Friday 6 May 2016

Bladder Control - Children who are “Rule Followers.”

A six year-old boy was referred for bedwetting. The boy wets every night.  He pees 7 times a day including at the prescribed time during morning kindergarten. Mom described him as a “rule follower” and scored him 9 out of 10 on the “perfectionist” scale.

This boy is an Attentive Voider. He does not hold his pee past full. His mother does not see holding postures, he does not need reminders to pee, he is not in a rush to pee, and he is always dry without even minor daytime dampness.

This boy is also a "rule follower." Many elementary school teachers request that a child only pee at break times. This message from a respected adult authority figure can have a strong impact on the behaviour of a young child. Likely this boy will only pee at scheduled breaks at school and he might be reluctant to ask to leave class to pee.

The combination of an Attentive Voider and a Rule Follower means that he will not drink much at school. Attentive voiders do not like the feeling of an overfull bladder or they are not prepared to risk daytime wetting, not even a few drips. Rule Followers restrict their trips to the bathroom to the scheduled breaks.  These children learn to self limit their fluid intake to allow them to stay attentive to the signals and to follow the rules.

Some of these children learn to pre-emptively pee at every break to make sure they are never overfull. These children also learn to pee before they get on the school bus.

Since they do not drink much at school, these children end up with very solid stool. The stool presses on the bladder and compromises bladder capacity. Children with a smaller bladder need to pee more often after they drink and since this might oblige them to leave class to pee, they learn to drink even less.

The body has healthy rules that should be followed and that are much more important than arbitrary rules about bathroom breaks at school. Paying attention to a bladder signal is an important rule. Holding the pee to wait for a break is not a healthy practice. Parents should empower their children to routinely leave class to pee and never to hold their pee to wait for a scheduled break. 

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