Parental Decisions Regarding Bed-wetting and Diapers

 I had originally posted “Bed-Wetting: Should Older Children, Adolescents, and Teenagers Be Required to Wear Diapers?” on the Health Central Network website. One of the readers felt that older children should not be required to wear diapers for bed-wetting and this article is a reply to these comments. 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.

 As pointed out in my article “Ways Parents Can Encourage Older Children,Adolescents,and Teenagers to Wear Diapers to Bed” I think it’s important for the parents of an older child to explain why you chose a particular style of diaper to manage their bed-wetting. This includes the advantages the particular product has over other products and how these advantages will help them more effectively manage their bed-wetting. This in turn will make the youngster feel more comfortable and secure. Additionally the parents should listen to the child if they have any misgivings about wearing a certain type of diaper and let them know that you understand how they feel. At this point the parents should talk to the child about various strategies the child can use to help them with wearing nighttime diapers and the particular reward system they’ve put in place to help them adjust to the protection. It would be helpful if the parents get the child’s feedback on the reward system. By discussing the merits of a particular product and how this will help the child feel more comfortable,by listening to any concerns the youngster might have,and by getting their thoughts on the reward system,it makes the child feel that your decision is not an arbitrary one and that you’re not trying to belittle or humiliate them. Finally it shows that you respect the child’s feelings on the matter which will make it more likely that they won’t resist putting the garments on before going to bed. Many parents dread the possibility of this nighttime battle and the previous suggestions will help in this regard.

 As far as teenagers are concerned,it can be quite a challenge convincing them of the merits of wearing diapers to bed. The majority of teenagers are very sensitive about the idea of independence and many of them are highly resistant to parental demands in general and wearing protection to bed in particular. The need for autonomy increases significantly during these years. The book “Reclaiming Youth At Risk Our Hope for the Future” by Larry K. Brendtro, Martin Brokenleg,and Steve Van Bockern has the following to say concerning this: “The desire to acquire greater independence accelerates rapidly during early adolescence. One survey asked students to rate the importance of 24 value statements,one of which was “to make my own decisions.” This value increased more between fifth and ninth grades than any other.”

 With this in mind, a different approach is warranted with teenagers. In some cases parents give teenagers a certain amount of money for good grades. For example,they might give the teen a certain amount for each B earned and a certain amount for each A received. A similar system could be put into place to encourage the youngster to wear diapers to bed. Or the parents can use the reward system described in my my article “Ways to Encourage Older Children,Adolescents,and Teenagers to Wear Diapers to Bed and Other Topics.”

 I’ve since rethought somewhat my previous position on requiring teenagers to wear diapers to bed for bed-wetting. I still feel older children should be required to wear diapers to bed if the attempts to cure the bed-wetting have been unsuccessful and garments such as pull-ups and “Goodnites” are ineffective at protecting both the youngster and the bed. I also feel teens concerns with image will prevent them from objectively evaluating the merits of certain forms of protective garments.

 When talking to your teenager about his or her bed-wetting and possible ways to manage it, it’s important to put yourself in their shoes. First off,it’s an embarrassing situation to talk about,and second,this embarrassment is compounded by the possibility they might feel you’re treating them like a baby by requesting them to wear diapers to bed. With a teenager it’s important that they feel in control of the situation. This entails involving them in the decision making process. If the parents feel that a certain type of diaper would be best to manage their bed-wetting given their particular circumstances and the teenager balks, you can say something along these lines: “Both your mother and I have been doing some research on the different types of products available to manage bed-wetting and we feel that due to your level of incontinence,it would be best for you to wear pin-on diapers covered by plastic pants. These offer excellent protection which in turn will make you feel more comfortable. We worked out a reward system to encourage you to try these out for a while. Please realize that we have your best interests at heart and we’re not doing this to punish you or humiliate you. We hope you don’t think we’re treating you like a baby. Keep in mind that there are plenty of cases where adults persuade other adults to wear diapers such as in the case of married couples who deal with bed-wetting. There are also instances of children purchasing diapers for their parents suffering from incontinence,for instance if their parent has Alzheimer’s disease. We’d like for you to at least try these out for a while. Who knows, you might feel real comfortable wearing them and wouldn’t consider going to bed without them on. Eventually you’ll realize it’s not so bad wearing them .In the long run you’ll realize the merits of wearing these to bed. As I said we’ve come up with a reward system designed to encourage you to try these out for 6 months. If after the 6 months you don’t want to wear them you can wear other garments.” I would stress to the teen that it’s best for them to wear the most effective garments to deal with their bed-wetting not the garments that have the best image.

 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 that I’m callous 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 articles. It’s good to have constructive dialogues regarding this issue. Many people have preconceived ideas concerning this matter and I hope my articles 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 subjects 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.

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