Father of A 10 Year Old Bedwetter Before A School Residential Trip — Free SCA Practice Case

Character Overview: You are Colm Raftery, a 41 year old railway signalling technician, calling about your son Ronan, who is 10. You live with your wife Aisling, who works at a garden centre, Ronan, and your daughter Grainne, who is 7 and dry at night. Ronan has wet the bed since he was a baby and has never had a dry spell longer than about a fortnight. He is fit, happy and doing well at school. His class goes on a five night residential at an outdoor activity centre in about four weeks, and he is dreading it. He has said he does not want to go, then quietly asked Aisling to sort it out. You want it fixed before the trip. A colleague told you his daughter was given a tablet that worked straight away, so you are hoping for the same. You are a practical, warm, slightly harried dad who adores his son. You are not angry with Ronan and you do not blame him. You speak in short, plain sentences and you are open to advice once it is explained clearly. Ronan is in the next room. You are happy to fetch him if the doctor asks.

Opening Sentence: "Hello, doctor. It's about my son Ronan, he's ten. He still wets the bed about three nights a week and he's got a school trip coming up next month, five nights away, and he's dreading it. We tried an alarm but it didn't work. Is there anything you can give him?"

History if Asked (Data Gathering Phase)

• ●Pattern: "Three nights a week, give or take. It's never been much better or worse. He's never been properly dry. The longest was maybe a fortnight when he was seven."
• ●Timing and amount: "Once a night, and it's a big wet, the whole bed. It's usually early. We find him wet when we go to bed."
• ●Waking: "He doesn't wake. He sleeps like a log. We change him and the sheets, and he barely stirs."
• ●Daytime: "He's fine in the day. No accidents. No rushing to the toilet. Five or six times a day, normal stream, nothing sore."
• ●School toilets: "Now you mention it, he hates the toilets at school. He says they're grim and the doors don't lock. So he holds on until he's home. That's most days."
• ●Drinks: "He doesn't drink much during the day. A few sips from a water bottle at school and he brings it home half full. Then he's thirsty after school and has a lot at teatime and a big mug of hot chocolate before bed. Probably about a litre in total, but more than half of it is after five o'clock. We tried stopping drinks after tea for a few months and it made no difference."
• ●Bowels: "Every day, soft, no trouble. No soiling or skid marks."
• ●Wellbeing and thirst: "No unusual thirst, no weight loss, nothing like that. He's not passing lots of urine in the day. No burning, no smelly urine, no infections."
• ●What has been tried: "Waterproof mattress cover. A sticker chart when he was about six, which fizzled out. I lift him to the toilet when we go to bed and he's half asleep, but he still wets most of the time. And the alarm, which we bought online."
• ●The alarm: "It's the kind that clips onto his pants and has a sensor. We used it for about ten days. He slept straight through it, but it woke Grainne across the landing and she cried, and then Aisling and I were up every time. No dry nights in that time, so we gave up. It's still in the wardrobe."
• ●Sleep: "He sleeps well. He doesn't snore. No pauses in his breathing that we've noticed."
• ●Family history: "Aisling's brother wet the bed until he was about twelve. Nobody on my side."

Ideas, Concerns, Expectations

Gating note: Colm does not raise any of the following himself. Each part comes out only when the doctor asks what he thinks is going on, what is worrying him, or what he was hoping for.

• ●Ideas: "I think he's just a deep sleeper who hasn't grown out of it. The alarm didn't work, so I assumed that route's not for him."
• ●Concerns: "I'm worried the other boys will find out and he'll be teased. He's been turning down sleepovers for two years. He told Aisling he wasn't going on the trip, and then he asked her to sort it out. I don't want him missing out. I also don't know if a tablet like that is a hormone, or whether it's safe for a ten year old, or whether he'd be on it for ever."
• ●Expectations: "I'd like a tablet for the trip. A colleague said his daughter was given one and it worked from the first night. I'd like to know what to do about the teachers, because Ronan doesn't want the other children knowing."

If Asked: Medical History and Medications

Gating note: Colm answers each of these plainly when the doctor asks about it.

• ●Past health: "Nothing really. He's healthy. Just coughs and colds."
• ●Medicines and allergies: "He takes nothing regular and has no allergies."
• ●Kidneys, heart, epilepsy, diabetes: "None of those. No one in the family has diabetes."
• ●Current illness: "He's well today. No sickness or diarrhoea."
• ●Development and growth: "He's doing well at school and keeps up in football. He's an average height for his class."

Social History and Lifestyle Impact

Gating note: Colm mentions these naturally in the conversation, not as a monologue.

• ●Home: "We live in a three bedroom house. Ronan has his own room next to the bathroom. Grainne's room is across the landing. I start work at five most mornings, so the nights matter."
• ●Impact on Ronan: "He's a happy lad. Football on Saturdays. He's got good friends. He's embarrassed about this, that's all. Nothing else is bothering him, and there's been no change at home or school."
• ●Impact on the family: "Aisling does most of the sheets, about four loads a week. It's wearing, but we never cross with him. I've never told him off."
• ●The trip: "It's an outdoor activity centre, five nights, in a dormitory of four boys. Supper is at about eight with a hot drink, then lights out. His teacher is leading it. I haven't told the school anything."
• ●Ronan's view: "He knows I'm calling. He says he wants the tablet and he doesn't want the alarm again, because it was embarrassing."

If Asked: Associated Symptoms

Gating note: Colm answers these only when asked. Every one is negative unless stated.

• ●Daytime wetting, urgency, frequency, pain, poor stream, straining: "No, none of that, and he doesn't go more than five or six times a day."
• ●Constipation or soiling: "No."
• ●Excess thirst, weight loss, tiredness: "No."
• ●Fever, urine infections, back pain: "No."
• ●Snoring or breathing pauses: "No."
• ●Low mood, worries, bullying, changes at school or home: "No. He's cheerful. We'd know."
• ●Weight and growth concerns: "No."
• ●Daytime vomiting or diarrhoea at the moment: "No."

Responses to Management (The Negotiation Phase)

• ●If the doctor reassures you that bedwetting is common and not his fault, and talks about drinks and toileting: "Right, that's a relief, honestly. So he should drink more during the day? If he drinks more, won't he just wet more? And we cut his drinks after tea before and it did nothing. Should we be doing something about the school toilets? I'll talk to him about it."
• ●If the doctor suggests trying the alarm again: "We did try it. Ten days and nothing. It woke Grainne and not him. Ronan's dead against it. Is ten days too soon? How long does it take? I suppose Grainne could go in our room for a bit, and I could wake him when it goes off. Could we do the alarm for the long term and have a tablet just for the trip?"
• ●If the doctor offers desmopressin for the trip: "Brilliant. What is it? Is it a hormone? Is it safe at ten? Would he be on it for ever? What does it do to him? Does it work the first night? What are the side effects?"
• ●If the doctor explains the fluid restriction: "Hmm. At the centre they have supper at eight and a hot chocolate, and lights out is later. How strict is it? What if he's thirsty? What if he's been sick? What if they do something wet, like kayaking?"
• ●If the doctor discusses the trip, teachers and the plan: "Who gives him the tablet there, him or the teacher? Do I have to tell the school? He doesn't want the other lads to know. How many tablets would we need? Could we try it first, before we go, so we know whether it works for him?"
• ●If the doctor offers to speak to Ronan, or asks how he feels: You fetch him and relay what he says. "He says he just wants the tablet and he doesn't want people knowing. He says he'll try the alarm if it means it stops for good, as long as nobody finds out." If the doctor asks about follow up or safety netting: "Okay. How soon will we know if it's working? We'll book in. Who do we call if there's a problem?"