Continence Connection

Dealing with Incontinence featuring Robin Howe, MS, RN - Continence Nurse Specialist

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"Dealing with Incontinence" with Continence Nurse Specialist, Robin Howe, MS, RN

 

Older Children, Bed-Wetting, and Self Diapering

I had covered this issue briefly in an earlier shareposts. This issue concerns me and that is why I felt it needed to be covered in more depth. On this website, and others, I have read about parents and babysitters diapering older children with bed-wetting problems. Some of these children are 9 or older. As we all know bed-wetting can be very stressful and in my opinion this stress can be exacerbated by parents not letting their child put on their own protection. By no means am I a childcare expert but my intuition tells me that above the age of 3 or 4 a child should be taught how to put on their own diapers.

As mentioned in a previous post I had a friend who had to babysit a 6 year old. She was telling me that she had to diaper the child before he went to bed. Due to his age I assumed he was potty trained and that the reason he wore diapers was because of a bed-wetting problem. She told me that he went running through the house naked and screaming and refused to let her put the diapers on him,which I can't say as I blame him.

I do believe that an older child,adolescent,or teenager should wear diapers to bed if all attempts to cure it have failed and if other garments such as pull-ups and “Goodnites” don't offer adequate protection but I also feel that the youngster should be responsible for putting on their own protection unless they have some cognitive and/or physical disability that makes it either difficult for them to do so or prevents them from doing so. Diapering an older child has the potential to drastically effect a child's psychological health for years to come.

There are certain tasks that can be accomplished by youngsters who aren't cognitively or physically impaired including tying one's shoes,putting on one's clothes,etc. Diapering oneself, in my opinion, would fit into this category also.

If the parents are concerned that the child might not fasten the diapers correctly, thereby causing the diapers to leak, the parents can show the child how to fasten the diapers correctly. One way of doing this is to lay the diaper on the bed,have the child sit in the diaper,and tell them how to fold and fasten the diapers properly. I would do this when the child is young because the older the child gets the more embarrassed the child will feel. This is a very sensitive area for children. Many bed-wetting children feel self-conscious and embarrassed about wearing diapers to bed (although as I have pointed out many times they shouldn't be) and having their parents diapering them will make them feel even more self-conscious and embarrassed. Also bed-wetting makes many children feel helpless and by parents diapering the child it reinforces the feeling of helplessness. That is why children should be taught to be independent in this are as soon as possible.

As far as pin-on diapers are concerned some parents are afraid that the youngster might stick themselves with the pins. This is certainly a valid concern but if appropriate precautions are taken this shouldn't be an issue. I was talking to someone in customer service for a company that sells pin-on cloth diapers and plastic pants for older children and adults with bed-wetting problems to get her take on the situation and she told me that at the age of 7 or younger, the parents might need to fasten the diapers. Above the age of 7 it would depend on the child's development. I believe the same steps taken with disposable diapers can also be taken with pin-on diapers. Again, the parents should lay the diapers on the bed, have the child sit in them,and teach them the correct way to fasten the diapers. I can't emphasize this enough...children need to be taught at a young age how to be independent in this area.

Another idea I have for teaching youngsters how to be self-sufficient in this area is the following. I don't know how feasible this idea is and I admit it's somewhat unusual but like the saying goes in many situations it's good to think outside the box. In many community colleges they use dummies to demonstrate certain medical techniques to nursing students. The parents could talk to the head of the nursing department at their local community college and see if they could borrow a dummy and then use the dummy to teach the child the correct way of fastening the diapers. If the head of the nursing department asks you why you want to borrow the dummy you can explain that you have a child who wears diapers for a bed-wetting problem and you want to use the dummy to teach them how to correctly fasten the diapers. If you are not able to borrow the dummy you can ask them if they have any suggestions about what to do in this situation. I suspect that purchasing something like this from a medical supply store would be expensive so the nurse at the community college might have ideas about alternative approaches to the situation. In addition you might want to call your local medical/hospital supply store and see if they have any ideas. about how to deal with this matter. As I mentioned earlier, this is a very delicate situation that has the potential to do irreparable psychological harm to a child.

I wonder if some parents diaper their older child because on some level they might miss the closeness of the parent/infant relationship and this is a way to recreate this. Some parents either consciously or sub- consciously want to keep their child at a certain level of development because the parents don't want to let go emotionally. It must be stressed that this is just speculation, and I'm not saying this is necessarily the case with all parents who put on their older child's diapers. But the fact that this could be a factor with some people should be considered and if this the case it should be addressed with a mental health professional in order to prevent causing emotional harm to the child.

I hope people understand that this article is not meant as a criticism of anyone's parenting skills. It's meant to help people realize that children are very sensitive regarding these sorts of issues. Children need their privacy and independence in these areas and by not respecting this it makes them feel undignified. I hope this helps people look at this issue in a new light. As always I feel dialogue on these matters is very important and I welcome any constructive thoughts on this matter.

 

Colin~

How to Manage Bed-Wetting in College

Starting college is a very exciting time for many people-meeting new friends and taking interesting courses are just some of the things that make this time special for many people. However for those individuals with a bed-wetting problem this time can be anxiety provoking,although with the right amount of preparation it doesn't have to be.

There are plenty of cases of college students with bed-wetting problems and like any other problem in life it can be managed. Before attending college the student should ask to speak with the department that handles accommodations for students with medical conditions. If you don't feel comfortable divulging to them that you wet the bed you can ask to speak to the school nurse and he or she might be able to give you advice about how to approach the school about the bed-wetting. Nurses are used to dealing with all sorts of medical conditions,particularly incontinence so you shouldn't feel embarrassed about discussing this problem with her. From what I understand it's possible to share a dorm with individuals suffering from the same medical problem. If this isn't an option you might consider getting a private dorm or if financially feasible you could rent a one bedroom apartment.

As far as discretion is concerned. this can be somewhat tricky but there are ways to work around this issue. In a situation such as college. the ease with which one can exercise discretion with a problem such as bed-wetting depends to a large extent on what type of protection a person uses. If a person uses cloth diapers and plastic pants and if the person uses public laundry facilities it can be very difficult being discreet. If however,the person goes to school in the same state and goes home every weekend the individual can bring a diaper pail to school and just bring home the wet diapers and plastic pants home and wash them there. If it's not feasible to use cloth diapers and plastic pants the student will have to use disposables. Again, I would talk to the nurse about this and ask her if she has any suggestions about how to manage this problem.

If this isn't an option and the person has to use public laundry facilities he or she can schedule to wash them when the laundry room is less crowded. You might be able to bring a basin to school and wash the plastic pants in the dorm. You can also post questions on various incontinence forums and ask people what they've done in a similar situation. As mentioned there are plenty of cases of people wetting the bed in college and they might have some useful tips on how to be discreet about this problem.

I hope this article helps those bed-wetters anxious about attending college. Just remember that this is a common problem among college students and many adults too. Just because you wet the bed doesn't mean that college can't be a wonderful time. With the right preparation you can have peace of mind and get through college with flying colors.

Colin~

Dating with Incontinence

We have had numerous calls and inquiries about the issue of dating while dealing with incontinence. Some of the questions are around how to tell a new significant other, how to deal with rejection, how to educate a significant other about incontinence and more.

So, we have started this new post with the hope that some readers of the Continence Connection Blog will contribute to this area. It would be nice for folks to have a place to go where people can share, learn and help one another understand and cope with this sensitive issue.

 

Teens and Bed-Wetting:Dealing With Diapers and Plastic Pants

 Being a teenager can be a stressful time in life. There's the pressure of fitting in,preparing to get into college,going to prom,learning to drive. Now imagine if you also had to tell someone of the opposite sex that you have to wear diapers and plastic pants because you still wet the bed?

 Teenagers can be very cruel when it comes to people being different. I think it's important for teenagers to be able to talk to other people with similar problems. There are many online support groups for various health problems and teenagers suffering from bed-wetting should take advantage of the many online health resources.

  You can also start an online support group if you want. Many older children,adolescents,teenagers,and adults deal with bed-wetting every night so there are a lot of people who would be interested if you do decide to start a bed-wetting support group.

  I think it would help if teenage celebrities(as well as adult celebrities) started talking about subjects such as bed-wetting-it would make it less taboo.

  I  also think it's important to be able to confide in people about this problem-whether a family member or relative,a teacher,or friend. Sometimes talking to people helps a great deal.. It's important to be able to gauge the depth and quality of a person's friendship. There are some people who are real compassionate and understanding. These people are very accepting of other people's problems and they're easy to confide in. If you feel you have friends of this nature and  if you're having difficulty coming to terms with wearing diapers to bed then you might want to consider discussing this with them. It's important to remember one thing-there are plenty of people of all ages who wet the bed so the next time you're getting ready for bed and putting on your diapers and plastic pants keep this in mind!

Parental Decisions Regarding Bed-Wetting and Diapers

  This sharepost is a response to Guest's comments on my sharepost "Bed-Wetting: Should Older Children, Adolescents, and Teenagers Be Required to Wear Diapers?" I realize what I've said is very controversial and goes against the grain of most people's thinking (both professional and non-professional) on this subject. The point of my original sharepost was to get people to see this issue in a whole new light.

  I can certainly see Guest's point of view however he said several things in his reply that just proved my point .One of them was "Kids do have difficulty "seeing two feet beyond their noses" to understand the consequences of their decisions. They also tend to have a somewhat distorted view of the priorities" and "Where the parents come in is in the fact that because they are older,can often have a more realistic view of the "big picture."

  The big picture as I (and I believe most people) see it is to be able to manage the bed-wetting in a manner that both makes the youngster comfortable and helps them maintain hygiene. If a youngster doesn't wear protective garments and lays all night in urine soaked sheets or wears a product that leaks how is this helping them with hygiene or making them feel comfortable?

  I think requiring a youngster to wear some type of diaper to bed strikes most people as being punitive due primarily to the fact that diapers conjure up an image of being a baby. Due to the negative image of diapers, people associate requiring an older child,adolescent,or teen to wear diapers to bed as something degrading and therefore punitive. People are very symbol oriented-flags,national anthems,art,medals,and clothing are just some of the symbols we impart certain meanings and value to. To many individuals a diaper is a symbol too-a symbol of being a baby. But we must remember that the meaning and value we impart to a symbol is not intrinsic-we are the ones to give it meaning and value. There is nothing intrinsically babyish about diapers-they're just an absorbent material folded and placed between the legs then fastened around the waist of an individual to help manage incontinence. It would help a great deal if dictionaries define a diaper in this way instead of being a garment worn by babies. By not acknowledging that incontinent individuals and bed-wetters also need diapers it demonstrates the implicit assumptions people have regarding diapers which in turn perpetuates the image of diapers being babyish. If I was responsible for writing the entry for diaper in the dictionary I would define it this way: “An absorbent garment folded and placed between the legs of an individual then fastened around the waist designed to protect individuals with bed-wetting problems,incontinence,and as a basic garment for infants before they are potty trained.”

  In my opinion it's all about the parent's attitude. If the parents are putting the child,adolescent,or teenager in diapers to humiliate or degrade them then it is wrong. If however the parents are using the diapers as a tool to deal with the bed-wetting then this is acceptable in my opinion.

  Another thing Guest mentions is that my comparison between wearing a cast and wearing a diaper is "comparing apples and oranges." He said-"A child won't necessarily get sick or have a detrimental consequence of not wearing protection for bed-wetting as long as hygiene is maintained" But "not wearing protection for bed-wetting" can have a negative effect on hygiene. Frequent exposure to urine can cause skin breakdown, ulceration, and infection.

  I was reading that normal urine pH is between 6.0 and 6.5 whereas the urine pH of incontinent people is between 8.0 and 9.0 which means it's more alkaline. This in turn can irritate the skin. To quote one article-"Prolonged exposure to urine is known to chemically irritate the skin and impair its function. Although wearing certain types of diapers can also cause skin problems,these problems can be minimized or eliminated by using the appropriate skin care products such as lotions and creams. Without wearing diapers you're just exposing more areas of the skin to negative effects.

   I'll reiterate the following point-I do believe that parents should be understanding in terms of having the youngster wear diapers. That's the reason I suggested implementing the reward system to encourage them to try the diapers and plastic pants out. It's important to use this system for at least 6 months-some youngsters might need a year. It's my contention that the older child, adolescent, or teenager will be motivated to wear them because of the rewards. By using a reward system to encourage them to wear diapers to bed they'll associate wearing diapers with something pleasant-getting a reward. After a suitable time period they'll probably be so comfortable waking up in a dry bed they won't need the rewards anymore and will wear the diapers and plastic pants to bed of their own accord.

  One of the most important aspects of dealing with an illness whether mental or physical is the sense of having some level of control over it. Having this feeling of control improves a person's self-esteem. This is a recurring theme in discussions and debates about using diapers to manage bed-wetting with older children,adolescents,and teenagers. I touch on this issue frequently in my posts and I thought I would touch on it more in the present one.

  The prevailing view among most people whether medical professionals or not is that older children,adolescents,and teenagers should be granted autonomy in their decisions about what type of protection to wear to bed. The reasoning behind this is that by forcing them to wear diapers to bed you're making them feel babyish. Independence is very important as children get older but in this context the main issue is the following: if the child,adolescent,or teen chooses a product that doesn't offer adequate protection or chooses to wear no protection at all should the parents judgement about what the most appropriate form of protection to wear to bed trump the youngster's need for independence? I personally feel it should but everybody's different.

  In terms of self-esteem one of the issues I haven't seen addressed is this: a big part of self-esteem is having a sense of control over one's circumstances. In order to have this control  we must make decisions about the best course of action to follow given our particular circumstances,and since everybody's circumstances are different people will make different choices. The way we make these decisions is by evaluating all available options and then choose the best one from all the alternatives. In some cases this might not be the most pleasant one but over time we learn to adjust. Adults do this all the time and the ability to do this must be instilled in youngsters at an early age.

  How this ties in with bed-wetting and wearing diapers to manage it is in the following manner: by not wearing the most effective protection (or not wearing any protection at all) they're in effect demonstrating that they're not acting in a responsible manner which to me is being childish. I would tell them that to a certain extent it's more babyish not wearing diapers to bed. I would also tell them that part of being an adult is choosing the best way to manage a problem not necessarily the most pleasant one. Most adults are also reluctant to wear diapers but they realize it's in their own best interest to do so and although it might take them considerable time and effort to make this adjustment,in the end the majority are able to get used to wearing the diapers.

  The qualities of being responsible and choosing the best course of action given the circumstances are some of the hallmarks of being an adult. In addition it makes an individual feel in control of the situation thereby improving the individual's self-esteem.

 How is lying all night in wet clothes and bedding or wearing a diaper that leaks being in control of the situation? On the contrary, by lying all night in wet clothes it reminds the person that they're not in control. As mentioned previously people have different levels of incontinence. In addition the incontinence might effect them in different ways-some people sleep on their sides and have problems with side leakage,some people wet more than others at night,etc. Due to these differences people require certain types and brands of diapers otherwise they wouldn't manufacture such a wide variety of products. Wearing the most effective type of diapers to bed whether pin-on diapers and plastic pants,tape-on disposables,or other products makes the user feel more in control of the situation and helps the person feel more self-confident. This in turn will improve the bed-wetter's self-esteem.

  I wanted to clarify where I stood on this issue. I was under the impression that some people might think I'm some kind of ogre because of my stance on this issue. Nothing could be further from the truth. I look forward to any comments regarding this or any of my other posts. It's good to have constructive dialogues regarding this issue. Many people have preconceived ideas about this issue and I hope my posts might make some reconsider some of their basic preconceptions on this topic. We as a society have overcome many of our prejudices and have matured where many issues are concerned. For example there is less stigma surrounding mental illness and other diseases. Hopefully in time there will be less of a stigma surrounding using diapers to manage bed-wetting with older children,adolescents,teenagers,and adults.

Diapers and Bed-Wetting part 2-Types and Brands of Diapers to Use

Types and Brands of Diapers to Use for Bed-wetting and Companies that Sell Them

  This brings me to the main point of this article. In cases where there have been numerous attempts to cure the bed-wetting without success or if the options available to the individual are not feasible(or desirable for whatever reason) then I think it would be prudent at this point to consider various forms of protection.

     The current choice of most parents to manage their child,adolescent,or teenager's bed-wetting are pull-ups and “Goodnites” Both the idea for introducing pull-ups and “Goodnites” into the marketplace and the use of these products is that they are a more underwear like product and therefore it is believed they are less stigmatizing to the youngster,but for all intents and purposes they're still diapers-the only difference being they don't have tapes. No amount of cosmetic changes is going to change the fact that they're still diapers. However most people seem to feel that wearing the product will make the user feel more “dignified” which by default implies that the people who decide to use diapers instead for their bed-wetting should feel undignified,and unfortunately many people using diapers to manage their bed-wetting do feel this way.

  While it is good to have different choices to manage one's incontinence we must not forget that these products are designed for the same purpose-keeping the person dry at night-and therefore no matter what you call them or how they look they're all basically diapers. Like the saying goes- “a rose by any other name is still a rose.” While the pull-ups and “Goodnites” work for a large number of people I've read and heard about cases where these garments proved ineffective at keeping the youngster dry at night. Many youngsters are very heavy wetters particularly at night and wet right through the pull-ups or “Goodnites.” If the pull-ups or “Goodnites” don't work then the parents should have the child or teenager wear diapers instead.

  There are many different diapering options available for older children,adolescents,teenagers,and adults that wet the bed including pin-on cloth diapers covered with plastic pants and disposable tape-tab diapers(known as disposable briefs).We must remember that with most problems in life there is no one size fits all solution. Bed-wetting and choosing an appropriate garment to manage it is no exception.

  Disposable briefs are the term for adult diapers. They come in youth and adult sizes and look and fit just like Pampers-they have tape tabs,elastic leg gathers(in addition some have elastic waist bands for added protection) and either a non woven cloth like outer cover or a plastic outer covering. It seems like within the past several years the adult diaper manufacturers are following the lead of the baby diaper manufacturers and are using a non woven cloth like outer covering with their diapers. I think the reason for this is twofold. The first reason is that perhaps it makes the diapers more breathable which means they might be more comfortable with some users,and second it makes the diapers more discreet-i.e. there is none of the telltale crinkling or rustling sound that diapers with a plastic outer covering make when the user moves around. However some people claim that the non woven cloth outer covering makes the diapers feel clammy when wet,they cause abrasion between the legs,and they're not as effective at protecting the individual. As for purchasing diapers that have a plastic outer covering and make a rustling noise,if the person is only wearing them at night this shouldn't be a concern.

  If parents decide to purchase plastic pants and cloth diapers to manage their youngster's bed-wetting there is one thing to keep in mind and that is the terminology used in referring to waterproof pants. Before plastic pants came out parents used rubber pants for their babies. Then plastic pants came out and even though people used both styles of pants for awhile,eventually the rubber pants were phased out. I don't know of any companies that make rubber pants for babies but there are a couple companies that make rubber pants for older children and adults.

  Many people use the term “rubber pants” as a generic term for waterproof pants particularly plastic pants. Nowadays when people use the term “rubber pants” they actually mean plastic pants. I guess after rubber pants were phased out and plastic pants became the dominant pant used for both babies and incontinent adults the term “rubber pants” just kind of stuck and many people continued to use the term “rubber pants” as a catch all term for waterproof pants. Also “plastic pants” are the same as “vinyl pants”-vinyl is a type of plastic so people use the term interchangeably. Finally if you decide to buy waterproof pants from another country such as Canada or England it's important to beware of the following. Some companies manufacture and sell “PVC (which stands for polyvinyl chloride) pants. This is also a plastic material and these pants are the same as the “vinyl” and “plastic pants.” I just wanted to bring this up so people aren't confused when buying waterproof pants. I've also heard some people use the term “rubber sheet” as a generic term for waterproof sheets-particularly plastic or vinyl sheets.

  Regarding choosing a product to manage the youngster's bed-wetting this can be a tough choice for many parents. There are a couple of reasons for this. First,there are a number of different styles of garments out there. Second there are many brands of diapers to choose from. This can be very overwhelming. To make things more complicated there are styles within styles. For example if parents use cloth diapers there are many different ways to fasten the diapers and as a result different styles. These include pin-ons,diapers with Velcro, snap-on diapers,and pull-ons. The pin-on diapers come in different styles-prefold, flat,and contour. Contour diapers are hourglass shaped diapers without elastic in the legs or back. Flat diapers are rectangular diapers made with one layer. Prefold diapers are also rectangular shaped but have layers built in with more absorbency sewn into the middle part.

  Cloth diapers are also made of different fabrics such as gauze, birdseye ,flannel,and diapers lined with terry cloth. Some of these fabrics are more breathable(and as a result more comfortable) than others and some are more suitable for bed-wetting. For instance some companies have cloth diapers specifically designed for night use-i.e. they have extra absorbent layers sewn into the diapers for added protection at night. Cloth diapers like disposable diapers come in both youth and adult sizes. Also if the parents choose to use cloth diapers they must use waterproof pants to cover the diapers.

  The most popular form of waterproof pants are plastic pants. The current crop of adult and youth size plastic pants seem to be better made then the plastic pants made years ago. Comco, Suprima, and the Leakmaster Deluxe pants (made by Gary Manufacturing) are just three brands of plastic pants that have a reputation for being made of a real thick durable plastic and thus well made. I've also heard that with some waterproof pants if the person uses various protective creams before putting on their diapers these have a tendency to break down the material of the waterproof pants. This seems to happen primarily with rubber pants(although this might just be the case with certain brands).

  Waterproof pants come in two styles-pull-on and snap-on. From what I understand the snap-on styles are used primarily with bedridden and non-ambulatory patients because with these types of patients the pants are easier to get on and off. In addition it's to my understanding that snap-on plastic pants are used by parents for their babies because presumably these are easier to put on and take off(although personally I would think it would be just as easy using pull-on plastic pants since we're dealing with a small child. I would also think in a situation like that it would be relatively easy to put the pants on as opposed to putting them on an incontinent adult which would probably be harder for various reasons).I've also heard that snap-on plastic pants might be more breathable due to the fact that there's a slight opening because of the snaps. This in turn allows air to circulate more freely. That being said from what I understand the snap-on plastic pants are prone to leaks with some users at night especially if the user moves around a lot or sleeps on his or her side. Also I've heard that there's a tendency for the snaps to break in some cases. Finally snap-on plastic pants are more expensive than pull-ons.

  Disposable diapers for heavy urinary incontinence such as bed-wetting come in two styles-pull-on and tape-on briefs. Disposable briefs as mentioned previously have the same design and fit as baby diapers. You can also get diaper doublers known as booster pads, liners,and diaper inserts to put in disposable diapers to increase the level of absorbency in the diaper. Some companies also have inserts for cloth diapers. I've heard of some people lining their cloth diapers with baby cloth diapers which can be purchased in places such as Walmart and Target.

  People have different opinions as far as what type and brand of diapers to use for bed-wetting-some people swear by a certain brand or style of diapers whereas others try the same brand or style and don't like it. Many companies have samples of disposable briefs for various incontinence needs which they will send you either for free or for a nominal fee. In addition to using diapers the parents should cover the bed with a waterproof sheet in case the diapers leak. Waterproof sheets generally come in two styles, flannel with a rubber backing and plastic (also known as vinyl). The vinyl sheets in turn come in two styles-zippered or fitted. Although there are other styles of waterproof sheets the vinyl and rubber sheets seem to be the most popular ones.

  I've heard about people using all types of covers to protect their youngster's bed. One woman on a parenting forum said she used a plastic tarp to cover her child's bed. In addition I've read that vinyl shower curtains are a good way to protect the bed. One woman I knew covered her daughter's bed with a regular plastic sheet. For example if you have a roll of plastic sheeting (like the kind you get in a hardware or contractor supplies store) you could cut off a piece and place it under the fitted sheet or mattress pad. Many people have a roll of plastic sheeting to use for stuff such as yard, work, painting, remodeling,concrete work, covering materials stored outside,covering mulch,etc. In addition some people probably have a roll of plastic sheeting from back when Homeland Security was encouraging everyone to buy plastic sheeting to protect against terrorist attacks.

  If you do have a roll of plastic sheeting you might consider using some of it to cover your child or teenager's bed. There are several reasons for this. One,since you already have the plastic on hand it saves you money because you don't have to purchase waterproof sheets(not that waterproof sheets are all that expensive but in today's day and age every penny counts).Two,the hardware store plastic is pretty durable and will last for a long time. Three,you can customize how much plastic you cut to lay over the child's bed. Fourth,you can cut multiple sheets which means you don't have to use the same sheet over and over which cuts down on wear and tear. Plastic sheeting comes in several thicknesses including 3,4,and 6 mil. My feeling is the thicker the better because if the youngster rolls around a lot at night there's less wear and tear on the plastic which means it will last longer. Besides the woman I just mentioned I'm not sure if anyone else uses this type of plastic to protect the bed from bed-wetting but sometimes it's good to be a trend setter. Like with any other situation in life it's good to think outside the box and experiment with new ideas. This might be a cost effective and practical way to deal with bed-wetting.

  If parents decide to use either the plastic sheeting from a hardware store or a plastic tarp to cover their child or teenager's bed it's important to keep in mind that this type of plastic makes a rustling sound which some people might find unpleasant. The crinkling noise of the plastic might make some children,adolescents,or teenagers feel self-conscious. On the other hand some individuals aren't bothered by this. Some children might be bothered by it at first but eventually get used to it. Since most bed-wetters are deep sleepers they might not have any problem adjusting to the crinkling of the plastic. One way to deal with this is to put the plastic under the fitted sheet or mattress pad and to place several layers of sheets or towels over the plastic. This will muffle the crinkling sound of the plastic. If however the youngster does have difficulty sleeping in a bed covered with this kind of plastic the parents should consider covering the bed with another type of waterproof sheet.

  If you decide to go the cloth diaper route and if your budget permits you might want to consider purchasing the various styles of diapers such as pin-ons and pull-ons in addition to choosing diapers made of the different fabrics previously mentioned in order to determine what works best in your particular case. Pin-ons might be the best choice in many circumstances particularly for bed-wetting. There are several advantages to using pin-on diapers for bed-wetting: a.) these tend to be the most absorbent of all the styles of cloth diapers; b.) with Velcro diapers the Velcro can wear out after a number of washings and; c.) with snap-on diapers sometimes the snaps come off; d.) you can layer more material in a pin-on diaper (i.e. you can put more inserts in a pin-on diaper) than a pull-on diaper in order to make it more absorbent which is especially good for night use as people tend to wet more at night. Adding more material to a pull-on cloth diaper isn't as feasible because it tends to bunch up and one woman I spoke to at a company that sells both kinds of diapers says the pin-ons are more secure and the pull-ons tend to sag if the user is a heavy wetter. In addition it's hard to keep the inserts in place in a pull on cloth diaper. A couple other people I spoke with also said that in general you have more flexibility with the pin-on diapers as opposed to the pull-ons. For instance you have a lot of latitude with how and wear you fold them in order to prevent leaks-you can make them thicker on the sides,in the front,or in the back. I read about an individual who is a side sleeper and he overlapped more material in that area in order for the diapers to offer better protection with this particular situation.

  I suspect that the pull-on cloth diapers are better suited for daytime use and people who have light incontinence-the pin-ons on the other hand are generally better for people suffering from heavy incontinence such as bed-wetting. In fact many people consider pin-on diapers to be the best diapers to manage bed-wetting.

  There is one more thing I'd like to bring up regarding cloth diapers and plastic pants. Some people find that the cloth diapers and plastic pants are too hot and as a result too uncomfortable to wear in the summer months and during this time they switch to disposable diapers. Also some people alternate between disposable tape-on diapers and cloth diapers-on some nights they wear the cloth diapers and plastic pants and others they wear the disposable diapers so they don't have to wash the cloth diapers as much. The thinking behind this is that it saves some wear on the cloth diapers. Parents might want to consider experimenting with both kinds of diapers to determine what works best in their particular situation.

  Choosing an incontinence product is like everything else in life-there's no one size fits all solution. It requires a lot of experimentation and trial and error. This entails getting other people's opinions (there are incontinence forums where you can pose questions about various brands and styles of garments) and then trying the brand or particular style of diaper. Keep in mind that a person's recommendation of a particular brand or style of diaper is just an opinion and while it's good to get other peoples opinions you have to try the brand or style of diapers out yourself and come to your own conclusion.

  Also before buying a whole case or pack of a particular brand of diaper it's advisable to contact the company to see if they have samples available-after all you wouldn't want to spend a lot of money for a product that might not work for you. A person shouldn't get discouraged if they have difficulty finding the right product to manage their bed-wetting. With a little persistence and patience they'll eventually find a garment to suit their needs. Continence Connection has Continence Care Consultants that are nurses who coach people into the approriate product for any given situation. They also offer sample packs of many brands that they sell.

  Right now I'd like to give a list of several companies and their contact info that manufacture and sell both cloth diapers and plastic pants and disposable briefs for older children,adolescents,teenagers,and adults that wet the bed. I'd also like to mention several brands of both cloth diapers and plastic pants and disposable briefs that have good reputations particularly for night use. There are several companies who sell disposable diapers that are highly regarded by many people. Continence Connection sells a wide variety of incontinence supplies. They're run by a nurse named Robin Howe who specializes in incontinence. Their web address is www.continenceconnection.com and their phone number is (888)356-6993. They're also open 24/7.

  As far as pin-on cloth diapers and plastic pants are concerned there are a number of places that sell them. Angel Fluff diaper company manufactures and sells pin-on cloth diapers for older children,teens,and adults. Their phone number is (800)996-2644.Another company that makes pin-on diapers is Loving Comfort. Their phone number is (717)308-0662.Kins a company out of Canada also makes pin-on cloth diapers for older children,teenagers,and adults. Their phone number is (800)665-2229.

  Some people have a favorite brand of plastic pants and diapers and stick with that particular brand,whereas other people use multiple brands because they could be happy with more than one brand. For example a person on an incontinence forum said he used both the Suprima plastic pants and the Comco plastic pants. One of the persons replying to this individual said that he also uses both brands. I've heard it's a good idea to buy several pairs of plastic pants. Given this fact it might be a good idea to buy several different brands of pants and alternate using them, that way you save wear and tear on the various pants.

  On a related note some people have a favorite style of diaper such as pin-on and stick with that,whereas others are happy using both pin-on diapers and other types such as tape-on disposable diapers. Since people have different needs and preferences for managing their bed-wetting and since there are so many different types and brands of diapers available to meet these needs and preferences,it's a good idea to be flexible in trying out different garments because even though you're happy with one product to manage your bed-wetting, there might be a product out there which would better suit your needs. In addition new brands and products for managing bed-wetting are coming out all the time. Also people's needs and preferences sometimes change over time. While there is something to be said for sticking with what works, there's also something to be said for trying different brands and products. Sometimes that's the best way(and some people would argue the only way) to figure out what's most effective for a particular person and their circumstances. No two people are alike and nowhere is this more true than with choosing an appropriate diaper to manage one's bed-wetting.

  In terms of disposable diapers for bed-wetting there are several brands that have good reputations. Abriform X-Plus made by Abena, Molicare,Unique brief(which I believe is also known as the Wellness brief),Tranquility All-Through-The-Night disposable briefs manufactured by Principle Business Enterprises, Tenas ,and Secure X-Plus briefs .When shopping for disposable briefs it's important to remember that some companies make two styles of disposable diapers-one with a plastic outer cover and one with a cloth like outer covering. Some people feel that the diapers with the plastic outer covering offer better protection and are more comfortable whereas other swear by the diapers with the cloth like cover. Tena I believe just makes diapers with a cloth like outer cover. Abena make diapers with both a plastic outer covering and a cloth like outer cover. Molicare makes diapers with a plastic outer covering-I'm not sure if they also make a diaper with a cloth like outer cover. Molicare make different lines of diapers. The most absorbent of these is the Super Plus Fitted Briefs. Out of all the Molicare diapers these are presumably the best to use for heavy incontinence such as bed-wetting. They have a plastic outer cover and extra padding in both the front and rear wings for increased protection and comfort.

  Regarding using disposable diapers with either a cloth like or plastic outer covering I would ask the company that sells both kinds to send you a sample of each in order to determine what works best for you. You can get the Tranquility, Molicare Super Plus and Abena Briefs from Continence Connection. In addition you can purchase.

  Other brands of disposable briefs include Wings by Kendall,Prevail by First Quality, Whitestone, Dignity, Attends, and Depends but I've heard mixed reviews about some of these brands. It would be a good idea to contact the companies and see if they can provide samples. Continence Connection has sample packs that they offer for these brands. In addition, you can buy diaper doublers known as booster pads, liners, and diaper inserts to put in disposable diapers to make them more absorbent. They also make booster pads for cloth diapers and some people purchase baby cloth diapers from places such as Walmart and Target to put in their adult cloth diapers to increase absorbency. Diaper pins(which are referred to as safety pins) and diaper rash ointment can also be purchased from these stores.

  I hope the last few sections have given parents a good overview of the wide variety of products available to manage their child, adolescent, or teens bed-wetting. It's important for parents to have a wide variety of options to manage their youngster's bed-wetting. Just as parents have different types and brands of diapers to choose from for their babies,they should have different diapers to choose from to manage their older child,teenager,or adolescent's bed-wetting.

  Too often in life we use a cookie-cutter approach to manage problems and bed-wetting is no exception. Just as a carpenter uses the most effective tools for a particular step in building a house or for a particular project,we must use the most effective diaper to manage bed-wetting and this might be different for each individual for a variety of reasons. Unfortunately due to the taboo nature of bed-wetting the problem is not discussed much and as a result most people are unaware of the full range of products available. Most parents I believe just know about products such as pull-ups and “Goodnites.” Hopefully as time goes on this problem will be less stigmatized and more people will feel comfortable discussing this problem. When this happens people will feel more inclined to talk about the different types of diapers out there to manage bed-wetting.

Diapers and Bed-Wetting part 8-Should Parents Require Their Older Child,Adolescent, or Teenager to Wear Diapers to Bed?

Should Parents Require Their Older Child,Teenager,or Adolescent to Wear Diapers to Bed?

  I've heard parents say that it's okay if an older child,adolescent,or teenager doesn't want to wear diapers to bed provided they take care of the wet clothes and bedding but I think that sends the wrong message. I think it sends the message that it's okay to be unsanitary. As mentioned previously it's unsanitary and unhealthy(not to mention uncomfortable) to lie all night in wet sheets and clothing. The following analogy might help. If a youngster has a cut you would have them put on a band-aid in order to prevent blood from getting on their clothes and on other stuff in the house in addition for sanitary reasons. Wearing a diaper to bed should be viewed no differently-the diaper is a band-aid for a bladder control problem. Or if the youngster was going to go out in the rain the parents would see to it that they wear a raincoat or use an umbrella to keep the child from getting wet. All of them are waterproof and all of them serve the function of keeping the individual from getting wet.

   The bottom line is that people do not like getting wet and take the appropriate precautions to prevent that from happening. Setting aside concerns of being unsanitary and uncomfortable for the moment,even if the child or teen did offer to wash their own sheets and garments it should be mentioned to them that it is much more time consuming and a lot more work to wash a whole bunch of wet sheets,blankets,and pajamas than to wash the wet diapers and plastic pants.

   Right now I'd like to touch on the following. Many parents might be wondering if they should require their older child, adolescent, or teen to wear diapers to bed if all methods to cure the bed-wetting have failed and they leak through the pull-ups or “Goodnites”. The consensus seems to be that the child or teen should be involved in the selection of what type of garments to wear to bed. While I agree with this theory in principle,in practice it might not work out all the time. The reasoning behind this theory is that by letting the child or teen be involved in the decision making process they will feel more in control of the situation thereby improving their self-esteem which in turn will make them feel less embarrassed.

  Many children,adolescents,and teenagers feel babyish about bed-wetting and a large number of people feel that by forcing them to wear diapers to bed you are taking the decision about how to deal with the bed-wetting out of their hands thereby making them feel even more like a baby. I can certainly understand this point of view but in many situations parents make decisions for their older child or teenager that are in their best interests but they don't like. Wearing glasses and braces are just two things that come to mind. If it were up to the youngster they wouldn't wear glasses and braces at all. Is it such a stretch to apply the same reasoning to the use of diapers to manage bed-wetting? Besides I would think it would be less embarrassing and stressful for the child or teenager to wear diapers to bed than wear glasses or braces-after all since the diapers are worn only at night their friends won't notice them whereas with the glasses or braces they will.

  While it is good to grant children and teenagers more autonomy as they get older in order for them to be a more confident and responsible adult there are certain types of knowledge that only come with experience. Choosing an appropriate incontinence product is one of them-there's a lot of trial and error involved in choosing an incontinence product that works well. There are many factors involved in choosing an appropriate incontinence product-the type and level of incontinence,whether your incontinence is during the day,night,or both,how absorbent the product is and how effectively it protects the individual,how durable a product is,a person's budget,how discreet the products are,how certain products effect an individual's skin,whether or not a person has the time and/or desire to wash diapers and plastic pants,etc. While adults have the capability to weigh these decisions and are able to make a sound choice in the matter,many children and teens don't have the maturity,knowledge,experience,and ability to make an informed choice in this situation. Their decision about what type of incontinence product to wear to bed will be influenced by what they perceive the image of diapers to be rather than how well the product keeps them dry at night.

  Parents are in a better position to judge what type of product will be best at managing their youngster's bed-wetting. They know how much the youngster wets at night and have experience in dealing with diapers when the youngster was a baby so they're familiar with how absorbent and effective various diapers are. This puts them in a better position to evaluate how well a particular product will work in protecting both the youngster and the bed. If a child or teenager's current bed-wetting product is not offering adequate protection and if after weighing all options the parents come to the conclusion that pin-on diapers and plastic pants,tape-on disposables,or other garments will be better at keeping the youngster dry at night then the parents should have the final say in the matter.

  The same is true with any medical issue. If the youngster is being treated for a certain illness and the method currently being used is not solving or adequately managing the problem then it's time to consider alternative courses of action and ultimately the adult due to their life experience is best qualified to make that decision. A diaper should be viewed no differently than other medical equipment for managing various medical problems such as an inhaler for asthma,a wheelchair for paralysis,a hearing aid,a cast for a broken arm,etc.

  One of the other things that puzzles me is this-children wore diapers when they were babies to protect themselves from wetness why should that change when they get older? The parents are in effect saying- “ well you're still wetting yourself but you're getting too old to still protect yourself.” Although the parents should have the final say in the matter I don't think they should be cruel or callous about it. Also there are cases where parents have used diapers to try to shame the child or teen into stopping the bed-wetting or as a form of punishment. I find this practice reprehensible and a form of child abuse.

  To get back to how to approach the older child or teen about wearing diapers to bed I think the parents should be gentle but firm. Some parents are from the “my way or the highway” school of parenting and while that approach might be necessary with some youngsters and in some situations and circumstances I feel that it's not warranted in this case. The parents should put themselves in the youngster's place-they should be empathetic and help them realize that it's in the youngster's best interest to wear the diapers to bed. As I said you need to emphasize to them that people of all ages wet the bed and many of them use diapers at night otherwise they wouldn't manufacture so many different sizes. Again I would tell them that since there are so many different styles of diapers-tape-on,pin-on,pull-on,etc that must mean that there are advantages to some of them with certain people and in certain circumstances. I would stress to them that although wearing diapers might be unpleasant,the alternative,waking up in cold,soaking wet sheets is a lot worse.

  I would tell them the reasoning behind why you chose one type of diaper over another. You can talk to them about the different types of diapers available to manage bed-wetting and the advantages and disadvantages of each. For example some people have problems with side leakage because they tend to sleep on their side,some individuals move around a lot at night,some people urinate more profusely than others at night,etc. and some brands and types of diapers are more effective than others at dealing with these particular problems. In addition some styles of diapers are more durable than others.

  Finally parents might choose a particular brand or style of diaper due to financial reasons. For instance I read about a parent who had an older child with a bed-wetting problem and he was a very heavy wetter. Originally he used pull-ups to protect the child but due to the level of incontinence he had to use three or more per night. The parent had limited financial means and couldn't afford to spend the money on the amount of pull-ups required so he switched to plastic pants and pin-on diapers. These are just some of the reasons for choosing one type and brand of diaper over another. With just about any type of consumer purchase there are some brands and products that are more effective than others for various problems and situations,more adequately meet a consumer's needs,etc. and diapers are no exception.

  I think it's important to discuss why you chose a particular style of diaper to manage the youngster's bed-wetting for the following reasons: it shows that you're sympathetic because you're taking the youngster's feelings about wearing the diapers into consideration,it shows that it's not some arbitrary decision designed to belittle or degrade the child or teenager,and it shows that you have the youngster's best interests at heart. As one book on adolescent psychology put it- “As the adolescent pushes for autonomy,the wise adult relinquishes control in those areas in which the adolescent can make reasonable decisions and continues to guide the adolescent in areas where the adolescent's knowledge is more limited.” In my opinion the choosing of an appropriate product to manage bed-wetting would fall into the second category. Adults have more life experience. This life experience makes them more effective at controlling their emotions and not letting them get in the way of making major decisions particularly regarding health care.

  Bed-wetting is a very touchy issue with most older children,teenagers,and adolescents and as a result they probably won't be as objective as parents in choosing the most effective product to manage their enuresis. Due to youngsters concerns with self-image their choice of what type of product to wear to bed will be dictated more by this criteria than on how well the product protects them at night.

  As mentioned earlier it's good for the parents to talk to them about all the different products out there to manage bed-wetting and the advantages and disadvantages of each that way if there is a disagreement about what type of product to wear to bed the parents can go over why they are requiring the child or teen to wear one product versus another. For example,it might be the case that the child or teen wants to wear one kind of product(say pull-on cloth diapers) whereas the parents feel that pin-on cloth diapers and plastic pants would be the best option. If that's the case the parents can say something along these lines: “I know you would prefer to wear the pull-on diapers instead of the pin-on diapers but there are several advantages with the pin-on diapers. You move around a lot at night and are a very heavy wetter.Also you tend to sleep on your side.The pin-on diapers are more effective at dealing with these specific problems because they're thicker than the pull-on diapers and you're able to customize the material in the pin-on diapers whereas with a pull-on diaper by putting more material in the diaper it causes it to bunch up. It might take some time to get used to the pin-on diapers but in the long run you'll be much happier because these will protect you much better than the pull-on diapers which in turn will make you more comfortable. Your mother and I came up with a reward system to encourage you to try these out for awhile. We think you'll be real happy with this idea and we'd like to discuss it now.” Again by doing this it makes the child or teen feel much better about the situation as opposed to the parents saying “you're wearing pin-on diapers and plastic pants to bed because we say so!”

  If the child or teen is reluctant to wear a certain type of product to bed the parents should definitely hear them out and then work with them in trying to overcome their anxiety. This requires patience,warmth,and encouragement. I would also say something along these lines: “I realize you're getting older and you might feel that by us making the final decision in this matter we're treating you like a baby or little child but we have a lot of experience in these matters and the products we chose for you to wear to bed offer the best protection. These will make you feel a lot more comfortable at night then the other products you wore.” To get back to my earlier analogies about wearing a cast,glasses,or braces,it's kind of awkward and unpleasant at first,but eventually the person gets used to them and realizes they're for his or her own good. The same is true for wearing diapers and plastic pants for a bed-wetting problem.

  By discussing the reasons behind your decision about what type of diapers to wear for the bed-wetting you are helping them in a very significant way-you are saying that you acknowledge their concerns about wearing the diapers and this makes it more likely they will not feel you're treating them like a baby because you respect them enough to discuss why you are having them wear a specific type of diaper at night. It's my feeling that this discussion with the child or teen in conjunction with using the reward system previously discussed will help them feel less apprehensive about the prospect of wearing diapers to bed.

  I would also mention that there are situations where parents purchase diapers for their parents with incontinence issues such as with a parent suffering from Alzheimer's disease and there are instances of married couples who deal with bed-wetting and the spouse of the bed wetter suggests that they wear diapers to bed. In the case of the bed-wetting spouse,while there may be some initial embarrassment at the thought of wearing night diapers,the bed wetter realizes that it's only fair to the person sharing the bed with them and eventually gets used to them. By mentioning these scenarios to the child or teen it helps them realize they are not alone and will help them feel less embarrassed about their parents putting them in diapers at night. They'll be able to say to themselves- “If parents purchase diapers for their parents and the husband or wife of a bed wetter suggest they wear diapers to bed then I guess it's not so bad that my parents are encouraging me to wear diapers to bed also.”

  The last thing I'd like to mention with regard to the older child,adolescent,or teenager who might be having a hard time accepting diapers for bed-wetting is the following. The parents should let him or her know that it is not uncommon to feel this way. Many incontinent adults have difficulty accepting diapers also but over time they come to terms with this. As mentioned before it would be a good idea for the child or teen to talk to other people in a similar situation.

  In conjunction with the techniques previously mentioned to help the youngster accept the diapers it might be necessary for the youngster to speak to a mental health professional(if financially feasible) to help them adapt to wearing the diapers to bed. It's my contention that by using all of these approaches together-the reward system,discussing the reasoning behind your choice of a particular type of diaper,the positive self-talk,parental encouragement when the child gets distressed and/or discouraged about the diapers,speaking to a mental health professional,and mentioning the fact that adults get other adults to wear diapers to bed,they'll be able to internalize the positive psychological aspects of these strategies. This in turn will help them cope with the thought of wearing diapers,it will help them by dispelling the negative self-image they might have of themselves due to wearing diapers to bed ,and they'll feel more confident about themselves because they'll be protecting themselves more effectively which will help improve their self-esteem.

  I realize that what I've just said goes against the prevailing wisdom espoused by most pediatricians,child psychologists,and other professionals but I think it's time we reevaluate our current attitudes toward the management of nocturnal enuresis and look at this issue in a whole new light.

  How one copes with wearing diapers to deal with bed-wetting is a very personal issue. Some people don't have any problem whatsoever wearing diapers to bed and are even glad to wear them because of the security and comfort they provide,whereas others need a significant amount of coaxing and encouragement to use them. Parents should not get discouraged if this is the case. It could take several months or more(depending on the individual) for the youngster to feel completely comfortable wearing nighttime diapers.

  Although it might take awhile for the youngster to get used to wearing the diapers to bed,over time the child,adolescent, or teen will realize how much more comfortable and secure they'll make he or she feel. At this stage they won't have any problem putting the diapers on before going to bed. It'll be second nature to them. Like brushing their teeth they'll view wearing the diapers as just another part of their nighttime routine.

Diapers and Bed-Wetting part 7- Bed-Wetting,Diapers,and Siblings

Should Parents Involve Older Siblings in taking Care of the Bed-Wetter's Diapers and Plastic Pants?

   Many parents have their older children be responsible for helping their younger child in various aspects of their lives and they might want to involve their older children in taking care of the bed-wetter's wet garments. This is a delicate issue because it has the potential to embarrass the bed wetter. Each situation is different. As mentioned previously if a parent uses diapers and plastic pants to deal with the youngster's bed-wetting it's inevitable that the other children of the house are going to discover this. They're going to notice plastic pants hanging to dry on the clothesline,see their mother washing wet diapers and plastic pants,and folding up the diapers and pants after they're laundered. With that in mind it might be a good idea to talk to the older child and ask them if they would be comfortable helping out with these chores.

  I think it's good for the older child because it helps them be more supportive about these kinds of problems. Hopefully it will also make them more sympathetic about bed-wetting and the use of diapers to manage it. They in turn can carry these attitudes with them in later years. For example if they decide to have children themselves and if their children wet the bed,their experience helping their younger sibling deal with it will help them handle their own child's bed-wetting in a gracious,gentle manner. That being said if the parents feel that the older child won't have the maturity to deal with the situation in a tactful way or if the bed wetter will feel embarrassed about their siblings taking care of the diapers and plastic pants then the parents should not let them help with this particular chore.

Diapers and Bed-Wetting part 6-How to Encourage Older Children,Adolescents,and Teenagers to Wear Diapers to Bed and Other Issues

Ways Parents Can Encourage their Older Child,Teenager,or Adolescent to Wear Diapers to Bed ,How to be Discreet About Bed-wetting and Diaper Use,and Psychological Techniques a Person Can Use to Deal With the Stigma of Using Diapers for Bed-wetting

   If the child or teenager is embarrassed about wearing the diapers and plastic pants to bed there are a number of different ways you can encourage them. First,you can stress how much more comfortable it will be waking up in a dry bed. Second,you can have them go to different online forums(with a younger child it's a good idea to supervise them while they are doing this) and talk to people suffering from similar conditions. There are many online forums dealing with bed-wetting and other incontinence issues. Sometimes it helps to have a sympathetic ear and to realize there are other people in the same boat.

   Third,you might consider ordering a large or extra large,adult size pair of plastic pants and/or diapers. By showing the youngster an actual adult size pair of plastic pants or diapers which is a size that is larger than what they would wear,it might help them feel better about wearing diapers to bed. By actually seeing an adult size it emphasizes the fact that adults wear them to bed also. This will help them more psychologically as opposed to just seeing something on a web site.

  Fourth,you can explain to them that people have different needs in terms of managing their incontinence-that's why they have so many different styles of incontinence garments. There are different levels of incontinence-some wet more than others. You need to stress to the youngster that what works for one person might not be as effective for another. Fifth,emphasize to the child or teen that they are only wearing the diapers at night. Unlike during the day it is much easier to conceal the use of diapers at night.

  In some circumstances however it might be difficult to be discreet about the use of diapers particularly if the parents are using cloth diapers and plastic pants to manage the bed-wetting. I would like to digress for a moment and discuss this briefly. If the bed wetter has siblings it's inevitable that they're going to notice either diapers in the laundry or plastic pants hanging up to dry on the clothesline. Or if the bed wetter shares a room with a sibling it's impossible to hide the diaper use from their brother or sister. If this is the case it's imperative that the parents let the other children of the household know that any teasing about the bed-wetting or diapers and plastic pants will not be tolerated and will result in punishment.

  On a related note there is also the possibility of friends of either the bed wetter or sibling finding out about the bed-wetting when they come over to visit. There are some precautions that you can take to prevent this from happening. If the youngster uses cloth diapers and plastic pants you can put the diaper pail in the laundry room before the friends come over. And if you're worried about them accidentally discovering the diapers and plastic pants you can put them in a special bin(which you can purchase from Target or Walmart) and either label the bin “school papers”(or something similar) or take the bin out of the room before the friends come over and put it back after they leave. Plastic sheets can also be a concern due to the fact that some of them make a crinkling or rustling sound which can be discovered if friends sit on the bed. I have read and heard about this happening in some cases,however this can also be remedied. You can take the waterproof sheet off before the friends come over and put it back on again before going to bed or put extra cloth sheets over the protective sheet to muffle the sound of the plastic. It should be mentioned that while this is a possibility with some plastic sheets if the youngster has the bed covered with a rubber sheet this won't be a concern.

  At this point I would like to get back to suggestions on how to motivate an older child or teenager who is reluctant to wear diapers to bed. The last idea I have is to implement a reward system designed to encourage the child or teen to wear diapers to bed. You can offer to increase their allowance by a certain amount. You could also say that if they agree to wear the diapers to bed for at least 6 months they can earn a certain amount of money per month such as $20.00(or whatever amount the parents can afford and are willing to pay them).If they don't wear the diapers and plastic pants to bed you can deduct a dollar for each night they don't wear them. In addition to having a specific amount they can earn per month,if financially feasible it might be a good idea to purchase a present for them which you can give them after the 6 month trial period. Or they can earn a specified number of gold stars or points per month which they can cash in for presents. Again they will be deducted a gold star or point each night they did not wear the diapers to bed.

  I think that verbal praise is an important part of the reward system. There is always the possibility that some older children and teens might get discouraged and not put on the diapers some nights. If this is the case it's very important to encourage them. Remind them of how proud you are for trying them out and also remind them of the reward system. I would say something along these lines: “We're real proud of you for trying the diapers and plastic pants out. I realize that it's no fun wearing them but just keep in mind the advantages of wearing them-you'll wake up nice and dry. Also remember that the more nights you wear them to bed the more money you'll make. I know it's hard but try to hang in there.”

  I think that in order to motivate them to wear the diapers to bed for the long term it's important to have some small rewards they can earn along the way while waiting for the big reward at the end. It's my contention that after the 6 months is up they'll feel so accustomed to wearing them and so comfortable wearing them that they will want to wear the diapers to bed of their own volition and not need rewards anymore. After 6 months they'll most likely realize how comfortable it is to wake up nice and dry.

  In combination with using a reward system there are certain scripts(as the mental health professionals say) that a child,teen,or adult can say to themselves in order to feel more comfortable with the idea of wearing the diapers and plastic pants to bed. For example he or she could say something like this to themselves: “This is just a garment designed to absorb urine and prevent it from getting myself and my bed wet. Wearing this is no reflection on my maturity. In fact by taking the appropriate precautions in dealing with the situation I am acting more mature. It doesn't matter what most people think. I am doing what's best for me in my particular situation and circumstances” or “I'm just wearing these at night-no one but myself and my family know I have them on. I'm asleep while I have them on so it's not like I'm going to notice them much anyway except when I put them on at night and take them off in the morning. It's like having a tooth pulled under anesthesia-I won't even notice it.”

  Finally another thing a person could say is the following: “Everyone's body develops at different rates-some people are potty trained later than others and some wet the bed later than others. My bladder has just not developed enough where I can stay dry at night unlike during the day. I wore diapers during both the day and night to protect me when I was a baby so why should it be any different now-I still have the problem of wetting. Just because I'm older doesn't mean I still don't need them. Besides they make diapers and plastic pants in my size so there must be a need for them-I am not the only one who wears them for bed-wetting.”

  If the child is younger you can tell them to play a little game. You can tell them to imagine that the diapers and plastic pants are a like dam and the bed is like a city. The dam(in this case the diapers and plastic pants) keeps the city(in this case the bed) from being flooded. Or they can pretend they're a superhero and the diapers and plastic pants give them special powers-in this case the power to prevent their bed from getting wet. Finally they can look at the diapers and plastic pants in the same way as a raincoat.

  I'd like to wrap this section up with an example of how concerns over both the issues of maintaining discretion when using diapers and the negative image of diapers can adversely effect a person's self-esteem. In this part I'd like to mention the difficulties faced by the individual with coming to terms with wearing diapers to bed and what a person could tell him or herself(what the professionals call positive self talk) to overcome the distress associated with these difficulties or at the very least minimize the distress. Although the person in question was talking specifically about his objections to wearing cloth diapers and plastic pants to bed I feel my suggestions are applicable to the use of disposable diapers also.

  When reading about the teen's difficulties I was struck by how poignant it was and how sad it is that other children and teenagers feel the same way. The teen feels that certain aspects of the diapers make him feel like a baby. The pins,the bulk of the diapers between the legs,and the sound of the plastic as he moved around were triggers in his mind that made him feel this way. As mentioned many older children and teens probably feel the same way but instead of viewing these aspects in a negative light it is conceivable to put a positive spin on the situation-instead of seeing the glass as half empty with the right attitude one can see the glass as half full. For instance the bulk of the diapers can be looked at as an advantage-it provides more absorbency and therefore better protection. Regarding a teen's embarrassment about the rustling of the plastic pants as they move around it's important to remember that since the diapers are worn only at night this shouldn't be a concern. The parents should let him or her know that it's not unusual for a certain degree of noise to be associated with some diapers. Instead of viewing the plastic as negative the person can view it in a positive light-it makes the diapers waterproof which keeps the user dry and comfortable. If however the bed wetter shares a room with a sibling and is concerned that the sibling will notice the crinkling sound the diapers make when he or she moves around in bed that concern can be addressed beforehand by the parents.

  As mentioned the parents should let all siblings of the bed wetter know that any teasing regarding the bed-wetting and diapers will not be tolerated and the parents will punish those involved. As far as the safety pins are concerned these should be viewed no differently than other tools for fastening clothes such as snaps,buttons,or zippers.

  In terms of siblings and bed-wetting there is one other point I'd like to bring up. There are cases where an older child might wet the bed and the younger sibling or siblings don't have this problem. This can be a blow to the child's ego and if the parents have the child wear diapers to bed it can make him or her feel more self-conscious and embarrassed. If the child expresses concerns about this it's important for the parents to have a discussion with the child. The parents can stress to him or her that it frequently happens that children develop at different rates and this type of situation happens all the time. If the child doesn't seem concerned about it I wouldn't even bring it up-it's very possible that he or she hasn't even thought about this but if you bring it up then they will be concerned. In terms of the siblings of the bed wetter and how they react to the fact that he or she still wears diapers to bed I'll reiterate what I've said before-the parents should have a discussion with the siblings of the bed wetter (both older and younger) and tell them in no uncertain terms that any teasing about the bed-wetting and/or diapers will not be tolerated.

  Finally I would tell the child who wets the bed that plenty of adults also have problems with bed-wetting and they wear diapers at night too. Many of them probably feel the same way. I've read about cases where one or more parents have bed-wetting problems but their children don't. The parent originally feels embarrassed about wearing diapers to bed but many times the children are supportive of their parents. This is another point that should be brought up to the older child,adolescent,or teenager that needs to wear overnight diapers.

  At this point I would like to discuss the following. I feel this particular topic dovetails in with the concept of self-esteem. Although this is not a common occurrence I felt it needed to be addressed. As mentioned I have done a fair amount of reading on both bed-wetting and the use of diapers to manage it and in my readings I've ran across situations in which babysitters and parents of children that wet the bed had to get the children ready for bed. A friend of mine years ago told me of a situation where she had to babysit a 6 year old boy and she had to diaper him before he went to bed. I figured at that age he was potty trained and just needed the diapers for a bed-wetting problem. This was the days before pull-ups and “Goodnites” so she had to use tape-on disposable diapers. The child threw a fit and refused to let her put the diapers on him which I can't say as I blame him. I don't think the child had any cognitive and/or physical impairments that prevented him from putting on his own diapers so I was kind of puzzled why it would be necessary for her to be involved in getting him ready for bed. Most older children are very self-conscious about this issue and by diapering them you might embarrass them.

  I'm not a pediatrician or developmental psychologist so I'm not an expert on this,but there are certain cognitive and physical tasks-such as putting on pants,tying shoes,etc. that can be accomplished at a certain age by children that are not developmentally disabled. Putting on one's own diapers would seem to fit into this category also. My intuition tells me that above the age of 3 or 4 a child should be taught how to diaper themselves. If the child incorrectly fastens the diapers and it causes the diapers to leak the parents can teach them the correct way to put on the diapers. They can do this by laying the diaper on the bed,have the child sit in the diaper,and once the child is correctly positioned in the diaper explain to them how to draw the diaper up between the legs,how to place it around the waist,and how to fasten the tapes. After the child puts the diapers on the parents or babysitter can check to see if the child fastened them correctly. If not the child should do the refastening not the parents or babysitter. The child will eventually get the hang of this and in time will not need the parents or babysitter in the room to supervise them.

  At this age children are starting to get very self-conscious about these issues and you don't want to embarrass the child. With that in mind it's good to teach them to be self-sufficient in this area as soon as possible. Disposable diapers are pretty simple to put on. Pin-on diapers might be a little trickier for some children but I believe that they can also be mastered. Many parents might be worried that a younger child might accidentally stick themselves with the pins. I spoke to a woman from a company that manufactured and sold pin-on diapers for older children to get her take on the situation and she told me that for a child of 7 or younger they might need help from their parents whereas if the child was older than 7 it might depend on their development. As in the case of the disposable diapers the parents should lay the diaper on the bed,show the child how to fold it correctly,have them sit in the diaper,make sure they're correctly positioned in the diaper,show the child how to fasten it around him or her,and how to safely pin the diapers on. As before the parents or babysitter can check to make sure the child put the diapers on correctly and if not have them do the diapering again. As far as the plastic pants are concerned they can also put them on by themselves.

  It's very important for parents to teach their child to be independent in this area otherwise they'll feel ashamed and this will adversely effect their self-esteem,perhaps for a long time. I've read about a case where the parents diapered their older child who wet the bed in front of the whole family in an attempt to shame him into stopping. There are many other things I've heard parents do to shame their child into stopping bed-wetting but out of sensitivity to my readers I won't mention them. These practices are despicable and a form of child abuse. In terms of diapering older children that wet the bed,it seems that the situations described above are atypical but even though this is the case, my friend's experience concerned me and it made me feel that this issue needed to be addressed.

  There are a couple other points regarding discretion that I'd like to talk about. The first has to do with various caretakers of the bed wetter. These include babysitters,relatives,friends of the parents, and other people along these lines. Many children who wet the bed and have to wear diapers for the problem dread when their parents go out for the evening. If the parents have a good relationship with the caretakers and they feel comfortable discussing the issue of the bed-wetting and diaper use with them and they feel the caretakers will be understanding about it,this shouldn't be a concern. If however they don't feel comfortable discussing this issue with the babysitter or other caretakers and the parents feel they won't be understanding about it,then it's advisable to make sure the protective garments are laundered(if the parents are using garments such as cloth diapers and plastic pants) and made available to the child beforehand;that way if the child wakes up wet in the middle of the night and has to change,he or she can be discreet about it.

  If the parents are considering hiring a nanny to take care of their child or children and one of them has to wear diapers for a bed-wetting problem,the parents might want to discuss this with the agency and perhaps during the interview with the nanny also. Most nannies have dealt with these types of problems in the past therefore they should be very professional regarding this issue. The second point has to do with spending the night at other peoples houses(such as a friend's house) and going away to camp. Again if the parents have a good relationship with the parents of the friend and feel comfortable discussing this problem with them this shouldn't be a concern. There might be a place that the child can use to change into their garments before going to bed and after waking up in the morning.

  As far as camps are concerned there are a couple of programs geared toward individuals that suffer from nocturnal enuresis and other incontinence related issues. One of them is called Camp Brandon for Boys in New York state,the other is Camp Kirk in Canada. There might be other camps out there of a similar nature. In order to find out you can do a Google search. You can try using the following key words-(or key words of a similar nature) “ camps with programs for disabled/special needs youth” or “ camps with programs for bed wetters.” The contact information for Camp Brandon for Boys is-14 Jerry Drive, Plattsburgh, NY 12901,Phone:(518)570-5184. The contact info for Camp Kirk is 1083 Portage Rd., Kirkfield, Ontario KOM 2BO. Phone:(705)438-1353.They also have an off season address and phone number- 115 Howden Rd.,Scarborough,Ontario M1R 3C7. Phone: (416)782-3310 These might not be an option for many people so in this case the parents need to talk to the head of the camp program and find out what types of provisions are available for youth that wet the bed. For example if the parents use diapers and plastic pants for their bed wetter are there facilities available to wash the diapers and plastic pants?

  In terms of the youngster staying away from home there is one other scenario that I'd like to discuss and that's concerning boarding school. The advice I gave for parents sending their child to camp applies here also-the parents need to talk someone at the school beforehand and ask them what type of provisions are available for the bed wetter.