Self-help for bed-wetters

An entertaining CD-Rom package featuring a chirpy, cheerful cartoon character, developed at the University of Nottingham, may bring lasting relief to youngsters suffering enuresis.

In Britain there are half a million children aged between five and 16 who wet their beds, causing much distress and embarrassment. Just 15 per cent stop of their own accord each year. But, with treatment, 80 per cent can shrug off the bed-wetting tag within four months.

Now a pioneering multimedia package designed at the University of Nottingham looks set to help bring lasting relief to many youngsters - with the help of a chirpy cartoon character.

The interactive CD-Rom package aims both to inform and involve youngsters and their parents in treatment, whether it be through use of medication, alarms or behavioural programmes. "All About Nocturnal Enuresis" has been developed by staff at the university's Department of Behavioural Sciences, clinicians at the Nottingham City Hospital NHS Trust and a professional animator.

It is designed to appeal to young people by using animation, text, pictures and voices to convey information, and lets children go at their own pace depending on their understanding and interest. It is in modular form, so youngsters can choose between options, clicking on sections which interest them with a computer mouse.

It is very much about empowerment. In one module, the cartoon character leads children through steps they can take to help themselves. For instance, the character demonstrates holding-on exercises. It is shown sitting on a toilet, knees apart, eager for a wee. The character practises counting to 10 before letting go. And to make sure the numbers are not said too quickly, it says, "One elephant, two elephants, three elephants..." and within 10 seconds is surrounded by 10 on-screen elephants.

Many children try to stop bed-wetting by reducing their fluid intake. But, as the module points out, this can be counter-productive. It is important to recognise the signals of a full bladder - but to avoid having fizzy drinks, tea or caffeine at night-time.

Other modules include an introduction to the health-care professionals the youngster may meet during their treatment, an illustrated depiction of how the kidneys and bladder work and an explanation of why they might wet the bed and how commonplace the problem is.

There is even a module for grown-ups - with more text and less emphasis on fun. It details practical help such as bedding protection and financial and social assistance which may be available if there is a bed-wetter in the family.

There is also a spoken option built in for children with poor reading skills. And to reduce potential embarrassment, headphones can be made available for sound output instead of speakers.

The King's Fund provided the project with a pounds 31,000 grant as part of its Promoting Patient Choice project. The programme has already won an award from the British Interactive Multi-Media Association - it was deemed to be the best interactive display produced this year.

Dr Jacqueline Collier, a lecturer in behavioural sciences at the University of Nottingham, was a member of the development team. She has considerable expertise in the field: she used to work as a health psychologist in the paediatric renal unit at the Nottingham City Hospital NHS Trust.

"To date, there hasn't been much material about enuresis that is specifically aimed at the child so the programme has been developed to improve the information that children receive about their bed-wetting," she says.

"Multimedia was chosen to attract children's interest and to promote learning about enuresis. The `gee-whiz' factor is important now that children experience many advanced forms of information technology at home and in school, and feedback has been sought from children at appropriate stages of its development.

"Checks were made to ensure the package was user-friendly and increased children's knowledge - for the modules tested there were marked improvements in the test scores of children, both immediately after using the programme and several months later."

The module on How Your Bladder Works was "road-tested" in local schools; the others in clinics where children were undergoing treatment.

The package is expected to go on sale to clinics, GPs and parents within the next couple of months. It will be sold through the Enuresis Resource and Information Centre, a registered charity. Penny Dobson, its director, says the package is ground-breaking and unique and will help children and young people understand how their bladder works and how they can help themselves.

The King's Fund is similarly enthusiastic. Christine Farrell, the director of the fund's clinical change programme, says: "This innovative package is particularly important because it recognises that children are people and that they, as well as adults, need high-quality information in an easily accessible form if they are to participate in decisions about their treatment and to benefit from being actively involved.

"The Nottingham team has created an excellent set of patient information materials which exemplify all the quality criteria which the Promoting Patient Choice project aims to disseminate."

The Trent Regional Health NHS Trust has just sanctioned pounds 50,000 for a two-year control trial to measure improvements in treatment when young people use the package. It will take place in Leicester where five clinics will use the package, five will provide a leaflet detailing the information the package contains and a further five will use traditional approaches.

Dr Collier believes the programme will yield lasting results - but that it is important that the trials go ahead. "Having a bed-wetter in the family can disrupt family dynamics - and we found that children enjoy using the programme, understanding how their body works and learning the steps they can take to help stop. In a couple of years' time we should have quantifiable research to see just how effective it is

A short demonstration of the package is available on the Internet at: http://www.ccc. nottingham.ac.uk/mczwww/enuresis.htm.