HAWK Clinic (Help Awaiting Wet Kids)
The HAWK (Help Awaiting Wet Kids) Center at Georgia Pediatric Urology provides specialized care for children with wetting issues and other forms of abnormal urination (voiding dysfunction). Symptoms of abnormal urination or dysfunctional voiding include:
- Daytime wetting
- Urinary tract infection
- Urinary frequency or infrequency
- Nocturnal enuresis (bed wetting)
- Constipation (soiling)
- Posturing to avoid voiding (squatting or dancing)
- Urinary urgency
Voiding dysfunction can cause a great deal of anxiety for patients and parents. These children are often excluded from social events such as sleep-overs and summer camps. At Georgia Pediatric Urology, we are committed to providing the best care for your child’s health, lifestyle and well-being.
The HAWK Center in Atlanta is devoted to pediatric bladder and pelvic floor muscle dysfunction. Because every child’s situation is different, an individual treatment plan will be recommended and may include a rehabilitation program.
To make an appointment, call 404-252-5206.
How Are the Emotional Problems that Accompany Bed Wetting and Voiding Dysfunction Handled at the HAWK Center?
HAWK stands for Help Awaiting Wet Kids. Dysfunctional voiding is not usually caused by emotional factors, but it can take an emotional toll on children and their families. The psychologist assists families in finding ways to integrate the treatment plan into their daily lives so that a successful outcome is likely.
Why Do Children Wet?
There are many reasons why children wet. Many do not want to stop fun activities to go to the bathroom. Some children urinate only two or three times a day. They simply are too busy to go to the bathroom until it is too late and then they cannot make it to a toilet in time. Other children have uncontrolled bladder contractions that make them feel like they need to go to the bathroom “right now!”
Still, other children do not fully empty their bladder when they do go to the bathroom, putting them at risk for urinary tract infections. Children who wet only at night wet for completely different reasons. Children do not generally wet out of laziness, emotional problems or inappropriate toilet training.
Sorting out why your child wets, and developing a plan to make the wetting stop, is the goal of the nurse practitioner.
What Will Happen at my Child’s First Appointment?
A physician or nurse practitioner (a nurse with an advanced degree) will take a thorough history and provide a physical examination of your child. In addition, we will want to know how often your child goes to the bathroom, how often he or she has accidents, and whether your child has a history of urinary tract infections. We will conduct a physical examination of the abdomen, spine and genitals. Contact us at 404-252-5206 to make an appointment at any of our HAWK Center locations.
What Diagnostic Tools Will Be Utilized and What Tests Will Be Performed?
We may recommend one or more of the following tests:
Your child will void into a special uroflow chair that measures the urine flow rate and the time needed to empty the bladder. After that, we will check for any urine left in the bladder with a special ultrasound called a bladder scan. Your child needs to come to the appointment with a full bladder to get accurate results.
Ultrasound of the Kidneys and Bladder
This painless procedure assesses the size and shape of the kidneys and looks for bladder abnormalities.
Video Urodynamic Study
This study is recommended when a more thorough bladder evaluation is deemed necessary. A special catheter is placed into the bladder to measure the pressure while the bladder is filled with fluid. A soft catheter is also placed in the rectum to measure the abdominal pressure on the bladder. We apply sticky electrodes on your child’s bottom to measure their sphincter (hold-on muscle) activity. Periodic x-rays are obtained throughout the study so we can look for bladder abnormalities. Once the child’s bladder is full and he or she can no longer hold urine in, the child will void into a special uroflow chair to evaluate the urine flow rate and the time needed to empty the bladder.
Voiding CystoUrethroGram (VCUG)
We may recommend this study if your child had a urinary tract infection and a fever. A catheter is inserted into the bladder and filled with fluid that can be seen by x-ray. This study can determine if there is vesicoureteral reflux, a condition where urine backs up toward the kidney. Reflux may persist in the presence of dysfunctional voiding patterns and may cause a bladder infection to wash back up into the kidney. Reflux can cause kidney infections (pyelonephritis), which can lead to permanent damage to the kidneys.
What Form of Treatment Will my Child Receive?
Based on the results of your child’s evaluation, we may suggest:
Changes in Voiding/Stooling Habits
We commonly recommend that children start stool softeners in order to treat any underlying constipation. We will also request that parents help children structure their schedule so that they are making attempts to void and stool regularly throughout the day.
Increasing Fluid Intake
Frequently, we find that children are not drinking enough water throughout the day. In an effort to control the wetting, families sometimes discourage the consumption of fluids. However, it is important that your child be taught to drink water throughout the day. We will explain to your child why drinking water is important and make recommendations as to how much water your child should drink each day.
Biofeedback training is a way to teach your child to relax the pelvic floor muscles so that the bladder can fully empty. Small sticker electrodes are attached to the child’s abdomen and buttocks, and the electrodes are connected to a computer. Our nurses will teach your child to perform Kegel exercises while viewing a computer monitor that shows the child’s muscle activity.
The initial training session takes about 90 minutes and each session after that is 45 to 60 minutes. Initially, we may recommend that you bring your child back every 2 to 4 weeks. As your child learns the techniques and improves voiding habits, we may recommend sessions further apart. Most children require a minimum of 3 biofeedback sessions with a maximum of 6 sessions.
We use medications most frequently to treat frequent urinary tract infections, for children with overactive bladder, and for children with nighttime wetting.
How Do I Make an Appointment?
Contact us at 404-252-5206 and our friendly and efficient staff will help you make an appointment at one of our pediatric locations.