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66
Associated Medical Conditions
One child was killed in an accident and 59 left the district. Theremaining
38 were referred to other clinics because their enuresis wa6 considered
to be part of a more extensive disorder; 28 to the Child Guidance
Clinic, 9 to the consultant urologist and one to the physician. Three were
found to have organic kidney disease; the child referred to the physician
had acute rheumatism. Those referred to the Child Guidance Clinic had
symptoms of emotional instability such as lying, stealing or aggressive
traits.
Family History
414 (41.4%) of the children had a close relative who had also been
enuretic. 502 (50.2%) had no such history and 84 (8.4%) did not know.
11 educationally subnormal children were treated, 8 of whom (including
two mongols) were discharged dry. Others referred but not treated included
one deaf and dumb subnormal child, one deaf child, one three year
old and one two year old.
The commonest age at the beginning of treatment was six years; (18%),
the next common being 5,7 and 8; (12%, 12.4% and 12.6%) and the average
length of time 5.8 months.
Follow up
In 1967 it was decided to survey 118 children who had been discharged
two years previously. The results were of interest. They showed that of
those who were discharged for non-attendance, 39 out of 44 were still wetting
the bed; showing that the theory that all children will "grow out of it"
is not accurate, or at least that the process takes longer than two years.
Of the 118 children discharged, 14 had left the district. Of the 62 discharged
dry, ten had relapsed to the stage of having more than one wet bed
per month. 7 of these had previously used the buzzer. Of the 42 discharged
for non-attendance still wet, five had become dry, five children had received
further treatment elsewhere since leaving the clinic, one had become dry,
the four others were still enuretic.

Conclusion
Enuresis is due to a neuromuscular disability and aggravated by a child
realising he is unable to satisfy parental expectations. The needs of a child
with this condition are not costly or powerful drugs, but confidence and moral
support, and in many cases the mother requires similar treatment, together with
advice on the management of the child.
The conditioning apparatus or buzzer is a valuable adjunct to this therapy
and is the treatment of choice where speed is essential and in teenage children.
Older children are more resistant to treatment.