Development of nighttime bladder control from 4 - 9 years: association with dimensions of parent rated child maturational level, child temperament and maternal psychopathology

Background This study investigates variability in acquisition of nighttime bladder control in a large, general population sample of children by defining a developmental typology through latent class analysis. We also examined the association of bedwetting classes with contributing factors in early childhood including maturational level, temperament and exposure to maternal psychopathology. Methods We used data from over 10,000 children from age 4-9 years from a UK population sample (Avon Longitudinal Study of Parents and Children). Mothers completed questionnaires asking about their child's bedwetting (on five occasions during the assessment period), maturational level (at 18 months), temperament (24 months), and maternal depressive / anxious psychopathology (21 months). We derived longitudinal phenotypes capturing population heterogeneity in nighttime bladder control using latent class analysis. Associations with the contributing factors were investigated using multinomial logistic regression. Results We identified five groups of children with different patterns of development of nighttime bladder control: 1) normative (69.9% of 10,818 sample); (2) delayed (8.4%); (3) severely delayed (9.3%); (4) persistent (8.6%), and (5) relapse (3.8%). Results indicated that developmental delay, difficult temperament traits and exposure to maternal depressive/anxious symptoms were associated with an increase in the odds of children experiencing problems either attaining nighttime bladder control or with relapse in bedwetting after a period of initial dryness. Conclusions Development of nighttime bladder control and onset of bedwetting problems are captured by this developmental typology approach, enabling factors that affect risk of bedwetting to be determined and targeted. Further investigation is required into contributing factors relating to individuals and their environments that are associated with difficulties attaining or maintaining nighttime continence, including neurobiological and genetic factors.