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3. Additional Home Care When Your Child Reaches Age 6

Follow the previous recommendations in addition to the guidelines given below:

1. Help your child understand his goal.
The key to becoming dry is to learn how to self-awaken every night and find the toilet. Getting up and urinating during the night can keep your child dry regardless of how small the bladder is or how much fluid he drinks. Help your child assume responsibility for doing this. Some children think that enuresis is the parent's problem to solve; they need to be reminded that "only you can solve this."

2. Have a bedtime pep talk about self-awakening.
To help your child learn to awaken himself at night, encourage him to practice the following routine at bedtime:

o Lie on your bed with your eyes closed.
o Pretend it's the middle of the night.
o Pretend your bladder is full.
o Pretend you feel the pressure.
o Pretend your bladder is trying to wake you up.
o Pretend your bladder is saying, "Get up before it's too late."
o Then run to the bathroom and empty your bladder.
o Remind yourself to get up like this during the night.

3. Daytime practice of self-awakening.
Whenever you have an urge to urinate and you're home, go to your bedroom rather than the bathroom. Lie down and pretend you're sleeping. Tell yourself this is how your bladder feels during the night when it tries to awaken you. After a few minutes, go to the bathroom and urinate (just as you should at night).

4. Parent-awakening.
If self-awakening fails, use parent-awakening to teach your child the correct goal: urinating into the toilet during the night. It makes much more sense than putting your child back into pull-ups and having him urinate in bed every night (the wrong goal). Your job is to wake your child up; his job is to locate the bathroom and use the toilet. You can awaken him at your bedtime. Try a hierarchy of prompts (the minimal one being the best), ranging from turning on a light, saying his name, touching him, shaking him or turning on an alarm clock. If your child is confused and very hard to awaken, try again in 20 minutes. Once he's awake, he needs to find the bathroom without any directions or guidance. When he awakens quickly to sound or touch for 7 consecutive nights, he's either cured or ready for an enuresis alarm.

5. Encourage changing wet clothes during the night.
If your child wets at night, he should try to get up and change clothes. First, if your child feels any urine leaking out, he should try to stop the flow of urine. Second, he should hurry to the toilet to see if he has any urine left in his bladder. Third, he should change himself and put a dry towel over the wet part of the bed. (This step can be made easier if you always keep dry pajamas and towels on a chair near the bed.) The child who shows the motivation to carry out these steps is close to being able to awaken from the sensation of a full bladder.