Many children seem to lose self-confidence as they grow older. The gleeful sense of self-pride that accompanies each childhood accomplishment seems to fade with age into a myriad of doubts: Will I be liked? Will I do well? Will I fit in?

Special needs children have the same questions and, the same doubts as other children do. They want acceptance. They want their peers to like them. They want to be like other kids. Yet they already have to deal with a difficulty, disease or disability that makes them different.

Then add to that the problem of nighttime enuresis – better known as bedwetting. It is estimated that up to 7 million children in the United States wet the bed on a regular basis. "Nocturnal bedwetting occurs in a fairly substantial number of children without a disability: at least 15 percent of 5- to 6-year-olds and even about 1 percent of adolescents. It is not unique to special needs kids," says Dr. Harvey Bennett, medical director of the Stanley L. Lamm Institute for Child Neurology and Developmental Medicine of Long Island College Hospital in Brooklyn, N.Y.

"It follows, then, that (the same) number of special needs children will be affected as well," Dr. Bennett says. "In fact, the number is probably higher since bladder control is part of the nervous system maturation process, something not always complete in special needs kids."

Enuresis in Special Needs Kids
Enuresis often runs in families. If one of a child's parents was a bedwetter, he or she has a 40 percent chance of being one, too. Increase that to 70 percent for children with two parents who are former bedwetters.

Dr. Bennett, who is also associate clinical professor of neurology and pediatrics at State University of New York (SUNY), says parents are the key to helping the special needs child with a bedwetting problem. "The most significant concern of children is their parents," he says. "They fear the parents may be angry, or, at the very least, disappointed. Most children are aware that their 'accidents' cause smells that are considered unacceptable, as well as unwanted increased laundry activity."

These type of issues are potentially stressful to both child and family in a developmental context, according to Dr. Cliff Mevs, a developmental pediatrician with the Brooklyn School for Special Children.

"Children with disabilities are more emotionally fragile than other children," Dr. Bennett says. "Parents need to rise to the occasion, treating bedwetting as one more issue to be resolved with love and attention."

How You Can Help
Most of the treatments for bedwetting in a special needs child apply to all children: decrease fluids before bedtime -- although not to excess -- and increase trips to the toilet. Disposable absorbent underpants such as GoodNites® can help you cope with the situation. The GoodNites Web site offers information specific to enuresis in special needs children. Get product information and money-saving offers at www.goodnites.com/sn.

As the child matures and his bladder catches up to his growth, bedwetting may decrease. If the child continues to awake wet despite precautionary measures, you should investigate the situation with your child's medical caregivers.

"Unlike other children, special needs children see more than one physician," Dr. Bennett says. All of the child's pediatricians, pediatric urologists, neurologists and other medical caregivers should be included in devising the best plan of action.

But how should the problem be treated if a child's disability limits his mobility? "Obviously, a child with motor impairment will have difficulty making it to the toilet," Dr. Bennett says. "The most important thing a parent can do in this situation is to make the child's physical environment as conducive as possible to allow reasonable toileting."

For example, the parent can make sure the bathroom is large enough to accommodate the child's wheelchair. Handrails can be installed, and light switches, sinks and other appliances should be at the appropriate height. "The more easily a child can get to the bathroom, the fewer accidents there will be," says Dr. Bennett. Having an appropriately equipped bathroom will also be physical evidence of support. Support is Key The most important key to a child's bedwetting problem is the support of his parents. "Special needs children need to be supported and told over and over again that (the bedwetting) is not their fault," Dr. Bennett advises. "Punishments are absolutely unacceptable."

The entire family may need help in dealing with the variety of stressors that can accompany bedwetting. "Parents must handle the night-waking episodes, additional laundry and supporting the child in an ongoing and positive manner – while dealing with fatigue," Dr. Mevs points out.

Using products like absorbent underpants or sheet protectors to keep the child's bed dry while working on the bedwetting situation may help everyone cope.

Dr. Bennett adds that parents should follow this advice when dealing with their special needs child's enuresis:

• Do not assume that they will never learn to be dry, unless there are physical impediments.
• Do not assume laziness on the part of the child.
• Do not punish. This will only prolong a difficult time in the child's life.

In addition, you can take positive steps to help you child through the situation:

• Do love and support your child.
• Do reinforce to your child that this condition is not their fault.

And remember that – like any real solution – solving the bedwetting will take time. "It's an investment that's often counted in months," Dr. Bennett says. "It's a poor idea to stop after a week or two. This will just frustrate the child and his parents."