Full-Spectrum Home Training for Simple Bed-Wetting

Description of the Strategy

Regular bed-wetting of several times a week is a problem for about 1 of every 10 children from elementary school through high school. In first grade, about 15 of every 100 children wet the bed most nights. In high school, only about 1 of every 100 children continue to have the problem. Most bed-wetting will simply go away as a child matures physically in terms of bladder capacity and nervous system development. Bed-wetting is not generally a sign of psychological or emotional problems but is instead a problem of maturation and learning the proper sequence of behaviors to control the bladder during sleep. Most children learn this control without any special assistance by the time they are 4 years old. Some children fail to acquire this night time control, and many of them have an unknown genetic basis for this failure to acquire nighttime control. Those children who continue to have routine bed-wetting past age 4 may need special assistance to overcome the problem. The reason for treating the problem as opposed to just waiting for it to go away is that continued bed-wetting can interfere with a child's normal development and association with peers. Children who continue bed-wetting and do not get help may develop feelings of inferiority and embarrassment due to the fact that they are restricted in social activities.

Full-spectrum home training (FSHT) is a behavior therapy procedure for teaching a child how to overcome bed-wetting. The basic idea behind FSHT is that bed-wetting can continue due to many factors. FSHT was designed to address several of these major factors, and each part of the procedure was also selected for convenience of use by parents and children. The entire set of procedures that make up FSHT have been written into a manual that parents and children can follow under the guidance of a health care professional who understands basic principles of conditioning and learning.

FSHT consists of four components: (1) basic urine alarm training, (2) cleanliness training, (3) retention control training, and (4) overlearning. The components are presented in an integrated manual for parents to follow, and a behavioral contract between parents and children forms the basis for implementing the procedures.

Family Support Agreement

The behavioral contract between the child and parents is called a family support agreement. Like most child problems, correcting bed-wetting requires cooperation from the entire family. The most demanding part of FSHT is training a child to wake to the alarm. Many children need their parents' help to wake up. Parents have to be committed to waking the child and requiring the child to get out of bed to be fully awake. A family environment of cooperation and firm resolve is necessary. Children have to be ready to do the hard work of getting up whenever the alarm sounds and be mature enough to do so without having tantrums and defeating the whole process. The family support agreement is a behavioral contract procedure between parents and children designed to promote cooperation and to clarify family rules for assisting the child. Siblings are included in the family contract so that they will know how to help and what to avoid. In extended families and blended families, all are included in the contracting process if the child spends the night with those people. Consistency and follow-through in each household are needed for success.

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