Screen Exposure in Paediatric Patients with Nocturnal Enuresis

Abstract

Aim: Nowadays, screen exposure can cause delays in the development of physical and cognitive skills in children. This study aims to investigate the duration and severity of screen exposure in paediatric patients with enuresis nocturna. Material and Method: A descriptive study was conducted with the parents of children diagnosed with enuresis nocturna who were followed up in the Akdeniz University Child Nephrology Clinic and who agreed to participate in the study. During a three month period, data were collected from the participants using standard questionnaire questions examining screen exposure simultaneously with behavioural treatment in the Department of Paediatric Nephrology, Akdeniz University Hospital. Results: A total of 28 patients diagnosed with enuresis, 60.7% of whom were girls with a mean age of 8.5±3.1 years, were included in the study. A family history of enuresis was present in 75.0% of the children. The mean age of toilet training was 2.4±0.7 years, and 23 (82.1%) children exhibited a dry period of more than six months. The symptoms associated with enuresis included pollacuria, urgency, urge incontinence, urinary delay habits and recurrent urinary tract infections. The mean screen exposure time for the children was found to be 4.7±2.3 hours/day, with 75% of the children having screen exposure just before sleep. Following behavioural treatment, a reduction in the frequency of enuresis was observed, with a mean of 20.00 (interquartile range (IQR) 23.2) days/month reported prior to treatment, compared to a mean of 7.0 days/month (IQR 14.2) after treatment (p < 0.001). Conclusion: The findings of our study indicate that children diagnosed with enuresis nocturna exhibit a screen exposure of approximately 4.7 hours per day. It is therefore recommended that screen exposure be addressed during family interviews, with suggestions made to the patient and their family about this issue.

Keywords

• Behavioral Therapy
• Screen Exposure
• Nocturnal Enuresis

Enürezis Nokturna Tanılı Çocuk Hastalarda Ekran Maruziyeti/ Screen Exposure in Paediatric Patients with Nocturnal Enuresis

Abstract

Amaç: Günümüzde, ekran maruziyeti çocuklarda fiziksel ve bilişsel becerilerin gelişiminde gecikmelere neden olabilmektedir. Bu çalışma, enürezis nokturna tanılı çocuk hastalarda ekran kullanımının varlığını ve şiddetini irdelemeyi amaçlamaktadır. Gereç ve Yöntem: Akdeniz Üniversitesi Çocuk Nefroloji kliniğinde takip edilen enürezis nokturna tanılı çocukların ebeveynlerinden çalışmaya katılmayı kabul edilenlerle tanımlayıcı türde bir araştırma yapılmıştır. Üç aylık süre zarfında Akdeniz Üniversitesi Hastanesi Çocuk Nefroloji Bilim Dalında davranış tedavisi ile eş zamanlı ekran maruziyetini irdeleyen standart anket soruları ile çalışma verileri toplanmıştır. Bulgular: Araştırmaya, ortalama yaşı 8,5±3,1 olan %60,7'si kız toplam 28 enürezis tanılı hasta dahil edilmiştir. Ailede enürezis öyküsü bulunan çocukların oranı %75,0’dır. Tuvalet eğitim yaşı 2,4±0,7 yıl iken, 23'ünün (%82,1) altı aydan uzun süre kuru kaldığı dönemin olmadığı ifade edilmiştir. Enürezise eşlik eden semptomlar arasında çok sık idrara gitme, aciliyet hissi, aciliyet hissi ile beraber kaçırma, idrar erteleme alışkanlığı ve tekrarlayan idrar yolu enfeksiyonu bulunmuştur. Çocukların ekran maruziyet süresi ortalama 4,7±2,3 saat/gün tespit edilmiş, %75'inde ise uykudan hemen önce ekran maruziyeti olduğu ifade edilmiştir. Davranış tedavisi sonrasında yapılan değerlendirmede, tedavi öncesi enürezis sıklığının ortanca 20.00 (IQR 23,2) gün/ay iken, tedavi sonrasında sıklığının 7,0 gün/ay (IQR 14,2) güne düştüğü belirtilmiştir (p<0,001). Sonuç: Çalışmamızda enürezis nokturna tanılı çocukların günde yaklaşık 4,7 saat ekran maruziyetinin olduğunu saptadık. Bu nedenle, aile görüşmeleri sırasında mutlaka ekran maruziyeti sorgulanmalı, hastaya ve aileye bu konu hakkında da önerilerde bulunulmalıdır.

Keywords

• Davranış Tedavisi
• Ekran Maruziyeti
• Enürezis Nokturna

Ethical Statement

Bu çalışma için etik komite onayı, Akdeniz Üniversitesi Klinik Araştırmalar Etik Kurulu'ndan alınmıştır (Tarih ve no: 05.09.2024, TBAEK-614).

References

1. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-81. doi: 10.1002/nau.22751.
2. Ferrara P, Franceschini G, Bianchi Di Castelbianco F, Bombace R, Villani A, Corsello G, et al. Epidemiology of enuresis: a large number of children at risk of low regard. Ital J Pediatr. 2020;46(1):128. Published 2020. doi:10.1186/s13052-020-00896-3.
3. Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C; Council on Communıcations and Media. Children and Adolescents and Digital Media. Pediatrics. 2016;138(5):e20162593. doi:10.1542/peds.2016-2593
4. Bezgin S, Özkaya Y, Akbaş Y, Elbasan B. An investigation of computer-game addiction, physical activity level, quality of life and sleep of children with a sibling with a chronic condition. Child Care Health Dev. 2024;50(1):e13228. doi:10.1111/cch.13228
5. Duran Ş, Küçük Alemdar D. Investigation of the correlation between internet addiction, obesity risk and sleep disorder in children. J Pediatr Nurs. 2023;73:e409-17. doi:10.1016/j.pedn.2023.10.009
6. Bozkurt H, Coskun M, Ayaydin H, Adak I, Zoroglu SS. Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction. Psychiatry Clin Neurosci. 2013;67(5):352-9. doi:10.1111/pcn.12065
7. Van Herzeele C, De Bruyne P, De Bruyne E, Walle JV. Challenging factors for enuresis treatment: Psychological problems and non-adherence. J Pediatr Urol. 2015;11(6):308-13. doi:10.1016/j.jpurol.2015.04.035
8. Gentile DA, Bailey K, Bavelier D, Brockmyer JF, Cash H, Coyne SM, et al. Internet gaming disorder in children and adolescents. Pediatrics. 2017;140(Suppl 2):S81-5. doi: 10.1542/peds.2016-1758H.

9. Khan A, Thomas G, Karatela S, Morawska A, Werner-Seidler A. Intense and problematic social media use and sleep difficulties of adolescents in 40 countries. J Adolesc. 2024;96(5):1116-25. doi:10.1002/jad.12321
10. Sun HL, Chen P, Zhang Q, Si TL, Li YZ, Zhu HY, et al. Prevalence and network analysis of internet addiction, depression and their associations with sleep quality among commercial airline pilots: A national survey in China. J Affect Disord. 2024;356:597-603. doi:10.1016/j.jad.2024.03.022
11. John R, Pokale A, Chutke A, Narula APS, Shinde S, Deshmukh R, et al. Prevalence of excess screen time among secondary school children in rural India. J Prev Med Hyg. 2024;64(4):E457-62. Published 2024. doi:10.15167/2421-4248/jpmh2023.64.4.3030
12. Guo X, Wang L, Li Z, Feng Z, Lu L, Jiang L, et al. Factors and pathways of non-suicidal self-injury in children: insights from computational causal analysis. Front Public Health. 2024;12:1305746. Published 2024. doi:10.3389/fpubh.2024.1305746
13. Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, et al. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019;38(2):478-98. doi:10.1002/nau.23939.
14. Ono T, Watanabe T, Oyake C, Onuki Y, Watanabe Y, Fuyama M, et al. Sleep features of nocturnal enuresis: relationship between rapid eye movement sleep latency prolongation and nocturnal enuresis. Sleep Biol Rhythms. 2023;21(4):461-66. Published 2023. doi:10.1007/s41105-023-00473-1
15. Zhang Q, Zhu W, Wang C, Shan S, Zhang G, Wen J, et al. Nocturnal bladder function and sleep in the children with refractory nocturnal enuresis: A Prospective Study. Urology. 2023;182:218-24. doi:10.1016/j.urology.2023.08.032
16. Fernandes AER, Roveda JRC, Fernandes CR, Silva DF, de Oliveira Guimarães IC, Lima EM, et al. Relationship between nocturnal enuresis and sleep in children and adolescents. Pediatr Nephrol. 2023;38(5):1427-38. doi:10.1007/s00467-022-05818-5
17. Von Gontard A, Mattheus H, Friese-Jaworsky J, Moritz AM, Thome-Granz S, Roozen S, et al. Incontinence and sleep disturbances in young children: A population-based study. Neurourol Urodyn. 2022;41(2):633-42. doi:10.1002/nau.24866
18. Nunes VD, O'Flynn N, Evans J, Sawyer L; Guideline Development Group. Management of bedwetting in children and young people: summary of NICE guidance. BMJ. 2010;341:c5399. Published 2010. doi:10.1136/bmj.c5399
19. Caldwell PH, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2013;(7):CD003637. Published 2013. doi:10.1002/14651858.CD003637.pub3