Early childhood psychological factors and risk for bedwetting at school age in a UK cohort.

Carol Joinson,Jon Heron,Alexander Von Gontard,Sarah Sullivan

doi:10.1007/s00787-015-0756-7

Carol Joinson, Jon Heron + Show 2 more

Open Access

https://doi.org/10.1007/s00787-015-0756-7

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Abstract

There is evidence for a link between psychological factors and bedwetting, but the direction of this association is unclear. Using data on 8769 children from the Avon Longitudinal Study of Parents and Children, we examined whether difficult temperament (Toddler Temperament Scale at 24 months; Emotionality Activity Sociability Questionnaire at 38 months) and psychological problems (Revised Rutter Parent Scale for Preschool Children at 42 months) are linked to bedwetting at school age. We examined the association between these risk factors and different patterns of bedwetting from 4 to 9 years using multinomial regression. Difficult temperament and psychological problems in early childhood were associated with increased odds of bedwetting at 4–9 years. The strongest associations were most often found for the pattern of bedwetting that was both frequent (at least twice a week) and persistent (up to age 9) e.g. the temperament traits of ‘adaptability’ and ‘mood’ were associated with a 33 % increase (95 % confidence interval = 1.14–1.55) and a 27 % increase (1.10–1.47) respectively in the odds of persistent and frequent bedwetting per one standard deviation increase in risk score. Early behaviour problems (e.g. conduct problems [1.43 (1.25, 1.63)] and hyperactivity [1.29 (1.11, 1.50), p < 0.001]) were also associated with frequent and persistent bedwetting, but there was less evidence that early emotional difficulties were risk factors for bedwetting. Adjustment for confounders did not alter these conclusions. The presence of difficult temperament and behaviour problems in early childhood might help to identify children who will continue to experience bedwetting at school age.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-015-0756-7) contains supplementary material, which is available to authorized users.

Highlights

The prevalence of bedwetting decreases with age [1], with most children attaining nighttime bladder control by around 4–6 years [2]; a significant number of children are still wetting the bed at school age
The proportion of children with bedwetting decreased over time and proportions did not change markedly when the sample was restricted to participants with more data— see [18]
We focused on the sample with bedwetting data available from at least three time-points (n = 8761) for the analyses presented here, but conclusions were consistent for the other two samples

Summary

Introduction

The prevalence of bedwetting decreases with age [1], with most children attaining nighttime bladder control by around 4–6 years [2]; a significant number of children are still wetting the bed at school age. Bedwetting was reported in 15.5 % of 7-year olds in the Avon Longitudinal Study of Parents and Children (ALSPAC) [3]. Nocturnal enuresis is the term used by the International Children’s Continence Society to describe bedwetting in children aged 5 years or older after ruling out organic causes [4]. The aetiology of bedwetting is believed to be multifactorial, involving a complex interrelationship of biological, developmental, genetic, psychosocial and environmental factors. The relative importance of each type of risk domain is unknown and the extent to which each one contributes to the risk for bedwetting is likely to differ between children. There is evidence for a link between bedwetting and psychological factors, but the direction of this association is unclear since the majority of earlier studies are crosssectional—see [5] for a review.

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