Brain storm re child's medical issue

[Logic]

I am seeking some advice and/or opinions from this collective of smarty pants. I know not all of you are qualified to give advice and I waive my legal rights blah blah

I have a niece who is 7 and is still wetting herself, not just in bed but anytime she feels like it really.

I am hoping someone might make a suggestion not yet thought of as her mum is out of ideas.

Her parents are both school teachers and she is the middle child of a hyperactive older sibling (some behaviour problems) and a stable younger sibling.

She is a bright child who did take longer than average to talk as a toddler but now reads at above her age level. She is happy to play with dolls by herself and often amuses herself. She is physically coordinated and is 'sporty'. She is often in an uncommunicative mood and will not give you eye contact or engage in conversation with you. At times though she is chatty and outgoing.

This wetting started after she was toilet trained (as far as I can remember she was trained for a short while but then started this behaviour) and still goes on.

Her parents have taken her to a range of doctors, child psychologists etc So far no luck.

One diagnosis suggested a weak physical signal from bladder to brain. This resulted in treatment with an alarm which would go off at night to wake her up. This worked with limited success but reverted back to old behaviour.

Child psych suggested attention seeking behaviour so a range of things were tried from ignoring, to encouraging, to explaining peer reaction to this, but no success.

I was wondering about her being on the autism spectrum but she doesn't fit all the symptoms as far as I can tell, and I don't know what that has to do with wetting. I'm also pretty sure she was tested for that with a negative result.

Does anyone have any ideas re avenues worth exploring? Would be appreciated.



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[Annie]

Given that child psychs have been consulted and their findings haven't lead to anything substantive, my next port of call would be to a neurologist. Autonomic nervous systems are only tricky dickies because our common, conscious brains dont understand them. We can all thank Pikkiwoki that the neurologists do!
Hoping you find some answers.

[the_gelf]

Aside from working out any obvious trigger, perhaps list the times that she does NOT wet the bed might be useful.

Or is there a certain time of night that it happens (re: the alarm no longer working...why?).

Could be a sleep disorder where the brain doesn't properly turn off/on: as Annie suggests, a neurologist would be a sensible port of call - and they will probably like as much info as you have available (Re: above).

I have read accounts that these things can last as until the end of adolescence...sucks :/

Another information source suggests making her responsible for changing the bed etc (subconcious training of the brain to refrain from an activity by negative association)

Hope this helps

[rayne]

Originally Posted by Annie

Given that child psychs have been consulted and their findings haven't lead to anything substantive, my next port of call would be to a neurologist. Autonomic nervous systems are only tricky dickies because our common, conscious brains dont understand them. We can all thank Pikkiwoki that the neurologists do!
Hoping you find some answers.

The child psychs haven't found anything, that's positive. I'd hate to think it was related to tramua. Could be that her brain isn't registering when her bladder is full and not prompting her to go to the loo?

[BlueDevil]

Has she tried synthetic forms of ADH which are used in treating bed wetting? This comes as either nasal spray or tablets such as: http://www.racgp.org.au/cmi/fpcminir.pdf
This can be very effective in some cases of bed wetting, however I am unsure if it would be able to be used for day time wetting. In effect it reduces production of urine so makes bed wetting less likely overnight.

Does she have any other issues, in particular drinking excessive amounts of water and urinating large volumes? I am guessing probably not or you would have mentioned it. If this was present it may be indicative of a condition called diabetes insipidus (not to be confused with diabetes melitus which relates to sugar levels). It is caused by a lack of ADH (anti diuretic hormone):
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001415/

[Praxis]

If she's 7, presumably she goes to school? Out of curiosity, If she's spontaneously wetting, does she wear a nappy or pull-ups to school? I wonder how that affects her at school? Kids are alert and cruel. I'm not sure why I'm thinking along these lines - or is the wetting only outside of school? Just musing aloud.

More musing aloud: is she embarrassed by the problem or "proud" of it?

It's a tricky one given that evidence shows that it's fairly rare that a physical cause is responsible for prolonged bed wetting (in otherwise healthy children) but if the experts have found no evidence of trauma or attention-seeking behavior then I suppose it must be a physical cause. But who can be sure? Her parents are the best ones to provide insight into possible causes.

It generally resolves with time in otherwise healthy young people but of course that's cold comfort for parents already dealing with a child with special needs.

Hope the situation resolves, for the little girl as well as the family. I with Annie that neurological examination might be a good idea.

[Logic]

Originally Posted by Praxis

If she's 7, presumably she goes to school? Out of curiosity, If she's spontaneously wetting, does she wear a nappy or pull-ups to school? I wonder how that affects her at school? Kids are alert and cruel. I'm not sure why I'm thinking along these lines - or is the wetting only outside of school? Just musing aloud.

More musing aloud: is she embarrassed by the problem or "proud" of it?

She just wears normal undies but has a change with her. It's a strange situation because the fear of being teased or having no friends (because she smells like wee at times) does not seem to bother her. As far as I know, she does not seem overly embarrassed but she is not proud of it either.

[quote=Praxis;324730It's a tricky one given that evidence shows that it's fairly rare that a physical cause is responsible for prolonged bed wetting (in otherwise healthy children) but if the experts have found no evidence of trauma or attention-seeking behavior then I suppose it must be a physical cause. But who can be sure? Her parents are the best ones to provide insight into possible causes.

It generally resolves with time in otherwise healthy young people but of course that's cold comfort for parents already dealing with a child with special needs.

Hope the situation resolves, for the little girl as well as the family. I with Annie that neurological examination might be a good idea.[/QUOTE]

I'm leaning towards psychological reasons and thinking perhaps a second psych opinion might be in order.

Thanks for the response.



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[Logic]

Originally Posted by BlueDevil

Has she tried synthetic forms of ADH which are used in treating bed wetting? This comes as either nasal spray or tablets such as: http://www.racgp.org.au/cmi/fpcminir.pdf
This can be very effective in some cases of bed wetting, however I am unsure if it would be able to be used for day time wetting. In effect it reduces production of urine so makes bed wetting less likely overnight.

Does she have any other issues, in particular drinking excessive amounts of water and urinating large volumes? I am guessing probably not or you would have mentioned it. If this was present it may be indicative of a condition called diabetes insipidus (not to be confused with diabetes melitus which relates to sugar levels). It is caused by a lack of ADH (anti diuretic hormone):
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001415/

I'm not exactly sure but I think they did try her on a drug and made sure she wasn't drinking much before bed. I will ask them. Thank you.


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[Logic]

Originally Posted by rayne

The child psychs haven't found anything, that's positive. I'd hate to think it was related to tramua. Could be that her brain isn't registering when her bladder is full and not prompting her to go to the loo?

The signal between brain and bladder was one avenue they pursued. I'm not sure if this was GP or neuro specialist. I'm also not sure how they came to the conclusion that it wasn't that but they (parents) seem to have written that off. I'll try to find out more. Thanks.


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