Boys under twelve years of age seem to be affected more frequently than girls. It is wrong to assume that it is caused by negligence or laziness, as some parents do. It has generally a special cause, and the cause usually can be found if it is carefully sought for. It may be the result of bad habits: exposure to cold in the night; lying on the back; drinking too much liquid in the afternoon or at bedtime. It may be due to too much acid in the urine, and if so it will be found necessary to reduce meats and eggs the child is eating. Worms, stone in the bladder, some anatomical abnormality or deficiency, may be responsible for it. The diet may be at fault; adenoids are supposed by some physicians to be the cause. No matter what the actual cause may be, it must be found and remedied before we can hope for a permanent cure. A very large majority of these cases are due to nervousness. These children are of a nervous temperament. They are not necessarily sickly children; they are simply of a nervous type. They are well-nourished, active, and lively. Incontinence of urine during the day and long-continued bed-wetting does not at all affect the health of the child. If they are in poor health, it is essential to treat their general condition before trying to cure the incontinence.
It is absolutely wrong to punish or to crush the spirit of these children. Constant nagging and taunting, even if done in the hope of shaming the child into a cure, will simply make a coward of him and will not aid in improving matters, but will be distinctly detrimental.
Scrupulous cleanliness must be constantly practiced or these children, if neglected, may develop ulcers and sores of a very obstinate character. The odor is also bad for the health of the child.
Treatment.--Find and remove the cause if possible. If due to general poor health, give tonics, obtain a change of air, and build the child up. Reduce the total quantity of liquids, if in excess, and be very careful not to give any liquids near bedtime. Don't cover these children too much; they should never be "too warm"; they should sleep in a well-aired room, and they should receive a quick, cool sponge bath every morning. They should be taught to sleep on their sides, never on their backs. Their diet should be light but nourishing. When bed-wetting is established it will continue, if untreated, until the child is eight or ten years of age, and it frequently lasts much longer. When treatment is undertaken it should be distinctly understood by the mother that it will take many months to cure; and during these months she must give her constant attention to the child. If she does not undertake to do this, or if she fails to do it, the treatment should not be begun at all, as it will not succeed. Various plans should be tried to keep the child from sleeping on its back. The reason of this is because it has been found that the child wets the bed only when sleeping on its back and never when sleeping on its side. The simplest method, of tying a towel or cloth around the child with a knot over the spinal column, so that it will hurt and waken it, if it turns on its back, is a very good one and should be carefully tried for some time. The nervous system of these children should never be overtaxed at home or at school. Early hours and plenty of sleep are desirable. Certain articles of diet of a stimulating character should be entirely avoided,--for example, coffee, tea, beer, candies, sugars, and pickles. The best diet for these children is one composed exclusively of milk, vegetables, fruits, meats, and cereals. Meats, however, should be given only once every two days. It is a good plan to teach the child to hold his water during the day, as long as he can, to accustom the bladder to being full. Adenoid growths, which contribute to the nervousness of a naturally nervous child, should be removed. It is a good plan to take the child up when the parents go in bed and let him urinate. This often cures the condition in itself.