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Bedwetting, behaviour and self-esteem: a review of the literature
1Department of General Practice and Primary Health Care, Faculty of Medicine and Biological Sciences, University of Leicester, Leicester, UK.
Insights
This review found limited evidence on how bedwetting affects children's self-esteem, with more research needed. However, there is evidence linking bedwetting to increased behavioral issues in children.
Area of Science:
- Pediatric psychology
- Child development
Background:
- Bedwetting (nocturnal enuresis) can impact a child's emotional and behavioral well-being.
- Understanding these impacts is crucial for effective support and treatment.
Purpose of the Study:
- To review empirical evidence on the effects of bedwetting and its treatments on children's self-esteem and behavior.
- To assess the quality and limitations of existing research in this area.
Main Methods:
- Systematic review of empirical studies published between 1973 and 1999.
- Inclusion criteria: children aged 5-16 with primary nocturnal enuresis, using self-esteem or behavior measures.
- Focus on child-reported scales, with inclusion of parent-reported measures.
Main Results:
- Fifteen studies met the criteria; most were not randomized controlled trials.
- Evidence for sample bias and limitations in study designs (e.g., parent-reported data, lack of matched controls).
- Empirical support for increased behavioral problems in children with bedwetting, particularly older children with complex issues.
Conclusions:
- Current evidence on the impact of bedwetting on self-esteem is not convincing due to methodological limitations.
- Further high-quality research is needed to understand treatment effects on self-esteem and the causal relationship between bedwetting and behavior.
- Bedwetting is associated with behavioral problems, but the direction of causality requires more investigation.
Aim:
The aim of this review was to examine the empirical evidence on the impact of bedwetting and its treatment on a child's self-esteem and behaviour.
Inclusion Criteria:
The inclusion criteria for this review were empirical studies conducted on children, aged 5-16 years old, with primary nocturnal enuresis using measures of self-esteem or behaviour. Studies utilizing psychological measurement scales completed by children were the main focus although those that used scales completed by parents were also included.
Search Strategies:
The electronic databases from 1981 to 1999 were searched, and hand searching of the literature dating back to 1973 was conducted using the reference lists of key papers.
Research Findings:
Fifteen empirical studies matched the inclusion criteria. There was only one randomised-controlled trial and the rest of the studies were cohort, case-control or cross-sectional design. Evidence of sample bias predominantly due to the use hospital-based and/or 'volunteer' subjects was found in five studies. A further five studies used birth cohort data, which excludes important variables such as the impact of treatment. Four studies used single parent-reported measures, which may under or over-estimate the problem. No large cohort studies were available which compare the self-esteem of bedwetting children with matched controls. The most interesting line of enquiry is pursued by studies looking at whether self-esteem improves with successful treatment. However, the use of self-selected subject groups does not make the current evidence convincing and more work is required to determine outcomes for all children. There is empirical evidence for increased behavioural problems in bedwetting children. Studies conducted on younger children report less behavioural problems with more reported in studies conducted on older children with complex wetting disorders. This may point towards wetting being the primary problem, but more work is needed, as causation in any direction is difficult to ascertain from the literature.