Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1985-1993 (doi:10.1542/peds.2006-0894)
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ARTICLE

Psychological Problems in Children With Daytime Wetting

Carol Joinson, PhDa, Jon Heron, PhDa, Alexander von Gontard, MDb and the ALSPAC Study Team

a Department of Social Medicine, University of Bristol, Bristol, United Kingdom
b Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany

OBJECTIVE. This population-based study investigated the psychological problems associated with daytime wetting in children.

METHODS. A sample of 8213 children (age range: 7 years 6 months to 9 years 3 months) who were enrolled in the population-based Avon Longitudinal Study of Parents and Children participated in this study. Parents completed a postal questionnaire asking about their children's toileting behavior and assessing psychological problems, including childhood emotional and behavioral problems (99% completed the questionnaire by the time their child was 8 years 3 months of age). The rate of psychological problems was compared in children with daytime wetting and in those with no daytime wetting. Analyses adjusted for developmental delay, gender, sociodemographic background, stressful life events, and soiling.

RESULTS. {chi}2 tests of association and multivariable logistic regression indicate that children with daytime wetting have a higher rate of parent-reported psychological problems than children who have no daytime wetting. It is particularly notable that the reported rates of attention and activity problems, oppositional behavior, and conduct problems in daytime wetting children were around twice the rates reported in children with no daytime wetting.

CONCLUSIONS. The increased vulnerability to psychological problems in children as young as 7 years of age with daytime wetting highlights the importance of parents seeking early intervention for the condition to help prevent later psychological problems. Although treatment in a pediatric setting is often successful, clinicians should be aware of the increased risk of disorders, such as attention-deficit/hyperactivity disorder, in children with daytime wetting, because this is likely to interfere with treatment.

Key Words: child behavior • incontinence • daytime wetting • psychological problems

Abbreviations: DSM-IV—Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition • UTI—urinary tract infection • ADHD—attention-deficit/hyperactivity disorder • ALSPAC—Avon Longitudinal Study of Parents and Children • DAWBA—Development and Well-Being Assessment • WISC-III—Wechsler Intelligence Scale for Children III • SEN—special educational need • OR—odds ratio • CI—confidence interval

Accepted Jun 27, 2006.


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