3%), behavioural problems (43.3%) and excessive fluid intake (26.7%). Reasons for seeking treatment included restricted outdoor activities (90%), parental fatigue (86.7%), disrupted sleep for the household (46.7%) and fear of underlying pathology (26.7%). Perceived adverse effects on patients included social stigma (83.3%), disrupted sleep (33.3%) and impaired school performance (13.3%). Primary monosymptomatic nocturnal enuresis can thus be a chronic distressing problem in Asian communities.

Nocturnal enuresis in Hong Kong: different Chinese phenotypes.

Extensive studies of the epidemiology of nocturnal enuresis (NE) in Western countries indicate that the prevalence of this condition is relatively high (7-10% of children aged 7 years are enuretic). In the current study, questionnaires to assess the epidemiology of NE in Hong Kong were completed by 3521 school children, aged 4-12 years, the majority of whom (99.8%) were ethnic Chinese. Analysis of these questionnaires revealed a lower prevalence of monosymptomatic NE in this population of children (3.5%) compared with the results of studies conducted in Western countries. Furthermore, NE was found to be associated with arousal difficulties, nightmares, a positive family history of enuresis, poor school performance and poor relationships with classmates. A second study conducted to evaluate the response to desmopressin treatment of 25 children with severe monosymptomatic NE showed that 84% had a good response (> 50% reduction in the number of wet nights). Taken together, the results of these studies suggest that children with NE in Hong Kong may represent a more homogeneous population than in other countries, and that there is a strong genetic component in the aetiology of NE in this country. These children appear to be particularly responsive to treatment with desmopressin.

[Bedwetting by Dutch, Surinam, Moroccan and Turkish 3-4, 5-6, and 11-12-year-old children]. / Bedplassen bij Nederlandse, Surinaamse, Marokkaanse en Turkse kinderen van 3-4, 5-6 en 11-12 jaar.

OBJECTIVE: To investigate whether ethnic origin is related to the prevalence of bedwetting among children and how parents handle bedwetters. DESIGN: Descriptive study. SETTING: Department of Youth Health Care in Amsterdam, the Netherlands. METHOD: Parents of children who attended a child health centre in 1992/1993 were interviewed using a questionnaire. A total of 1506 children aged 3-4, 2422 aged 5-6 and 2081 aged 11-12 years participated in the study. RESULTS: The prevalences of bedwetting were 24.6%, 15.7% and 5.4% at 3-4, 5-6 and 11-12 years of age respectively. Moroccan and Turkish 3-4-year-olds wet their beds just as often as Dutch children, Surinamese 3-4-year-olds less often. However, Surinamese, Moroccan and Turkish school children wet their beds more often than their Dutch classmates. For Dutch children the prevalence of bedwetting at the age of 5-6 was clearly lower than at the age of 3-4, in contrast with Surinamese, Moroccan and Turkish children. Non-Dutch bedwetters were rewarded less often for a dry night and punished more often for a wet night than Dutch bedwetters, even at the age of 3-4. CONCLUSION: Bedwetting by school children still occurs often, and more often among non-Dutch than among Dutch children. Possibly, differences between Dutch and non-Dutch parents in the ways they deal with bedwetting plays a part. Appropriate information and support of (especially non-Dutch) parents of young children can perhaps reduce the prevalence of bedwetting at later ages.

[Treatment of persistent nocturnal enuresis in children of Turkish and Moroccan migrants requires extra attention for the family]. / Behandeling van hardnekkige enuresis nocturna bij kinderen van Turkse en Marokkaanse migranten vraagt extra aandacht voor het gezin.

OBJECTIVE: To assess the effect of the clinical dry bed training according to Azrin/Messer for Turkish and Moroccan children with nocturnal enuresis aged 11 years or more, living in the Netherlands, as compared with native Dutch children. SETTING: Overvecht Hospital, Utrecht. DESIGN: Comparative and follow-up study. METHOD: After an admission period of 8 days a home training of two months was given. 40 migrant children and 43 Dutch children were trained. Improvement rates were measured on the day of hospital discharge, after three and after nine months. Several adjustments, based on cultural differences, were needed in the course of the project. RESULTS: On the day of discharge about 90% of both children groups showed improvement. After three months 60% of migrant children and 81% of Dutch children showed improvement, after nine months 61% and 70% respectively. In the end 51% of the Dutch children and 36% of the migrant children remained dry. The parents of migrant children believed their children would alter their micturition behaviour when they met disapproval, punishment and shame. CONCLUSION: The clinical dry bed training is suitable for migrant children if intensive and time consuming support can be given during the follow-up period, especially to the parents (in Dutch children, training of just the child often suffices). Frequent home visits, use of interpreters and active involvement of the parents are needed. A positive approach with emphasis on praise instead of punishment and shame has to be taught to the parents.

Nocturnal enuresis in normal Jamaican children. Implications for therapy.

The prevalence of nocturnal enuresis has been investigated in 477 children (243 boys, 234 girls) attending government Basic Schools in Kingston, Jamaica. Enuresis, defined as wet at least 2 nights a week, occurred in 62%, 48%, 42% and 40% at 2, 3, 4 and 5 years of age, respectively. Enuresis, defined as wet at least one night a month, occurred in 68%, 58%, 53% and 52%, respectively. There was no significant difference between the sexes. Children with a family history of enuresis (first degree relatives wet beyond 8 years of age) were more likely to be enuretic than those with no family history, the difference reaching statistical significance for girls (less than 0.001) and for the sexes combined (p less than 0.001) but not for boys alone (p = 0.06). The prevalence of nocturnal enuresis in Jamaican children is higher than reported for Black children elsewhere, which in turn is higher than in their White counterparts. Cultural attitudes to bedwetting contribute to this variation and have implications for choice of therapy, both in Jamaica and elsewhere.

Enuresis in cross-cultural perspective: a comparison of training for elimination control in three Israeli ethnic groups.

Enuresis was investigated in the context of different styles of training for bladder control among three Israeli ethnic groups (Jews of Moroccan, Kurdish or Eastern European descent). Semistructured interviews were conducted in ethnically homogeneous agricultural villages with 46 mothers of 248 children between the ages of 3 and 18 years. In contrast to previous British and American studies, no sex differences were found, but there were higher rates of primary enuresis and lower rates of secondary (regressive) enuresis. Enuresis was correlated among siblings in the Kurdish group only and with disorderly sleeping arrangements in the Moroccan group. The Moroccan and Kurdish groups had higher rates of enuresis than the Ashkenazi group. The higher rates appear to be related to differences in the age of onset of training and a lack of age-appropriate changes in the parent-child interaction, which led to chronic enuresis and the inability to seek effective assistance. These results are discussed in terms of a proposed typology for training: an early symbiotic style, a strict toddler style, and a communicative partnership.