The Impact Of Using Disposable Diapers And Early Toilet Training On Prevalence Of Children's Enuresis

BackgroundPrimary nocturnal enuresis(PNE),also called bad-wetting,is one of the main diseases affecting children's physical and mental health.Using the International Children's Continence Society(ICCS)and World Health Organization(WHO)definitions and criteria,the symptom of PNE requires a minimum age of 5 years,a minimum of one episode per month and a minimum duration of 3 months to be termed a condition.The etiology of PNE is related to many factors,including delayed development of bladder control,dysfunction of bladder,hereditary factors,sleep wakefulness disorder,mental factors and abnormal secretion of anti diuretic hormone.If not timely diagnosis and treatment for sick children,1%~2% may cause lifelong bed-wetting.According to this diagnostic criteria a cross-sectional study of PNE was performed in 2006 by our team and it was found that the overall prevalence of PNE in Chinese children aged from 5 to 18 years old was 4.07%,and the prevalence of PNE decreased with the increase of age,from 11.83% in 5-year-old children to 4.19% in 10 years old and 1.05% in those over 16 year-old children,we also found that the prevalence of PNE in boys is significant higher than girls.At the same period Byrd reported the prevalence of PNE in America children aged from 5 to 17 years old is 10.63%,and 33.0% in 5 years old children.Spee-van reported in Holland children aged from 5 to 15 year-old is 6% and 15% in 5 year-old children.Chinese children's prevalence of PNE is lower than that reported from the West.At that time,the author postulated the possible reason may be due to the great cultural and economic differences between China and western countries.Chinese parents always wake up their children to void on time,started toilet training at early age and used less disposable diapers than the West,which might promote children to get voiding control ability.While children in West used disposable diapers(DD)too much and lacked of early toilet training(ETT)and caused them still wet the bad after 5 year-old.However,the conjecture was not supported by relevant literature and research data at the time.Meanwhile,the “toileting training guide” published by American association of pediatric(AAP)is playing an significant effect on human concept on the early toilet training in China.It advised that toilet training worked best for most families if it could be delayed until the child was ready to control much of the process herself,Children younger than eighteen months not only were unlikely to be ready in terms of badder and bowel control,but also might not yet have the physical skills needed to get to the potty and remove their clothing in time.Some children were ready to start toilet training at eighteen months,while others would begin until age three of four for learning more quickly and easily.Before that,it is good for children to use DD to void.However,with the development of society,some child carers and clinical experts recognized long-time dependence on diapers and delaying toilet training may be no benefit to children,which may be associated with urinary tract infection,unstable bladder,urinary frequency and urinary incontinence and some other excretion problem in children.This survey aimed to investigate the prevalence of PNE in China,dates about disposable diapers usage and early toilet training,and other related factors with PNE.An epidemiological survey on PNE among 15786 children and adolescent aged from 5 to 18 years old was carried out in 5 province with a high population density in mainland of China.These provinces are Hebei Province in the north,Henan Province in the middle,Shanxi Province in the west,Fujian Province in the south-east and Guangdong in the south of China Objective1.To investage the present prevalence of PNE in Chinese children and adolescent aged form 5 to 18 years old2.To describe the relationship between DD and prevalence of PNE3.To describe the relationship between ETT and prevalence of PNE Materials and MethodsFrom May 2017 to December 2017,an epidemiological survey on PNE among children and adolescent aged from 5 to 18 years old was carried out in 5 province with a high population density in mainland of China including Hebei Province,Henan Province,Shanxi Province,Fujian Province and Guangdong.Twenty primary schools,15 junior and 15 senior high schools in total were chosen by means of systematic sampling,and classes were randomly chosen according to the children's age distribution in the school.Totally 15786 children were investigated and questionnaires were filled by their parents,The contents of the questionnaire included if their children still have bed-wetting,dates about disposable diapers usage and early toilet training,and other related factors about PNE.ResultsThe present prevalence of PNE in Chinese children aged from 5 to 18 years old is 7.88%,which increased significantly compared to those of investigation in 2006 in China.We found that the longer time of using diapers,the later ETT,the higher the prevalence of PNE would be.The delay of beginning ETT as well as using of dipper more than 6 months were high risk factors for the increasing prevalence of enuresis.ConclusionThe possible of reason of significant increase of present prevalence of PNE compared to 10 years ago should be related to the long-term usage of diaper producing the dependence of it,and delay of toilet training(TT)that postponed the development of voiding control mechanism.We recommend the rational using diapers with early TT for expecting to reduce the increased prevalence of PNE in China.