Incontinence and sleep disturbances in young children: A population-based study.

AIMS: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI), as well as sleep and behavioral problems are common in young children. The aim of this study was to analyze the association of sleep and psychological parameters for all types of incontinence in a representative sample of young children. METHODS: Six hundred thirty eight (of 1161) children with a mean age of 5.9 years (50.9% boys) were assessed during their mandatory school entry examination. The participation rate was 55%. Instruments included the Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire and other clinical questions. Incontinence was diagnosed according to ICCS standards. Constipation was assessed by two questions. RESULTS: 17.1% of children had at least one type of incontinence, 14.8% had NE, 5.0% DUI, 2.1% FI, and 4.8% were constipated. 6.7% of children had clinically relevant psychological problems. 22.7% of children had sleep problems regularly (5-7 times/week). A wide variety of sleep problems were reported. Children with incontinence were not affected by a higher rate of sleep problems. Children with NE had fewer night wakings and those with constipation fewer parasomnias. Sleep and psychological problems were significantly associated, especially in children with DUI and FI. CONCLUSIONS: Sleep and behavioral problems are common in young children. Psychological problems have a clear impact on sleep. Young children with incontinence do not have more sleep problems than continent children. Therefore, both sleep and psychological problems should be addressed in young children with incontinence.

Incontinence and headache in preschool children.

AIMS: Headaches in preschool children are associated with behavioral and gastrointestinal symptoms. As the co-occurrence with incontinence is not known in young children, the aim of the study was to examine associations of headache, psychological symptoms and nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in a population-based sample of preschool children. METHODS: All preschool children of a defined geographical area were examined at school-entry. Parents completed a 22-item questionnaire, including 14 headache, 4 incontinence, and 25 items of the Strength and Difficulties Questionnaire (SDQ). Five hundred eighty-five children (50.4% males) with a mean age of 5.8 years were included. RESULTS: In total, 27.2% of all children had headaches. 15.7% had secondary and 11.3% primary headaches. Five children had migraine and five tension-type headaches, while all others were unclassifiable. 9.4% of children had incontinence (7.7% NE; 2.4% DUI, 1.2% FI) and 4.0% constipation. The rates of incontinence did not differ between children with primary and those without headache for NE (12.9% vs 7.5%), DUI (3.1% vs 2.7%) or FI (3.0% vs 1.0%), but for constipation (12.1% vs 2.6%). Incontinent children had significantly more behavioral and externalizing symptoms, children with headache more internalizing problems. Primary headache was a significant predictor for internalizing, while constipation and FI were predictors for externalizing symptoms. CONCLUSIONS: This population-based study showed that headache is associated with constipation, but not with incontinence in preschool children. Headache and incontinence are common risk factors for specific psychological symptoms and should be assessed in clinical practice.

Abdominal pain symptoms are associated with anxiety and depression in young children.

AIM: Abdominal pain symptoms and incontinence are common in childhood. The aim of this study was to analyse abdominal pain symptoms and their associations with incontinence and symptoms of anxiety and depression in young children. METHODS: We examined 1130 children during the school entry check-up (mean age 6.2 years) and 951 participated in the study. Parents completed a questionnaire contained 11 items regarding Rome-III functional gastrointestinal disorders (FGIDs) and incontinence and 14 items from the anxious/depressed scale of the Child Behavior Checklist (CBCL). RESULTS: Of the 951 children (55.6% boys) we recruited, 30.1% had experienced abdominal pain symptoms in the past two months and 14% had complained of them at least once a week. In addition, 2.6% had irritable bowel syndrome, 11.3% had childhood functional abdominal pain, 2.4% were affected by faecal incontinence, 2.1% were affected by daytime urinary incontinence, and 5.5% were affected by nocturnal enuresis. One in ten (10.6%) had symptoms of anxiety and depression, and these were significantly higher in the children with FGIDs, particularly if they were also incontinent. CONCLUSION: Nearly a third of the children (30.1%) had abdominal pain symptoms, and FGIDs were associated with significantly higher symptoms of anxiety and depression, especially if children were also incontinent.

Incontinence and parent-reported oppositional defiant disorder symptoms in young children--a population-based study.

BACKGROUND: Oppositional defiant disorder (ODD) and incontinence are common disorders of childhood. We have examined associations between ODD symptoms and incontinence in a representative sample of young children. METHODS: A questionnaire with seven questions referring to incontinence, eight DSM-IV items of ODD, 15 items of the Home Situations Questionnaire and six items regarding eating, drinking or toileting refusal was administered to the parents of 718 children at school-entry from a defined geographical area at school-entry. RESULTS: Of the 718 6-year-old children included in the analysis, 8.2% had nocturnal enuresis (NE), 1.5% had daytime urinary incontinence (DUI) and 1.1% had faecal incontinence (FI). Significantly more boys than girls had NE (12 vs. 4.3%). Overall, 6.7% of children had ODD symptoms. Rates of ODD symptoms were significantly higher in incontinent children (19.5%) than in continent children (5.2%), with the highest rate of ODD symptoms in children with DUI (36.4%). Children with incontinence (mean 6.1 episodes) or ODD symptoms (mean 8.4 episodes) showed non-compliant behaviours in more problem situations than continent children (mean 4.5 episodes) or children without ODD symptoms (mean 4.5 episodes). CONCLUSIONS: Incontinence and ODD are common comorbid disorders at school-entry age. Boys are more affected by both disorders. Children with DUI have the highest rate of ODD symptoms. As ODD symptoms affect many daily family situations, ODD needs to be diagnosed and treated in children with incontinence, as it can negatively affect compliance.