DSSSB 14 August 2024
Child Health Nursing (Pediatrics)
Easy
At what age is night-time control of the bladder and bowel normally attained?
Appeared in: DSSSB 14 August 2024
Explanation
- Nighttime bladder control is the final milestone in the toilet training process.
- According to psychiatric and pediatric literature, this skill is typically achieved between the ages of 5 and 7 years.
- The clinical diagnosis of nocturnal enuresis (bedwetting) is generally not made until after age 5, which is the age by which a child is expected to have mastered this skill.
- Therefore, 6 years is the most appropriate answer representing the age by which nighttime continence is normally attained.
Why Other Options Were Wrong
- Option A: This is the typical age range for achieving daytime bladder control, not nighttime control, which develops later.
- Option C: At 1 year of age, an infant lacks the necessary neuromuscular maturation and cognitive awareness to voluntarily control their bladder and bowel.
- Option D: While toilet training may begin around age 2, consistent control, particularly at night, is not developmentally expected.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pediatric developmental milestones: Toilet training and elimination control as background academic context rather than a clinical decision trigger.
- Nurses play a crucial role in educating parents about the normal developmental timeline for toilet training to alleviate anxiety and prevent punitive actions towards the child.
- It is important to reassure parents that nocturnal enuresis (bedwetting) is common and not considered a clinical issue in children under the age of 5 or 6.
- What if? An 8-year-old child, previously dry at night for years, begins bedwetting again (secondary enuresis). The nurse's priority shifts from developmental reassurance to assessing for underlying causes, such as urinary tract infections (UTIs), diabetes, or significant psychosocial stressors (e.g., bullying, family conflict).
How to Approach the Question
- This is a factual recall question about a specific pediatric developmental milestone.
- First, identify the key skill in the question: 'night-time control of bladder and bowel'.
- Recall the general sequence of toilet training: bowel control often precedes bladder control, and daytime control always precedes nighttime control.
- This sequence helps establish that nighttime control is the last and most difficult milestone to achieve.
- Eliminate options that are clearly too early for any form of toilet training, such as 1 and 2 years.
- Differentiate between the age for daytime control (around 3-4 years) and nighttime control. Since nighttime control comes last, the correct answer must be older than the age for daytime control.
Concept Tested & Keywords
- Concept Tested: Pediatric developmental milestones: Toilet training and elimination control.
- Stem keywords: night-time control, bladder, bowel, age
- Lead-in keywords: At what age
Question ID
QYNVwO8kwNHpYYzIPx_ju2
Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1532-1534
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 11323-11325
Practise the full DSSSB 14 August 2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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