TRY for DRY Healthcare TRY for DRY Healthcare Training Training Instructor Instructor Max Maizels, MD Max Maizels, MD Division of Urology Division of Urology Children’s Memorial Hospital – Children’s Memorial Hospital – Chicago Chicago Professor of Urology Professor of Urology Northwestern Medical School Northwestern Medical School Managing Enuresis – Managing Enuresis – Lesson 2 Lesson 2 www.TRYforDRY.com www.TRYforDRY.com
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TRY for DRY Healthcare Training Instructor Max Maizels, MD Division of Urology Children’s Memorial Hospital – Chicago Professor of Urology Northwestern.
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TRY for DRY Healthcare TrainingTRY for DRY Healthcare Training
InstructorInstructorMax Maizels, MDMax Maizels, MDDivision of UrologyDivision of UrologyChildren’s Memorial Hospital – ChicagoChildren’s Memorial Hospital – Chicago
Professor of UrologyProfessor of UrologyNorthwestern Medical SchoolNorthwestern Medical School
NEWBORN CONTROL AT SPINAL LEVELVOID REFLEXIVELY q 2h AT CAPACITY ABOUT 2oz.
INFANT•BEGINS TO SENSE FULLNESS WHILE AWAKE• CAN “WILLFULLY” “HOLD BACK” VOIDING BY CENTRAL INHIBITION OF DETRUSOR REFLEX• VOLITIONALLY CONTRACTS EXTERNAL SPHINCTER AND PELVIC FLOOR MUSCLES
SENSE THEN:• INHIBIT DETRUSOR CONTRACTION• CONTRACT PELVIC FLOOR MUSCLES
NOCTURNAL OLIGURIA
• INCREASED NOCTURNAL PRODUCTION OF VASOPRESSIN
PEDIATRIC ENUROLOGY
DELAYS IN ATTAINING NIGHT DRYNESS
• FAMILY HISTORY INVOLVING 1st ORDER RELATIVES• DELAY DEVELOPMENT @ 1 & 3 y.o. MILESTONES• PROLONGED SLEEP IN INFANCY• DAY TRAINING NOT STARTED UNTIL AFTER 18 mo old• MALE GENDER
PEDIATRIC ENUROLOGY
% S
TIL
L T
O A
TT
AIN
BL
AD
DE
R C
ON
TR
OL
AGE OF CHILD
PEDIATRIC ENUROLOGY
NOT RELATED TO DELAY IN ATTAINING NIGHT DRYNESS
• FAMILY SOCIAL BACKGROUND• STRESSFUL LIFE EVENTS• CHANGES IN PARENT FIGURES• CHANGES IN RESIDENCE
PEDIATRIC ENUROLOGY
“HEAVY SLEEP” The children don’t even realize they wet the bed.
The deluge from Springfield’s burst dam floats Ralph Wiggum, in his bed, to Homer’s front door
WHEN TO PURSUE TREATMENT OF ENURESIS?
• AFTER 3 years old?• AFTER 5 years old?• AFTER 7 years old?• AFTER 10 years old?
• ON PARENT’S REQUEST?
PEDIATRIC ENUROLOGY
WHEN TO PURSUE TREATMENT OF ENURESIS?Getting night dryness - B. Schmitt, MD
• 3 yo -self awaken hints limit evening liquids void before sleep praise for dry mornings
• 6 yo -concentrate on self-awakening motivational techniques