Childhood Cancers

To nurse one child in Nigeria with cancer, you need about N2 million on the average in a period of about two years

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By Drs. Azeezah Shopeyin and Ajayi Abass 

Childhood cancers occur in children less than 15 years. They are devastating not only to the children but their entire family. In Nigeria, it creates a huge financial burden on the family as there is no supportive treatment plan for children and the cost of treatment is very high.

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Cancer leads to abandonment of treatment and consequently death of children. Hence, prevention of childhood cancers cannot be over emphasized. It’s important to note that in most fields of medicine, pediatrics have been found to be of significant challenge, because of communication challenges, and caregiver support.

Burden to public health

The international agency for research on cancer stated in 2004 that worldwide 160,000 children under 15 years get childhood cancers and 90,000 will die from it every year. In 2007, 71.2 of every 1 million Nigerian children below 15 years had childhood cancers.

Due to the lack of data in Nigeria, and the paucity of studies on childhood cancers, it is not easy to appreciate the burden of childhood cancers, this might be due to the preoccupation with infectious diseases which are said to cause about 25% of childhood deaths.

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In an 11year retrospective study conducted in northern Nigeria, by A. Mohammed and A.U Aliyu, it was noticed that childhood cancers were 8.44% of cancers diagnosed within that period. A male: female ratio of 1.5:1.

In 2014, Consultant Paediatrician, Oncology/Haematology Unit of the Lagos University Teaching Hospital, LUTH, Dr. Adebola Akinsulirie, said about four or five cases of childhood cancer are seen monthly at the LUTH. That will give you about 50 children in a year. That is big as far as cancer in children is concerned in Nigeria. To nurse one child with cancer, you need about N2 million on the average in a period of about two years.

Types of childhood cancers

The most common childhood cancers accounting for childhood deaths in Lagos  include kidney cancer (nephroblastoma) and blood cancer (Acute lymphoblastic leukemia and Acute myeloid leukemia)

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Lymphomas (solid cancer of white blood cells) are also quite common childhood malignancies and neuroblastoma (cancer of nerve cells), others include leukemias, bone and muscle tumors.

Causal or pre-disposing factors

The cause of most childhood cancers are unknown in about 75-90% of cases, 5-15% are due to familial and genetic factors( intrauterine viral infections, parental occupational/ radiation exposures, war-torn regions and disasters, elderly maternal age above 35, parental especially maternal smoking and alcohol consumption.

 

and <5-10 % are due to known environmental exposures and exogenous factors (food, radiation, dyes, infections like intrauterine viral infection Epstein-Barr virus and leukemias/ lymphomas etc). It’s important though to note that cancers generally are caused by a variety of factors and are not limited to a single causative agent.

How to recognize childhood cancers early

Complaints about any of the following that does not go away in a child:

  • Feeling of an unusual lump or swelling
  • Unexpected paleness and loss of energy
  • Easy Bruising
  • An ongoing pain in one area of the body
  • Limping
  • Unexplained fever or illness that doesn’t go away
  • Frequent headaches, often with vomiting
  • Sudden eye or vision changes
  • Sudden unexplained weight loss

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Prevention of childhood cancers

  1. Avoidance of chewing or smoking tobacco.
  2. Protection from sunlight.
  3. Limiting fats in diet
  4. A healthy diet with at least 5 portions of fruits and vegetables per day.

Management of childhood cancers

Childhood cancers are managed by a team of specialized pediatric cancer care specialists, including pediatric oncologists, pathologists, radiologists, surgeons, radiotherapists, nurses and support staff include the nutritionist, social workers, pharmacists and other medical specialists. First, a correct diagnosis is made; depending on the stage of the disease from Investigations carried out, the child is given drugs,  and surgical intervention or radiation therapy may be necessary.

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The challenges in pediatric cancer are numerous but surmountable if there is the will. These are

  1. Recognition of symptoms by parents
  2. Time of presentation/ late presentation
  3. Lack of funds by caregivers
  4. Limited diagnostic equipment/ facilities
  5. High cost of diagnostic investigations
  6. High cost of treatment
  7. Effects of cytotoxic drugs/radiation therapy
  8. Lack of political standing of their own as such children are forgotten in most policies.

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The above challenges can be solved if

  1. Adequate awareness is provided about childhood cancers
  2. Children are exclusively included in the NHIS
  3. Funding is provided for research into childhood cancers
  4. Facilities for diagnosis and treatment are provided.
  5. Provision of psychological support and social welfare services.

In summary

Childhood cancers are a source of significant burden to the child, parents, and caregivers; as such a lot of support is needed; financial, psychological, and spiritual. The distress from the disease, the financial implications, and stress of accessing treatment including the toxicity of the cytotoxic agents is of significant concern, however, children are more likely to recover from cancers when they are detected early and commenced on therapy as quick as possible.

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Dr. Azeezah Shopeyin graduated from the University of Lagos, college of medicine.With several years experience, she also has a master degree in public health. She’s interested in health education and promotion. She’s a wife and mother of two kids and she enjoys making people happy,

Dr. Ajayi Abass Oluwaseyi graduated from Ahmadu Bello University in Zaria. Also known as Juggernaut bn Yusuf, he is also a writer, an aspiring Neurosurgeon, and a Farmer. He currently works at the federal teaching hospital in Gombe.

POISONS AND OUR KIDS: A case study on kerosene and other toxic substances

WHEN SHE DRANK KEROSENE

 …could you please bring palm oil, mummy Jide, we want to give it to Blessing

Some minutes before, Grace’s mom had seen Blessing with a laCasara bottle containing kerosene

But, she only drank a little, said Bola, and moreover, you already gave her palm oil she would be okay

The scenario painted above is just one of those events that happen in our environment especially when there are no supervisions and in order to take care of such situations, people would proffer different solutions. As an African (A Nigerian) in particular, we have our science, our ways of “treating” conditions. Thus, in this write up we would learn if those remedies truly work and if they do, how do they work? Apart from kerosene, what other substances are injurious to the body either by ingestion (taking in through the mouth), injection, touch and so on. All these substances we term “poisons”.

What is a Poison?

A poison is a substance which causes illness or harm if someone eats, drinks, touches it or breathes it in and poisoning would mean exposure to chemical or other agents that adversely affects the functioning of an organism. It could be accidental, intentional or even for medicinal purpose.

The Swiss Alchemist and physician Paracelsus once said, ‘all substances are poisons,…the right dose differentiates a poison

For children majorly less than 6 years of age ingestion of harmful substance is the main cause of injury. This is because for the very young according to Sigmond Freud, they are in the oral and anal phase of development. But, for the adult, it is more of intentional -either by another to inflict pain or by an individual to gain attention.

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Examples of ‘poisonous’ Substances

As earlier stated any substance can be a poison depending on the dosage and poisoning may be a medical emergency depending on the substance involved.  Some of the substances are:

Those taken by children:  Cosmetics and personal care products; hydrocarbons like kerosene, lamp oil; a cough and other cold preparations; Perfume; Mouthwash;  Analgesics like paracetamol; Foreign bodies like button hole batteries; Pesticides; Topical agents for example nail polish and so on.

Other substances are Alcohol; Narcotics and Drugs of abuse; Organophosphates; Acetaminophen; Iron supplements; Benzodiazepines; Tricyclic Antidepressants

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These two kids above are taking dry gin probably from having access to parent’s stash

 

How You May Suspect an individual has taken A Poison

  • Eyewitness account and the individual might complain of

-wanting to vomit or even vomit

-difficulty with breathing or swallowing

-drooling of saliva (in children)

-drowsiness or confusion

  • Empty medication bottle
  • Chemical smelling breath or clothing
  • burn stains and odor
  • skin rash or burns around the mouth or lips

Specific poisons:

Kerosene Ingestion.

Kerosene is a chemical used mainly in paints, pesticides, lighter fluid, illuminating fuel and heating. The type and severity of symptoms vary depending on the amount of chemical involved and the nature of the exposure. Since most households store it in containers for ‘drinkable’ substances, most kids tend to go for it. Others are those who use kerosene to cure some ailment either by rubbing on the skin or inhaling.

The individual (mostly child) may present with:

– most times may not present with any symptoms if it is a little quantity.

– A cough, choking, gagging and grunting

– and the child may be breathing fast

– may feel the urge to vomit or even vomit

– there is a risk of taking into the trachea ( i.e risk of aspiration, thereby causing what the doctor might refer to aspiration pneumonitis)

– The child may feel burning sensation, belch a lot and even pass a lot of watery stool (i.e diarrhea) and so on.

Organophosphates (e.g Insecticide)

In addition to what has been said about kerosene above, the individual might be stooling and not being able to control it. Might feel restless, confused or even in a coma. Also might feel abdominal pain and may feel his heart beating faster than normal.

The differents substances that might cause the poisoning would in one way or the other present with the above-mentioned symptoms.

What Should You Do (Home Remedy)

– Call an emergency center (if it exists) to notify them of poisoning, by this, they would tell you the necessary things to do and prepare for the individual before arrival at the Emergency room (if needed).

– Remove the individual from the source of the poison if gaseous, remove clothes and expose to fresh air.

– If your child has been burned or spilled on, remove all clothing that the poison has touched and flush skin with cool or lukewarm water for 15 minutes.

– If the poison has been swallowed and is awake, small sips of water can be given.

-Please under no circumstance should you FORCE vomiting, it is no longer recommended.

– Protect yourself from coming in contact with the substance of poison either by touching, testing the taste, or even breathing it in.

– Note the substance of poison to be shown to the doctor or nurse in the emergency room or hospital.

– If the eye is affected, flush or irrigate well the eye immediately with water.

KEROSENE (AND LIKES) POISONING

Most of the above can be applied, but to reiterate

If vomiting occurs, lean patient forward or places on the left side (head-down position, if possible) to maintain an open airway and prevent aspiration.

Please do not induce VOMITING, and for the use of palm oil or milk, I would only answer with a research done by D.O Fagbule and others in a 6-year retrospective study in the University of Ilorin Teaching Hospital.

They said; “Approximately, three-quarters (74.3%) of patients with radiologic abnormalities had palm oil alone or in combination with milk as home remedies. The severity of poisoning was influenced by the type of home remedy and the interval between accident and admission”.

In essence, very early presentation at the hospital is better. Most of the scholars do not mention the use of palm oil as first aid.

At the HOSPITAL

The doctor would ask you some questions concerning the poisoning, what, how, where it happened. If the victim is awake, the kind of substance that has been ‘taking in’, the quantity and so on, what has been done and so on. He or she would ask for some tests, draw blood for some tests, do a chest x-ray if kerosene poisoning. Then he or she would go ahead with the appropriate measures to save the victim. For some poisons, antidotes are given. The hope here is, most times even for large kerosene ingestion, symptoms resolve within 2-7 days, only that chest infection may have ‘come in’

Prevention is Better Than Cure

Using the host, Agent, Environment model. The host is the victim (the child), the Agent is, for example, the kerosene or bleach and the environment are the containers. You have to take care of the three.

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The reduction in the incidence of childhood poisonings in the past half-century has been dramatic as result of the combination of highly effective active and passive methods of intervention.

Passive interventions eg: the introduction of child-resistant containers for drugs and other dangerous household products.

Active interventions, which require a change in behavior by parents and caretakers, include the safe storage of household products.

– Never transfer medicines or other harmful substances into drinking or food containers

-Store drugs (medicines), cleaning products, paints, and liquid cosmetics in a locked cabinet or out of reach of children.

-Do not put rat or insect poison on the floor or close to the reach of children.

-For kids playing with toys or other electronics which contain button hole batteries, monitor them carefully as swallowing the batteries would be more injurious to them as it could also lodge in their throat thereby causing a great problem. Note that ingestion of alkaline liquid is more dangerous than the acidic ( though both are not good).

In a nutshell, what I really want you to get from this write up is that prevention is better than cure and if it so happens that the accident has occurred, follow the necessary steps in addressing the situation and not a shortcut which may or may not have saved the day.

 

 

Ibrahim Olajide DADA is affable and a graduate of medicine and surgery. His interests are the prevention of diseases with emphasis on child and mental health. His maxim “for every child and the mentally affected there is hope”, ennobles his views to ensuring healthy lifestyles and promoting adequate wellbeing for all. He is also a prolific writer with a couple of publications to his credit. 

ERUPTIONS! Dealing with Rashes

Although rashes can be very annoying, they are usually symptoms of conditions that range from simple conditions to life-threatening medical emergencies

What is a Rash?

A rash is a change that occurs on the skin, altering either its color/appearance, and/or texture. Rashes have all sorts of local names that can be quite confusing and misleading and they are one of the commonest complaints in children as well as in some adults too. Their appearance may be any of these;

  • Macular — Flat, red spots
  • Papular — Small, raised, solid bumps
  • Macular and papular — A combination
  • Papulosquamous — A combination of papules and scaly areas
  • Vesicular — Small, raised, fluid-filled blisters

Although rashes can be very annoying, they are usually symptoms of conditions that range from simple conditions to life-threatening medical emergencies. The fact that a rash can be any color from red to purple in spite of the natural skin color makes them quite unique. They can itch, swell, crack, bleed, contain pus, become painful and even artistic in ways that suggest they may be following a pattern.

Rashes in Children

Childhood rashes, starting with diaper rashes can be difficult to differentiate by appearance alone and it is the job of the parent to document and the doctor to extract all possible information to reach a logical conclusion which is usually a differential diagnosis. The are considered;

  • The appearance
  • Location of the rash (where it started, the pattern of distribution)
  • The clinical course (Events that preceded the rash and factors that have changed)
  • Associated symptoms (itching, fever, pain)
  • Associated medical conditions (Diabetes, immunocompromising diseases, malnutrition, obesity)

Types of Rashes

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  • Roseola is a rash presenting after resolution of a high fever
  • Impetigo is a superficial bacterial infection that most commonly affects the face and extremities of children.
  • Erythema infectiosum is characterized by a viral prodrome followed by the “slapped cheek” facial rash.
  • Tinea is a common fungal skin infection in children that affects the scalp, body, groin, feet, hands, or nails.
  • Eczema: Atopic dermatitis is a chronic, relapsing inflammatory skin condition that may present with a variety of skin changes.

Commonest causes of Rashes

  • Allergies
  • Bacteria infections
  • Viral infections
  • Heat
  • fungal infections
  • other forms of hypersensitivity reactions

Conditions associated with rashes

Measles is a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40 °C, cough, runny nose, and red eyes (conjunctivitis).

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  • Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik’s spots.
  • A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms.
  • Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.
  • Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others.
  • Rubella (German measles) and roseola are different diseases.

Chicken Pox is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in,

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  • characteristic skin rash that forms small, itchy blisters, which eventually scab over
  • It usually starts on the chest, back, and face then spreads to the rest of the body.
  •  Other symptoms may include fever, feeling tired, and headaches.
  • Symptoms usually last five to ten days. Complications may occasionally include pneumonia, inflammation of the brain, or bacterial infections of the skin among others.
  • The disease is often more severe in adults than children.
  • Symptoms begin ten to twenty-one days after exposure to the virus.

Scabies is one of the three most common skin disorders in children, along with ringworm and bacterial skin infections.The most common symptoms are

  • Severe itchiness and a pimple-like rash. Occasionally tiny burrows may be seen in the skin.
  • The symptoms of scabies are due to an allergic reaction to the mites.
  • Often only between ten and fifteen mites are involved in an infection.
  • Most often spread during a relatively long period of direct skin contact with an infected person such as that which may occur during sex.

Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.These diseases are characterized by

  • Itchiness, red skin, and a rash.
  • In cases of short duration there may be small blisters while
  • In long term cases the skin may become thickened.
  • The area of skin involved can vary from small to the entire body.

Ringworm, is a fungal infection of the skin.About 40 types of fungi can cause ringworm. Risk factors include using public showers, contact sports such as wrestling, excessive sweating, contact with animals, obesity, and poor immune function. Ringworm can spread from other animals or between people. Typically it results in

  • a red, itchy, scaly, circular rash.
  • Hair loss may occur in the area affected. S
  • ymptoms begin four to fourteen days after exposure.
  • Multiple areas can be affected at a given time.
  • Infections of the groin are more common in males
  • Infections of the scalp are most common in children 

Urticaria, or Hives, frequently occur following an infection or as a result of an allergic reaction such as to medication, insect bites, or food. Psychological stress, cold temperature, or vibration may also be a trigger.In half of cases the cause remains unknown.Risk factors include having conditions such as hay fever or asthma. The presentation may include

  • skin rash with red, raised, itchy bumps.
  • They may also burn or sting.
  • Often the patches of rash move around. Typically they last a few days and do not leave any long lasting skin changes.
  • The condition frequently recurs.
  • Prevention is by avoiding whatever it is that causes the condition.
  • Treatment is typically with antihistamines
  • Keeping the environmental temperature cool is also useful
  • Can be associated with anaphylaxis (which is life threatening)

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MANAGEMENT OF RASH

General

  • Cleaniness, wash your hands frequently, bathe regularly and avoid sharing clothing or personal grooming items with other people.
  • Check that you and your children are up-to-date in your routine immunizations.
  • Avoid the specific food, medicine, skin care products or cosmetics that you had a reaction to. Never take a medicine prescribed for someone else.
  • For diaper rash, change diapers as soon as they become wet or soiled. Make sure that your baby’s bottom is completely clean and dry before closing up the fresh diaper.
  • For sensitivity to chemicals in cleaning products, switch to laundry soaps and fabric softeners that are free of dyes and perfumes.
  • For irritation due to cosmetics, use hypoallergenic products that contain fewer skin-irritating preservatives and fragrances.

Specific

  • For people with skin allergies, they should always have anti-histamines on hand
  • Pityriasis rosea usually resolves spontaneously in two to 12 weeks without active treatment.
  • Although impetigo is often self-limited, antibiotics are commonly prescribed to prevent complications and spread of the infection
  • The use of emollients is recommended for children with atopic dermatitis. A very good one is shea butter and black seed oil!
  • Do not use oral antibiotics for atopic dermatitis unless there is clinical evidence of infection

Very specific

  • Consult a doctor, specifically, a dermatologist promptly if a rash:
    • Worsens
    • Lasts longer than one week
    • Shows signs of local infection (oozing, redness or swelling of the skin)
    • Occurs together with fever, chills, swollen glands or other symptoms of infection (sore throat, cough, headache, nasal congestion, etc.)
    • Occurs together with symptoms that suggest an autoimmune disorder, such as recurring fever, malaise, fatigue, unexplained weight loss or joint swelling

 

 

Dealing with Child Abuse: Physical Abuse

Beating/spanking a child is customary to we Nigerians, which as one, I’ll plead the fifth…

“If the fear of pankere is the beginning of wisdom, the child has not seen a four-headed koboko”

Child abuse is a vicious act against the rights of a child. It is when a parent, caregiver or guardian, through action or inaction, encourages acts that cause harm, injury, or death to the child. Child abuse presents in form of physical, emotional, sexual and mental/psychological abuse.

Child Abuse tends to happen for a long time in several of our communities and awareness towards it is poor. Caregivers are expected to care for and protect a child entrusted to them and a failure in that role can set back the proper development of the child.

Physical Abuse

This is when the caregiver harms the child physically. This can be done by using any part of the body, or with a tool, to inflict pain/injury on such child by punching, slapping, beating, kicking, biting, burning or even shaking the child. The caregiver may not have intended to harm or hurt the child, but the injury may have resulted from overly harsh physical punishment.

Beating/spanking a child is customary to we Nigerians, which as one, I’ll plead the fifth. Parents are physically bigger and stronger, thus, when a parent tries to get their children to behave better or concur with their perspective by beating them, they may be encouraging their children that hitting people who are smaller or weaker is an acceptable way of getting what you want from them.

The Effects:

  • Emotional effects caused by child abuse can result in long-term and short-term consequences. This can ultimately affect a child’s upbringing and development.
  • Children can experience a condition called Reactive attachment disorder which presents as markedly disturbed and developmentally inappropriate social relatedness that usually begins before the age of 5 years. RAD can present as a persistent failure to start or respond in a developmentally appropriate fashion to most social situations.
  • Shaken baby syndrome is a common form of child abuse that often results in permanent neurological damage. It is as a result of increased pressure in the skull after bleeding in the brain as well as damage to the spinal cord and neck, and rib or bone fractures.
  • Impaired brain development: Important regions of the brain may fail to form or grow properly, resulting in impaired development. These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities and a reduction in lifespan
  • Poor physical health: In addition to possible immediate adverse physical effects, household dysfunction, and childhood maltreatment is strongly associated with many chronic physical and psychological effects, including subsequent ill-health in childhood, adolescence, and adulthood, with higher rates of chronic conditions, high-risk health behaviors.

Beating a child may modify bad behavior but damage them and your relationship with them in the long run!

How do you correct a child?

There are many strange reasons why parents beat their children beyond frustration, tiredness, and anger. When parents don’t have the patience to deal with what their kids are dishing out, hitting the child may induce a form of relief that may be relishing. And this defective pleasure may drive the parent to hit the child more or even harder and chances are high that it may be overdone.

Soon, you’ll find it easy to hit your child for even the slightest things because you will have become addicted to that rush of relief you get from hitting someone defenseless and this feels eerily good despite not intending to feel so from the outset

Good parenting requires a skill set that imbibes good behavior without physical abuse. It utilizes strategies that involve shaping behavior with patience and proper communication.

Kids don’t understand adult complex communication set, they are not aware your cold stare can mean different things! And when they begin to understand, it is after gradual and repetitive efforts, and they may conform out of fright and not understanding. Why would you want to compound this fear by getting physical?

Excellent means to deal with your child/children include:

  • Leading by example
  • Focusing on communicating in a language the child understands
  • Showing them the consequences of their actions in simple/correlative but clear explanations
  • Loving and caring can never be enough, never get tired of trying
  • Educating guardians you leave your children with to conform to your methods, don’t forget it takes a village to raise a child, though, especially in Africa.

Stay tuned for updates on other forms of abuse and how to deal with them.

Dr. Abdullah-Enifeni Fatima is a wife and mother who is very passionate about childcare. She currently practices at the pediatric department of a general hospital in Lagos State. When she has the time, she enjoys watching horror and crime related movies.

 

OF BEDWETTING KIDS AND SMELLY HOMES…

1. Bedwetting is more than just a physical thingy. It has psychological causes too. So, if a child bedwets beyond the age of 7, you need to identify what his problem is: change of environment, bullying at school, family discord etc., and address it.

2. Below 7, bedwetting should not necessarily be a cause for alarm and scolding the child may cause more harm than good. Don’t make fun of him and don’t let his siblings and friends know about it. Reward him for dry nights and let him know that you’re not mad at him.

3. Once you start toilet-training your child (around age 2), you should be consistent and disciplined about it. Children love routines. If you’re waking him up to pee at 1am, and you suddenly stop doing that, sometimes the brain may wake up at that time while the body remains physically asleep, hence the child thinks he’s in the toilet and starts to pee on the bed.

4. Restrict fluids and semi-solid foods around bedtime. For example, if he sleeps at 8pm, let his last juice or water be at 6:30pm. Then, let him pay one last visit to the toilet before going to bed.

5. If you can afford it, buy one of those toilet-training devices, alarms or vibrators that let kids wake up when they’re about to start peeing on the bed.

6. Bedwetting can also be due to diseases of the urinary tract whereby the bladder cannot hold too much urine, or the valve holding back urine has lost its control. If you’re in doubt, go and see a specialist doctor to help you take a look.

7. An odour-free home is totally dependent on your level of cleanliness. If you’re buoyant enough, let the child wear diapers until the problem is completely solved. Remove, wash and sundry bedclothes immediately he pees on them. Cover the bed with macintosh. Opt for leather chairs if you can afford them. Opt for rubber carpet instead of woolen rugs. Above all, don’t be lazy!