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Johan Vande Walle Pediatric nephro-urologic centre, University Hospital, Ghent

Bedwetting is a problem for children and parents a problem largely to be tackled by an EBDM approach. Johan Vande Walle Pediatric nephro-urologic centre, University Hospital, Ghent. 14/07/2012.

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Johan Vande Walle Pediatric nephro-urologic centre, University Hospital, Ghent

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  1. Bedwetting is a problem for children and parentsa problem largely to be tackled by an EBDM approach Johan Vande Walle Pediatric nephro-urologic centre, University Hospital, Ghent 14/07/2012

  2. Bedwetting is a problem for children and parentsa problem largely to be tackled by an EBM approach Johan Vande Walle Pediatric nephro-urologic centre, University Hospital, Ghent 14/07/2012

  3. Parents : Ideas on nocturnal enuresis • Organic • Mismatch • Nocturnal diuresis • bladdervolume • heriditary • Psychological problems • Lack of motivation • To deep sleep • To much drinking • Self healing condition Doctors / care givers : Ideas on nocturnal enuresis

  4. Parents : Ideas on nocturnal enuresis • Organic • Mismatch • Nocturnal diuresis • bladdervolume • Heriditary • Persistent ½ severe cases • Psychological problems • Lack of motivation • To deep sleep • To much drinking • Self healing condition Doctors / care givers : Ideas on nocturnal enuresis

  5. Parents : Ideas on nocturnal enuresis • Organic • Mismatch • Nocturnal diuresis • bladdervolume • Heriditary • Persistent ½ severe cases • Psychological problems • Lack of motivation • To deep sleep • To much drinking • Self healing condition Doctors / care givers : Ideas on nocturnal enuresis : 70%

  6. Parents : Ideas on nocturnal enuresis • Organic • Mismatch • Nocturnal diuresis • bladdervolume • heriditary • Psychologicalproblems • Lack of motivation • Todeepsleep • Tomuchdrinking alarm Desmopressin

  7. Parents : Ideas on nocturnal enuresis • Todeep sleep • Psychologicalproblems • Lack of motivation • Tomuchdrinking • If the child would wake up • Stress,.. • If he would be motivated • Less fluid intake • Wrong conclusion • Its the problem of the child • It is not a disease… not needing medical treatment • Internet and population “wisdom”

  8. If the child drinks to much .. Not drinking after 5 o clock

  9. If the child sleeps to deep .. Wake him up to void

  10. If the child sleeps to deep .. Wake him up to void

  11. Vande Walle enuresis fabels ?

  12. PSYCHOLOGICAL?

  13. PSYCHOLOGICAL?

  14. Psychology : rimary or secondary? Enuresis Psychological problems Risk factors

  15. Enuresis → psychological problems • *Impact child: self-esteem↓ stress ↑ • Emotional reactions • Sadness • Moodiness • Feeling upset • Embarrassment • Humiliation • Guilt • Dreaded anticipation before sleep *University Hospital Ghent studies: Theunis et al 2002, Van Hoecke et al 2006, Van Hoecke et al 2004

  16. Enuresis → psychological problems • Impact child: self-esteem↓ stress ↑ • Social impact • Being teased • Having a secret • Feeling different • No sleepovers • No camps

  17. Enuresis → psychological problems • *Impact family: Parentalintolerance? parental stress ↑ • Tolerant • Concern • External attribution • Effort • Empathy • Intolerant • Burden • Financial • Practical • Guilt • Helpless • Child is blamed • - Child is punished *University Hospital Ghent study: De Bruyne et al 2009

  18. Psychological problems → enuresis • (Secondary) enuresis • Stressfull life event • Parental divorce • Birth of sibling • Parental sickness/death • Removal • Natural disaster

  19. Evaluate the impact/psychological problems individually How? Good history + clinical observation! SSIPPE Short Screening Instrument for Psychological Problems in Enuresis

  20. Emotional problems If > 2 times YES: full psychological screening

  21. ADHD problems If > 2 times YES: full psychological screening

  22. 20-30%: psychiatric disorder(s) (ICD-10 / DSM-IV) General population: 10-15% Externalizing Internalizing Others At risk: older age, male, low SES, admission to specialized clinics, NMNE, SNE

  23. Baeyens et al 2004-2007 • 2y FU • 73% of ADHD diagnoses confirmed • 65% still had NE • 4y FU • 64% of ADHD diagnoses confirmed • 42% still had NE

  24. Is WAIT and SEE attitude defendable?

  25. Yes, if all the following conditions are fulfilled • It cures spontaneously, always, fast • It is an idiopathic condition or a maturation defect, and not a disease • It has no negative influence on cognitive functions • There is no effective therapy or there is one fantastic therapy with 100 % success • It has no psychological consequences • For the child • For the parents • It is cheaper not to treat

  26. Social isolement Anxiety Stress Parental stress Profound psychological and social impact 1.A. Von Gontard , J Urology 2011 april (185),1432-1437 2. De Bruyne E, J of urology,182,2012-2021

  27. ”Enuresis affects self-esteem more than chronic illness” Hinde M et al. Lakartidningen. 1995 Sep 6;92(36):3225-9

  28. Improves self concept of the child parents perception of childs behaviour Treatment of enuresis Longstaffe et al. Pediatrics 105,935-940

  29. Bedwetting is a problem for children and parentsan impact not identifiedby caregivers and society

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