Bedwetting Linked to Cognitive Problems
> 12/14/2007 3:22:17 PM

Nocturnal enuresis, or bedwetting, can be embarrassing for the child and frustrating for the parent who must clean the sheets, but many experts counsel parents not to worry or make a big fuss. While it is true that punishing children or blowing incidents out of proportion will most likely only put undue stress on the child, enuresis should not be dismissed as a trivial bump on the path to growing up because a recent study from the University of Hong Kong found that bedwetting can signal the presence of significant mental health problems.
Dr. Chung Kwong Yeung, chairman of Pediatric Urology at University of Hong Kong, observed 95 frequent bedwetters over a two-year period. In addition to suffering from embarrassment, these children showed sizable deficits on a broad range of cognitive functions. Compared to controls, the bedwetters exhibited impaired memory, learning, and concentration. The link between nocturnal enuresis and cognitive impairment is cemented by the fact that when subjects were treated for six months with desmopressin, a medication that lowers urine output, all cognitive functions returned to normal.

A clue to why bedwetting correlates with impairment can be found in the observation that administration of desmopressin alleviated both enuresis and sleep disruption. Previous studies found that children with nocturnal enuresis have a variety of sleep abnormalities; they wake much more frequently during the night, and find it much harder to reach a fully awake state in the morning. As adequate sleep is crucial for memory, learning, and concentration, the sleep disruptions may be the primary cause of cognitive impairment. It is also possible that further studies will find that some other factor, such as diet or stress, leads to both cognitive impairment and behavioral problems.

Dr. Yeung's finding is important because there is widespread misunderstanding among parents of how to handle bedwetting. A poll showed that 44% of parents thought that waking their child in the middle of the night would be a good way to treat the problem, something that would exacerbate the problem if it is lack of sleep that causes cognitive impairment. The best advice is to try and facilitate adequate sleep, destigmatize the problem by avoiding punishment and emphasizing the accidental nature of events, and seek medical help if bedwettting persists. As much as people may want to avoid talking about this topic, it has serious potential consequences and must be addressed.

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