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• W2094955207 abstract "In her Nov 25 commentary on bladder dysfunction in children, Anna-Lena Helström1Hellström A-L Influence of potty training habits on dysfunctional bladder in children.Lancet. 2000; 356: 1787Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar concludes that bladder training in early childhood might be important in preventing later bladder-sphincter dysfunction. Although this relation might be true, she does not, however, mention a confounding factor that is probably important in maturation of bladder function and the attainment of normal continence. The rate of breastfeeding has fallen since the introduction and promotion of formula feeds. As well as being associated with the earlier development of visual maturation and increased intelligence quotient, breastfeeding is important in attainment of nocturnal continence. The latter is dependent on development of normal daytime continence, delay of which leads to late onset of nocturnal control. Inability to control continence at night is thought to be related to at least three interdependent components. These include absence of circadian rise in vasopressin at night, bladder instability, and inability to wake to a full bladder.2Butler RJ Holland P The three systems: a conceptual way of understanding nocturnal enuresis.Scand J Urol Nephrol. 2000; 34: 270-277Crossref PubMed Scopus (96) Google Scholar Workers in at least three studies have suggested an influence of breastfeeding on night-time control. Kalo and Bella,3Kalo BB Bella H Enuresis: prevalence and associated factors among primary school children in Saudi Arabia.Acta Paediatr Scand. 1996; 85: 1217-1222Crossref Scopus (70) Google Scholar in a case-controlled study showed a significantly lower incidence of breastfeeding in children with nocturnal enuresis, and in a limited study. Singh and colleagues4Singh H Kaur L Kataria SP Enuresis: analysis of 100 cases.Indian Paediatr. 1991; 28: 375-380PubMed Google Scholar suggested that the frequency of nocturnal enuresis was lower in previously breastfed babies than in non-breastfed babies. In a study of the treatment of nocturnal enuresis Devitt and colleagues5Devitt H Holland P Butler R Redfern E Hiley E Roberts G Plasma vasopressin and response to treatment in primary nocturnal enuresis.Arch Dis Child. 1999; 80: 448-451Crossref PubMed Scopus (27) Google Scholar showed that children who had been breastfed for at least 3 months were more likely to respond to treatment with an analogue of vasopressin than non-breastfed babies. The normal neuronal pathways were probably, therefore, intact but there was a failure in the circadian release of vasopressin. Bladder control is associated with reorganisation of neural pathways during infancy. In the first few months after birth, bladder emptying progresses from being part of a simple spinal reflex to being controlled by higher central nervous system inhibition. Finally between age 1–2 years children become aware of a full bladder and can delay voiding. To obtain continence in the daytime and at night, an intact neuronal pathway is needed. At night the established circadian rhythm of vasopressin release is necessary to prevent excessive urine volume and to arouse the child if it exceeds bladder volume. Bladder training might establish continence early in children with an intact neuronal pathway, but probably not in those who have delayed maturation of the continence pathway. The reduction in breastfeeding, through its importance in promoting neuronal maturation, could be an alternative explanation for the increasing incidence in non-neurogenic bladder instability. Bladder dysfunction in infantsAuthors' reply Full-Text PDF" @default.
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• W2094955207 date "2001-04-01" @default.
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• W2094955207 title "Bladder dysfunction in infants" @default.
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• W2094955207 doi "https://doi.org/10.1016/s0140-6736(00)04436-6" @default.
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