Preschoolers: Dyspraxia and Enuresis

Dyspraxia

Impairment in the development of fine or/ gross motor coordination, oculomotor function, memory, and speech.

may exist in isolation OR concurrent with_____

learning disabilities, autism, or attention deficit disorders

What are the risk factors for dyspraxia

Preterm and SGA are at the highest risk

Effects boys more than girls

Strong familial tendency

Overall, affects 5-10% of children

Signs of dyspraxia

- Delay in acquired early motor skills such as sitting, crawling and walking

- Difficulty getting dressed and using cutlery

- Poor understanding of spatial concepts, such as on/under/over/in front of

- Anxiety and low self-esteem

- Difficulty paying attention, reacts to all stimuli without discrimination

- Works better in small groups or 1:1

- Difficulty managing time

- Often loses things

Is dyspraxia a cognitive impairment

No, as it is caused by reduced cortical thickness and grey matter volume in the cerebellum, amongst sensorimotor and planning locations

Does dyspraxia affect academic achievement and/or activities of daily living

Yes, absolutely

Enuresis

Repeated involuntary voiding by a child who has reached an age at which bladder control is expected.

Primary enuresis

The child never achieved consistent nighttime dryness. Caused by

1) Delayed bladder maturation, or ADH maturation, Deep sleep patterns

2) Genetic factors (familial)

Secondary enuresis

The child was previously dry for 6 months. Can be caused by:

1) Stressors

2) Medical conditions or illness, i.e., UTI, constipation, obstructive sleep apnea

Is enuresis a disease

NO, enuresis is a sign typically of an underlying issue

At what age do children develop the sensation of urinary fullness

years 2-4 years, this is when the muscular development occurs, as well as control contractions of detrusor and relaxation in bladder emptying

When are the kidneys fully developed

By 2 years of age

What is the enuresis criteria

Repeated (>2times/ week) involuntary voiding by a child who has reached the age of 5 years old, at which bladder control is expected.

What is the average age to be toilet-trained

27 months

Monosymptomatic enuresis (MSE)

Nighttime bedwetting without daytime urinary symptoms

Nonmonosymptomatic enuresis (NMSE)

Day & night symptoms

With nonmonosymptomatic enuresis, what questions do you want to ask

- When are they voiding, are they having frequent voids (>8 times per day) or (

What are some symptoms of Primary monosymptomatic enuresis

- Difficulty waking to stimuli

- Familial, underdeveloped bladder

- Overactive detruser muscle

- Nocturnal polyuria, as kidneys do not concentrate urine appropriately, or there is a decrease in vasopressor release from the pituitary

Symptoms of secondary monosymptomatic enuresis

Nocturnal enuresis, which can be supported with management of constipation, UTI, stressors, OSA and diabetic mellitus onset

Causes of primary nonmonosymptomatic enuresis

1) constipation, diabetes mellitus, overactive bladder

2) Underlying neurological disorder

3) Urinary tract obstruction

4) Urinary tract malformation

What assessment data is used for enuresis in regard to a bladder journal

1) Urinary frequency

2) Urinary volume

3) Dysfunction: interrupted, incomplete sensation, urgency, dysuria

4) Time of day

5) Intake: 1-3 hours prior to bedtime; caffeine

6) Abdominal assessment (constipation)

7) UTI: Fever, dysuria, urgency, irritability, FLACC

How can you support children with primary monosymptomatic enuresis

1) Tell parents they will grow out of it

2) Give education, reassurance, and positive reinforcement

3) Void in AM & before bed. AND frequent voiding schedule (q2 to 3hr)

4) Take the child out of the diaper

5) Wear a vibrating watch

6) Optimal posture: sit upright, middle of the toilet, feet on a footstool

7) 80% of fluid intake before 4: 00 pm; no caffeine

8) High fibre diet (constipation)

9) Enuresis alarm

10) Desmopressin (special occasions, sleepover)

Desmopressin

It is a medication that reduces urine production by acting like antidiuretic hormone (ADH), helping the kidneys reabsorb more water. Support normal circadian variation of plasma vasopressin