If the parents have exhausted all avenues at curing the bedwetting, the youngster should wear protection to bed for a number of reasons. First, it's important to wear protection in order to maintain an appropriate level of hygiene – it's not healthy for the skin to lie all night in wet clothing and bedding. In the article “Prevention of Incontinence-Associated Dermatitis in Nursing Home Residents” published in the Annals of Long-Term Care: Clinical Care and Aging, Della Lambert, a nurse certified in wound, ostomy, and continence nursing, had this to say: “Ammonia in urine is caustic, making the skin susceptible to breakdown”. By wearing protective garments to bed there's less exposure of the skin to urine. Wearing protective garments coupled with a good skin care regimen can prevent the skin damage resulting from long term exposure to urine. Second, it makes cleanup easier – wearing overnight diapers reduces or eliminates the wet laundry resulting from nighttime accidents. Third, it eliminates the urine odor accompanying wet beds. Finally, it's uncomfortable waking up in a cold, wet bed, especially in wintertime.
Most children and teenagers are embarrassed about discussing this issue so it's important that you be discreet about it and approach this subject in a sensitive manner that respects their feelings and allows them to retain their dignity. You can say something along these lines: “I'd like to talk to you about something. I understand you may feel embarrassed discussing this, but I can't stress this enough ‒ this is nothing to be ashamed of – there are plenty of people all over the world in all age groups (including many adults) who also have this problem. As you've guessed by now, I'm talking about your nighttime accidents. I realize how unpleasant it must be waking up in a cold, yucky, wet bed and I want to take some steps to make you feel more comfortable and secure. I'd like to try a little experiment – I think it'd be a good idea for you to wear protection to bed. There are diapers available in your size and I'd like for you to wear them. The reason we’re having you wear a diaper to bed is that we’ve tried various methods to cure your bedwetting and they haven’t worked. I've come up with an idea for a reward system which I think might make wearing the diapers easier and even fun. I can see that you’re anxious about this but just hear me out.”
“Here's how the system will work. I want you to choose three things that you really like – things like toys, books, and other stuff along those lines and rank them in the following way – your favorite item, your second favorite item, and your third favorite item. Once you pick them I'll purchase them – these will be presents you'll receive for wearing the diapers. If you wear the diapers to bed for at least 7 days you'll receive your third favorite present, if you wear them to bed 8 to 29 days you'll receive your second favorite present, and if you wear the diapers to bed for the entire month you'll receive your favorite present.” The child or teenager doesn't have to wear the diapers consecutively – for example the youngster may skip some nights but still wear them 7 days total that particular month, and they'll still earn the present you both agreed on for wearing them that number of days. It would be a good idea to set up a chart in their room so both of you can monitor their progress.
I would add the following: “You probably feel that you're too old to be wearing diapers, that diapers are just for babies, but I suggest you look at it in the following manner ‒ it's more babyish if you don't wear a diaper to bed. Part of being an adult is taking responsibility for managing the various problems we encounter throughout our lives, this includes different health problems. In some cases we may not prefer the options available to handle these problems, but as adults we learn how to adjust and make the best of the situation. By wearing the diapers to bed you're demonstrating how mature you are because you're taking care of the problem in a responsible, adult manner. As I said there are people of all ages – including many adults ‒ who wet the bed and most people with bedwetting problems wear diapers to make them feel more comfortable and secure in addition to making cleanup easier.”
“You may feel embarrassed about wearing diapers to bed, but this is a common feeling and it will go away over time - some adults with bedwetting problems are embarrassed about wearing them as well and they also have difficulty adapting to wearing diapers to bed. Eventually though, they get used to wearing them. In fact, there's a website where adults with bedwetting problems share their thoughts and feelings about living with bedwetting, discuss their experiences dealing with bedwetting, as well as talk about how they cope with the problem. One man, who's 29, described how he felt about having to wear a diaper to bed. He said that he was also anxious about wearing the diaper at first, but he got used to it over time and now he wouldn't even think of going to bed without it on ‒ he feels it's much better wearing a diaper because he gets a good night's sleep and he avoids having to launder bedding and clothing. Later on we'll go to the website and read about how he copes with wearing diapers overnight.”
I would also explain the advantages of wearing diapers to bed. As mentioned at the outset of this chapter, there are several reasons for wearing diapers to bed: you wake up nice and dry, there's less laundry to take care of, it prevents the skin damage that can occur from lying all night in wet bedding and clothing, and it prevents the smell of urine from permeating the room. According to an NAFC (National Association for Continence) article, “Bedrooms can pick up a urine smell even if parents take care of wet beds promptly”. By wearing the diapers to bed you avoid the urine smell entirely.
It may be necessary to experiment with the system and tweak it a bit depending on the circumstances – children and teenagers have different interests and tastes and the reward system will have to be tailored to those tastes, specifically regarding what presents to choose for the reward system. For instance one child or teenager may like books the most, video games second, and clothing may be their third favorite. One youngster may have a hobby such as painting or sketching and you can get them art supplies. Some children or teenagers may want a particular phone such as an iPhone or a Samsung Galaxy. If the parent or parents’ finances permit, I would make this a part of the reward system, but make it the present they can earn for wearing the diapers to bed the whole month. These are just some ideas – it's good to be creative in this situation.
In order for the reward system to be effective it's important that you let them choose things they really like. I would try this system for a month and see how it goes. If at that point the child or teenager feels comfortable wearing the diapers to bed you won't need to use the reward system anymore. If they haven't you can try it for another month, then a third month, etc. – every person is different. It could take several months for them to feel completely comfortable putting their diapers on before going to bed. After a suitable amount of time, however, the child or teen should get acclimated to wearing the protection at night and view wearing the diapers as just a normal part of their bedtime routine – no different than brushing their teeth before going to bed.
The reward system should be supplemented with verbal encouragement as well ‒ “We're really proud of you for giving this a shot. I know it's no fun wearing them but just remember there are plenty of adults all over the world who wet the bed and they also need to wear diapers at night. And just think of the advantages of wearing them – you'll wake up to a nice, dry, bed, they'll be less laundry to do, wearing them is more hygienic than lying all night in wet bedding and pj's, and you'll spend less time in the morning washing up ‒ many children, teenagers, and adults that wet the bed take showers in the morning and by wearing protection to bed you won't have to spend as much time on clean up – you’ll just have to clean up around the diaper area. Plus, you can make wearing the protection fun and challenging by viewing the reward system as a game or contest ‒ the rules of the contest are wearing the protection to bed, and the prizes you'll win by following the rules are the various presents you'll receive.”
I would also add something like the following to reinforce how pleased you are that they're giving the reward system a shot – “We're really proud of you for wearing the diapers to bed and you're making great progress. Let's look at the chart. Wow! You've worn them 20 days this month – that's spectacular! I know you've gotten frustrated on some nights and didn't put your diapers on, but that's okay. You've gotten some nice presents and we're very proud of you for sticking this out. Do you think you can wear them for 10 more days? As I’ve said before, I realize that it’s no fun wearing diapers, but if you can wear them for 10 more days you'll receive the iPhone you've always wanted. Let's shoot for that – I know you can do this. You've come so far and have worked so hard, I don't want you to give up now.”
There are several other ways a parent can encourage an older child or teenager to wear diapers to bed. One way is to get them to look at the diaper as a dam and the bed as a city – the dam (in this case the diaper) keeps the city (in this case the bed) from getting flooded. They can also pretend they're a superhero and the diapers give them special powers – in this case the power to keep their bed dry. A third way is to compare the diaper to a band aid – both are used for hygienic purposes as well as keeping off fluids from various surfaces. The diaper is a band aid for the bladder. Just like a regular band aid it helps the wearer maintain hygiene and it keeps fluids off various surfaces – in this case it prevents urine from getting on the bed. A fourth way to encourage the youngster is to get them to look at the diapers the same way they would a raincoat, a rainsuit, or an umbrella – all of these items are used to keep a person dry and comfortable. This analogy is particularly fitting if they're wearing cloth diapers and plastic pants. Finally, you can tell them that wearing a diaper is no different than wearing glasses or braces for the teeth – although it may be a bit awkward and uncomfortable at first, over time the person gets used to wearing them.
You can also add some humor to the mix. There are several things you can say - “Another good reason for wearing the diapers is that if you don't wear them, it'll be like Niagra Falls in your bed”, “Wearing the diapers to bed will prevent you from waking up with a rainbow in the room,” “If you don't wear the diapers and plastic pants you'll have to wear a life preserver or life jacket to bed”, “We think wearing adult size Pampers is the best option – that way you don't have to wear a raincoat to bed.” These are just some of the things you can say to add a little levity to the situation. Some of the ideas mentioned in chapter 5 of this book (about ways to tell a significant other you have to wear a diaper to bed) are also applicable to this situation. I think it would be a good idea to have your child or teen look them over – reading them should make them feel more at ease and put them in a better mood about the whole situation.
Some children or teenagers may resist wearing diapers because they feel you're using them to punish or humiliate them. I've heard and read about some parents using diapers as a form of punishment. I find this practice reprehensible and consider it a form of child abuse plain and simple. It's important that you assure them that you are not having them wear diapers to punish and/or humiliate them. Any concerns must be addressed by the parents and you need to reassure them that the only reason you're putting them back in diapers is to keep them dry, comfortable, and secure, to protect the bed, as well as for hygienic purposes. I think this reward system can be a very effective tool to help young people adjust to wearing protection to bed. In order for it to be effective though, the parents and their older child or teenager must stick with it.
At this point many parents are asking the following question – “how long should we use the system?” The goal of the system is to get to a point where the child or teenager is wearing their diapers to bed every night. Since each youngster is different there are a number of different scenarios that could occur. There could be a child or teen that wears their diaper the whole month at the beginning and the next month they skip a few nights. Or you could have a situation where it’s the exact opposite – the child or teen skips a few nights the first month and wears the diapers to bed every night the second month. Or you could have a child or teen that wears the diapers to bed for two whole months straight and then the next month they skip a few nights. As you can see there are multiple ways this could play out. One way to proceed is to stop the rewards after the youngster wears the diapers to bed for a whole month straight. If the next month they skip wearing the diapers a few nights I would implement the reward system again. I would proceed like this for 6 months. By that time I would think that the youngster should get used to wearing their diaper to bed, however if the youngster is still not comfortable wearing their diapers you may have to continue the system a few months longer. I suppose it’s possible that it might take some youngsters a year to feel completely comfortable wearing nighttime diapers, but I would think that this wouldn’t happen in the majority of cases. I think that it’s important to periodically remind the youngster that people of all ages wear diapers and that there’s nothing to be ashamed of.
Another point to take into consideration is the following. There is the distinct possibility that some children or teens feel comfortable wearing their diaper to bed but deliberately stop wearing it a few nights in order to keep getting the presents. Parents have to gauge how honest their child or teen is and take this into consideration when using the system. If the parents have a child or teenager that has a history of being dishonest I would be upfront with them and say the following: “I want to make it perfectly clear that if I suspect that you’ve gotten used to wearing the diapers to bed but you’re deliberately skipping a few nights just to continue getting presents there will be serious consequences.” This puts them on alert that you won’t tolerate any funny business.
Right now I’d like to raise the following point. I honestly feel that the plan I outlined in this chapter will work with the majority of children and teenagers, however if there are holdouts parents may have to take a more firm approach. This in turn raises another question – should parents require their older child or teenager to wear a diaper to bed if they have been unsuccessful curing their bedwetting or if it looks like they might wet the bed their entire life? Most pediatricians and other medical professionals feel that parents should not force their youngster to wear diapers and although I agree with this in principle, I feel that in reality it’s not practical. I think it’s a good idea for the parents to require a youngster to wear a diaper to bed if they haven’t been able to cure the bedwetting for whatever reason. While I don’t feel a parent should be callous about how they approach their youngster about wearing diapers, I do feel that in some cases it’s necessary for the parents to make the ultimate decision in this matter. I address this issue in greater detail in chapters 9 and 10 of this book.
For a while the youngster may feel frustrated and want to give up, but with the right rewards put into place, and the appropriate amount of encouragement and TLC, over time the youngster will get accustomed to wearing the protection, and in fact he or she wouldn't even think of going to bed without it on.
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