Rewards

There is much commentary out there about rewards and whether or not they are appropriate for dealing with enuresis and night time toilet training. But you will know your own child and what works best for them. Sometimes even taking action and making up a reward chart is enough to show the child that you care and are willing to help them get through this difficult phase. Rewards can help to reverse the negative emphasis on wet beds. Rewards often work best when combined with an alarm programme or scheduled wakening - see your GP for more information.

Star Charts for Bedwetting
Rewards can be used to reinforce behaviour aiming at dry nights and helps to maintain self image. Star or sticker charts are a reward system to encourage desired behaviour changes, such as going to the toilet before bed.
Reward charts can help change the behaviours that can have an influence on bedwetting but only sometimes cure the actual wetting.
They can be useful for decreasing the impact on the parents - for example, older children can easily remove a Brolly Sheet during the night, get changed into dry pyjamas and go back to sleep, all without disturbing mum or dad. By rewarding this helpful behaviour, the bedwetting becomes far less of a problem for everyone. Rewards should be used with lots of praise smiles and hugs.

Sometimes a positive comment e.g. "I like the way you go to the toilet before bed" combined with a hug is all that is required.

What behaviours to reward:
• Keep things simple and reward effort rather than result - remember keeping the bed dry is not directly under the child's control.
• Behaviour rewarded needs to be defined, clear and observable.
• Reward small steps - break the behaviour down to achievable goals.
• Allow early success and rewards.
• Avoid different rewards for different behaviours.
• Highlight behaviours one at a time.
• Change the menu from time to time
Examples of behaviour that can be rewarded:
• Going to toilet before bed
• Getting up to go to toilet
• Getting up to alarm
• Helping to change wet sheets
• Stop functional payoff e.g. not going to parents' bed after wetting.
• Not having temper tantrums

Be Careful!
• Stop if child is bored or can't achieve goals, this can undermine their confidence.
• Review the information on how to tell if your child is ready to be dry at night! Many children are not ready until well after they are 4 years old, and trying to 'train them' with a sticker chart will not work if they are not physically capable of staying dry - especially true with boys!

How to reward
• Chart should be specially made for each child – let them get involved.
• Make chart interesting and attractive, an older child may prefer a diary.
• Negotiate rewards the child truly values, but do not "break the bank."
• A limited choice of items gives mastery.
• Allow child to reward the whole family e.g. play at park, video rental
• Immediate reinforcement is best - use a token or sticker to swap later
• Once the reward is given, it should not be taken away.
• Always give praise and encouragement.
Examples of rewards: Best rewards cost time rather than money
• Special time with parents, e.g. 10 minutes extra playtime with parents.
• Extra privileges at home, e.g. choosing dessert for family.
• Special activities outside.
• Trip to park.
• Choosing a favourite cereal at the supermarket.
• Coin or $2 shop.

Our thanks to the Bedwetting experts at The Continence Assn for this excellent information http://www.continence.org.nz/index.php

Something fun to try - A ‘Dot-to-Dot’ surprise bag

Draw a large dot-to-dot picture of your child’s favourite and for every achievement the child joins up two dots. Every fifth dot is a larger one and reaching that is rewarded by a Surprise Bag which represents a small treat. This does not have to be a present - it could be time with a parent, playing a game or reading a story. Completing the dot-to-dot picture could result in a larger reward or the toy itself.

Another option is to make use of a Progress Chart. This helps you and the child monitor the frequency of his dry nights and can encourage him when he realizes that he doesn’t wet the bed as often as he thinks!