BEDWETTING...CHILD AND YOUTH CARE IN SOUTH AFRICA

Three bedwetting memorable moments...which surely, only a child and youth care worker will have !  

A visit to a dormitory facility for about 50 girls in a township setting in the Eastern Province. It was early days for me in child and youth care work.  Against the perimeter walls were lined up about 15 mattresses drying in the sun from bedwetting the night before. The Director said that the bedwetters were mainly 15 to 16 year old. The number overwhelmed me.

My very first exploratory visit - the "do I want to work here?" visit. Sitting in the foyer I heard the whack whack whack of a cane and a girl crying out in pain. The child and youth care worker came down the stairs kweperlat  (quince stick) in hand.
Me "Why did you beat her?"
She "She wet her bed last night and didn't take her sheets, rinse them, didn't make her bed and it's 3.o clock in the afternoon already". 

Boy's dormitory. Child and youth care worker frog-marched a 12 year old to the toilet, pushed his head into the bowl. "Sies man, You pissed your bed last night. This is where you piss. See! ..not in your bed" Then she flushed the toilet on his head.

All three incidents raise questions about bedwetting and child and youth care work

The first, I guess is frequency by age. Accepted statistics appear to more or less agree: up to 3 years 4 months - 1 in every 2 children wet the bed (50%). At 5 years 1 in every 5 children  At 8 years 1 in every 20 children. At 15 years 1 in every 50 young people.

The girls in that dormitory facility were way above the normal pattern  A social worker in a dicussion on bedwetting. its prevention and reduction said, "Unless you can deal with and reduce the young person 's anxiety, you wont prevent bedwetting".  She got me going.!  Was there something in the girl's  facility's approach or tone which hightened anxiety?  Was there a style of interaction going on that increased anxiety rather than help young people to self-regulation.. a pervasive culture of adversary, perhaps? As a visitor I was not allowed to see, but I do know that in some programmes, child and youth care workers used to walk around with rulers in their hands, as then did teachers.

Apart from stress, anxiety, night fears and the like, there are other possibilities or reasons given to explain bedwetting. Obviously the possibility of a physical condition. It's always useful to first check out the possibility of an underlying physical cause. Listed is: diabetes, urinary tract infection, urinary tract stones, anatomical abnormalities and sleep apnea.   

The sleep apnea story is interesting. Had one 10 year old with disrupted sleep. Apnea woke her up then she would wake up others She was put onto a medication which literally knocked her out at night. She then, what is called "flooded". Not just a patch on the mattress...sheets, duvet, pillow, the works.

Then comes the usual list of prevention methods. Nothing liquid for an hour before bed-time. Reduce the coffee intake    (coffee is said to be a diuretic and increases urination), To be woken up at night ans accompanied to the toilet, pills which are anti-diuretics, the bedwetting alarm...a cover on the mattress which sounds at the first drops and star charts. A 'social reward' system was said to be effective. It meant "go without wetting for say 3 consecutive nights and you are given an age appropriate  'social reward' Its not a physical reward...not sweets nor money, but a an appropriate activity usually with others that fits the social developmental stage of the bedwetter. Child and young people are quite good at suggesting what it might be.

Child and youth care workers say that this is all very useful but offers no guarantee of working. They are right. I rather like the 'social reward 'idea coupled with some of the others

Then we tackle the "What do we do when in the morning or in the night bedwetters wake up and we find a wet bed?" Certainly not the head in toilet routine nor the quince stick. Most thinking is that the child or young person should take some responsibility for wet bedding. Which reminds me, It caused a problem when I insisted on a plastic sheet across the usual bedwet area of the mattress.  They would take it off saying that they were being singled out to be babies  I then only used fully plastic covered mattresses throughout as standard equipment.... no discrimination and no singling out.
Taking responsibility varied from rinsing out sheets themselves in the bath to simply stripping them off and putting them into a laundry container...the least fuss the better. Mattresses do have to be aired if they are not plastic covered but the child and youth care workers made this as discrete an exercise as the possibly could. Making any kind of fuss, clearly doesn't work.

Techniques and procedures aside. Good child and youth care practice in any programme, aims at reducing any psychological stress and anxiety. Reduction of anxiety, confidence building, learning to feel good about themselves, a culture of acceptance and predictability go a long way. I have seen bedwetting considerably reduced through good child and youth care practice