Parental Decisions Regarding Bed-Wetting and Diapers part 1

Published: 11th May 2009
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I posted the article " Should Older Children, Adolescents, and Teenagers Be Required to Wear Diapers to Bed?" on the Health Central Network also and one reader named "Guest" felt that an older child or teen might feel they're being punished by their parents by requiring them to wear diapers to bed. I responded with the article "Parental Decisions Regarding Bed-Wetting and 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 article was to get people to see this issue in a whole new light. This article is divided up into three parts. I encourage you to read all three parts because I feel there is useful information in all sections.



  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 makes the youngster feel 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 them 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 reinforces 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,punish,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. In addition it's not comfortable for the child to sleep all night in wet bedding and clothing. Both of these consequences of not wearing protection for bed-wetting are certainly detrimental in my book and I believe that other people would feel the same way.



  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,powders creams,sprays,foams,baby wipes,and ointments in addition to cleaning one's self thoroughly after changing the diapers. There are plenty of companies that sell skin care products for incontinence. Furthermore there are places such as the National Association for Continence and the Simon Foundation for Continence that have literature on incontinence. You might want to contact them to see if they have any literature on how to manage skin care when wearing diapers. Without wearing diapers,though, you're just exposing more areas of the skin to negative effects. In essence the diapers keep the problem localized and easier to manage.





I strongly feel that it's important to instill in children at a young age that it's critical to be sanitary in order to maintain hygiene. This includes getting them in the habit of washing hands after going to the bathroom or if they have a cold, wearing band aids to prevent infection if they have a cut,covering their mouths if they cough or sneeze,and other things along these lines. Why should it be different for a situation like wearing diapers to manage bed-wetting? It's almost like some parents are giving their children a pass on this issue which to me makes no sense whatsoever. Parents should be consistent in terms of making sure their children take steps to maintain appropriate hygiene. If anything parents should be more judicious in this area because as mentioned there can be detrimental consequences as a result of not wearing effective protection to bed. To quote another article: "Urine is created by the kidneys as they filter impurities from the body,and it can irritate the skin after prolonged exposure. The germs which normally live on the skin in the genital area can transform some substances in urine into ammonia,which is very harsh on the skin. Urine can also affect the pH level,making your skin more susceptible to attack by fungi or yeast. People with incontinence problems often develop yeast infections,jock itch,or other types of fungal infection." Your child or teen is lying in bed for hours per night and when you multiply that by the number of days per week that is a lot of hours. If the youngster is a bed-wetter that is a long time to be exposed to urine and this has the potential to aggravate the skin significantly that is why I think it's crucial to wear the most absorbent type of products to bed and not just those that are considered less "babyish" by the majority of the public. In my opinion we need to take a more common sense approach to this situation. These garments were developed to meet a need- providing hygiene for infants as well as cutting down on laundry that parents need to deal with. Why should that be any different with a problem like bed-wetting or other forms of incontinence?As I've mentioned in other articles we let our concerns with image dictate what type of products to use for bed-wetting which ultimately hurts the person suffering from the problem because as I discuss later in this article, it makes the bed-wetter feel less secure and comfortable. With any health problem we want to use the best type of treatments or equipment available to deal with the issue and it should be no different with a problem like bed-wetting.

Another thing needs to be considered is this. Peoples' schedules nowadays are more hectic-we try to compress more and more activities into a shorter time period. By wearing diapers to bed the youngster can avoid taking a shower in the morning which cuts down on the time it takes to get ready for school and other things-all he or she needs to do is clean around the diaper area after waking up.







   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 articles 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. Most parents and professionals feel that if the child,adolescent,or teen chooses not to wear protection to bed(and some people feel even if they do wear nighttime protection) they should be responsible for taking care of the wet items. I tend to agree with this but not to punish the child as some parents do but as a way for them to take responsibility of the situation which ultimately will make them feel better because they will feel more in control .This in turn will make them feel more confident. However in this regard there is one thing that parents who believe in leaving the decision about whether or not to wear diapers to bed or what type or brand of diapers to wear to bed up to the child,adolescent,or teen don't seem to consider or downplay and that's the following:if the child or teen is reluctant to wear diapers to bed or resists wearing the type or brand of diaper that would be most effective at managing the bed-wetting this entails more work for the individual. Since the diapers are worn only at night and therefore only the person and their family knows about this,I would think it would be much more annoying for the youngster to spend most of the day taking care of a ton of laundry than wearing diapers.



The book "Adolescence" by John Santrock has a section on decision making and parenting styles which I feel are applicable to this topic. The book mentions that the trajectory of development from childhood to adolescence is as follows: in general as one gets older one gets more competent at making decisions. To quote the book: "Compared with children,young adolescents are more likely to generate different options,examine a situation from a variety of perspectives, anticipate the consequences of decisions,and consider the credibility of sources." The example that was given in the book regarding this ability was with examining the consequences of medical procedures,in this case cosmetic surgery. The book had the following to say regarding how younger adolescents consider the consequences of this decision versus versus older adolescents: "The older students were more likely to spontaneously mention a variety of risks,to recommend consultation with an outside specialist,and to anticipate future consequences. For example when asked a question about whether to have cosmetic surgery,a twelfth-grader said that different aspects of the situation need to be examined along with its effects on the individual's future,especially relationships with other people. In contrast, an eighth-grader presented a more limited view, commenting on the surgery's effects on getting turned down for a date,the money involved,and being teased by peers." If we extrapolate this to a problem like bed-wetting and choosing the most suitable product to manage it, younger people are less likely to choose garments that provide the best protection given their situation because many of them are embarrassed about wearing diapers. Adults with incontinence are more likely to weigh the pros and cons of certain types of incontinence products and they do this based on the following criteria: does the incontinence occur during the day,night,or both, what the level and type of incontinence is,how absorbent and comfortable a particular brand or type of diaper is,how the product effects the wearer's skin,whether the person has the time or inclination to wash diapers and plastic pants,a person's budget,among other things. Everyone's circumstances are unique so people will have certain preferences in terms of what style and brand of garments to purchase to help them manage their bed-wetting. The previous passages just quoted indicate that many older children and young adolescents won't consider these criteria which are essential to choosing an incontinence product that will most effectively manage a person's bed-wetting.



Another thing the book discusses which I believe is applicable to this topic is the concept of parents as managers. This is what the book has to say in regard to this idea: "A key aspect of the managerial role of parenting is effective monitoring of the adolescent. This is especially important as children move into the adolescent years. Monitoring includes supervising adolescents' choice of social settings,activities,and friends,as well as academic efforts." With this in mind it doesn't seem unreasonable for parents to take an active role in how the youngster manages his or her bed-wetting including what type of garments the child or adolescent should wear to bed. This is certainly open for debate and it's possible that we will never be able to come to a consensus on the extent to which parents should be involved in this matter. That being said I believe that at the very least we should take steps to make society feel less self-conscious about discussing this issue so we are able to make decisions about managing bed-wetting hat are well informed and not ones based on feelings of shame and stigma. The use of diapers to manage bed-wetting is very taboo and its essential for the bed-wetter's peace of mind(whether they're an older child,adolescent,teenager,or adult) to make them feel more at ease with their particular choice to manage the problem. Right now I'd like to reprise a quote from this book which I used in my article "Should Older Children,Adolescents,and Teenagers be Required to Wear Diapers to Bed?" : "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." Bedwetting and choosing an appropriate product to manage it might be a case where a parent's guidance is necessary due primarily to the fact that adults have more life experience which in turn makes them more able to look at things objectively and dispassionately. This is especially necessary in making decisions about the best measures to take to manage a health problem where people frequently let emotions and prejudices get in the way.



Ultimately whether or not a parent feels that they should be the ultimate arbiter of what type of protection the youngster should wear to bed depends on what type of parenting philosophy the parents subscribe to. Also a parent's choice about how much latitude to grant the youngster in this area hinges on the debate about when youngsters should be granted more autonomy and with what particular area they should be given more control over the decision making process. Of course like most things in life this is not cut and dried. A large part of this depends on how mature the child is. Many youngsters level of maturity exists on a continuum-the same child can be mature and responsible in one area and less so in another and from one situation to another. Because of this variability my intuition tells me that parents should take a more active role in this area than is traditionally done. I believe that my thinking on this matter goes against the grain of both the majority of child psychologists,pediatricians,and parents but I strongly feel that we need to reexamine our basic assumptions about this issue because it has the potential to make people feel less ashamed using diapers to manage their bed-wetting. At this point I'd like to talk more about adults views on both bed-wetting and how to manage it. There are plenty of cases where people have to wear diapers to bed for bed-wetting their whole lives and many of them feel embarrassed about using these garments at night as well. But most adults realize that they have to take steps to manage this problem in a way that helps them live their life in a manner that maintains their dignity. This entails buying products that help them stay dry and comfortable and provide good hygiene. If this means wearing pin-on cloth diapers covered with plastic pants versus reusable pull-on briefs that is what most adults will(and should) do. And since many adults are involved in relationships and therefore share a bed with someone it's even more crucial that they wear appropriate garments to bed out of consideration for their partner, after all their partner doesn't want to wake up soaking wet either! This is another point that should be stressed to a youngster who is reluctant to wear diapers to bed.



Many people might be wondering if there is a particular type or brand of diaper that I feel is particularly suited to manage bed-wetting with older children,adolescents,teenagers,and adults. As with most things in life there is no one size fits all solution to this problem but there are some products which a large number of people have found successful in managing their bed-wetting. For example a great amount of people find pin-on diapers covered with plastic pants to be particularly effective for heavy incontinence such as bed-wetting. Speaking of pin-on cloth diapers and plastic pants,as far as these types of garments are concerned I'd like to make the following analogy(borrowed from an earlier article of mine) which should help a reluctant youngster or adult come to terms with wearing them for a bed-wetting problem. People have no problems wearing plastic rain wear such as rain coats and rain suits consisting of plastic rain pants to keep them dry and vinyl or rubber waders when they're fishing. It should be no different with wearing plastic pants and diapers to manage a bed-wetting problem. I would mention this to a youngster who is having difficulty accepting the diapers and plastic pants. Furthermore, it should be impressed upon the child or teen that since the products are worn only at night and no one else but the immediate family know the youngster has to wear diapers,this should make he or she feel a little more at ease with wearing protection to bed. Many people have to wear diapers both day and night so the youngster is fortunate from this standpoint. Another form of protection for heavy incontinence are disposable briefs. There are a number of people who find disposable briefs(this is the term used for disposable tape tab diapers worn by older children,adolescents,teenagers,and adults) good for managing nighttime incontinence. I discuss different types and brands of diapers and plastic pants in the following articles: "Types and Brands of Diapers to Use for Bed-Wetting and Companies that Sell Them", "Additional Information Regarding Pin-On Diapers for Older Bed-Wetters",and "Brands of Plastic Pants for Older Bed-Wetters" The main point of my articles is not to advocate for a particular brand or style of protection for this problem but to get both parents and youngsters to become more open minded about trying less traditional and popular methods of managing bed-wetting(which in this case are diapers and plastic pants due to the stigma surrounding these items) and to be less concerned with a particular product's image and more concerned with how effective it is with managing the bed-wetting.





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. After discussing these advantages the parents need to stress to the youngster that the characteristics of the particular product that they've chosen for the youngster to wear to bed will make them 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 means the child can use to help them cope 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 and secure,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. The approach mentioned in this section is an example of the style of parenting called authoritative parenting. The book on adolescence mentioned earlier in this article describes authoritative parenting this way: "Authoritative parenting encourage adolescents to be independent but still places limits and controls on their actions. Extensive verbal give-and-take is allowed,and parents are warm and nurturant toward the adolescent." My article "Ways Parents Can Encourage Older Children,Adolescents,and Teenagers to Wear Diapers to Bed" goes into greater detail about various methods parents can use to help youngsters get used to wearing diapers to bed. Another way to help youngsters cope with wearing nighttime protection is discussed in my article "Should Older Children,Adolescents,and Teenagers Be Required to Wear Diapers to Bed?" This article talks about the possibility of having the youngster who is having difficulty making the adjustment of wearing diapers at night talk to a mental health professional who is well versed in this area in order to offer the youngster effective coping strategies and techniques.


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