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ENURESIS
Bed-wetting is a common complaint about which assistant medical officers are
frequently consulted and one that is distressing both to parents and child. The age
at which a child becomes dry at night varies considerably, and the reason for this is
that maturation of the nerves which enable voluntary control to take over from
reflex action may take place over a fairly wide age range; in fact, medical officers
are far less concerned than parents in the earlier years. It is usual, however, for a
child to be dry by the time he enters school and, if this has not come about by then,
medical advice is sought—usually at the first routine examination in school. In a
proportion of cases, simple instruction to the parents in the management of the
child, particularly stressing the necessity to avoid punishment and emotional
involvement is sufficient to clear the matter. In a proportion of cases, drugs may
be of value in treatment, in which circumstances parents would be referred to their
family doctor.
A further form of therapy is by means of the electric alarm apparatus and a
number of these machines is held in the Health Department and issued on loan at
the request of medical practitioners or assistant medical officers. The apparatus
works on the principle that the smallest amount of urine passed during the night
completes an electrical circuit which is powered by a low-voltage battery. This sets
off the alarm which wakens the child who can rise and attend to his needs. In this
way, a child is conditioned to remain continent whilst he is asleep.
Children who are selected for this form of treatment are normally over the age of
seven years and are carefully selected for their suitability. Children who are bedwetting
because of anxiety or emotional distress are not normally considered as
suitable, and in all cases treatment is with the knowledge and consent of the child's
general practitioner.
On receiving a request for the loan of the alarm apparatus, a specialist health
visitor arranges to visit the home and demonstrate its use to the parents. A standard
sheet of instructions is also left in case any difficulty should arise, together with the
health visitor's personal card, so that she may be contacted if necessary. Progress
cards are supplied to record the wet and dry nights, and there is provision also for
recording the size of the wet patch as an additional guide to progress made. A
second visit is usually made one week later to ensure that the machine is being used
correctly. The parent is advised not to discontinue the use of the machine until there
has been a three week period without a wet night. If, however, a child requests
to have the machine removed because he feels confident that he no longer needs it,
then the parent is encouraged to let him try. If he happens to relapse, then the
use of the machine can be continued for a further period. A further home visit is
paid after six months to ascertain that progress has been maintained.
During the year, the apparatus was loaned to 65 children. The great majority
of these children became dry or were improved after a single course of treatment.
CHILD GUIDANCE
Child guidance services are available at three points in the Borough, at Madeley
Road Centre and at Avenue Road and Northolt Grange Clinics.
The service to children in Southall prior to the amalgamation was provided by
Dr. Levinson of the Hounslow Child Guidance Clinic but, from April, 1965,
Dr. Portia Holman, M.D., F.R.C.P., D.P.M., of the Ealing Child Guidance Clinic,
accepted all referrals from Southall, although Dr. Levinson continued for a while the
treatment of children referred to him before 1st April, 1965.
The service of the whole Borough is now under the supervision of Dr. Holman,
who reports:
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