Enuresis among school-entrants in the changing population of Israel.

Abstract

Children generally acquire bladder control at the age of 3 to 4 years, but some fail to achieve this con trol at the appropriate age. Since enuresis is a source of suffering for the child and his parents and may have secondary effects on the child's emotional development, pediatricians, general practitioners, child psychiatrists, psychologists, and educators concerned themselves with this problem. Many theories have been advanced to explain the aetiology and pathogenesis of enuresis. Somatic factors, familial and constitutional factors, disorders of personality, and environmental conditions have been suggested as influencing enuresis. The medical literature on enuresis has been re viewed by Dimson (1959) and Bakwin (1961). The papers mentioned in these reviews deal almost exclu sively with children brought up in Western countries where conditions of life and patterns of child-rearing are comparatively well-established and are not under going major changes. Surveys carried out in Israel (Caplan, 1954; Levin, 1956; Kafman, 1957) have described the problem of enuresis among children of Western parentage in the communal settlements (kibbutzim). We have had the impression that the problem of bed-wetting has its peculiar public health aspects in Israel in the special conditions of a country of immigration. During the last 15 years over a million immigrants have entered Israel, more than doubling the previous population. The majority came from the Near East and North Africa, and these new comers have undergone a profound process of social adjustment and cultural adaptation in an entirely new environment. The possibility of comparing them with the stable population caused us to concentrate mainly on the possible environmental causation of enuresis and the relationship between social-cultural patterns and the disorder. A similar method of reasoning was noted by the Expert Committee on Epidemiology of Mental Dis orders (W.H.O., 1960) in regard to the examination of socio-cultural change in relation to the distribution of psychiatric disorders: If high correlations were found between social change and disorganization and psychiatric disorder, and conversely a relative lack of disorder in the stable sector of the population, there would be an opportunity to gather evidence on the kinds of disorders most likely to be related to environ mental conditions.