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There's the midnight stirring down the hall, the pitter-patter of footsteps across the hardwood floors and the creak of the linen closet door.

Your nine-year-old daughter is trying, in vain, to discreetly change the sheets she just wet.

It may seem puzzling, since she hasn't had a problem with "accidents" since she was in kindergarten, but this is prime time for bedwetting relapses.

Last fall, the Johns Hopkins Children's Centre in Baltimore, Md. reported an uptick in September visits to its pediatric urology clinic, a trend staff see annually. The cause in most cases? The physical and emotional stress from the cruel switch from the lackadaisical days of summer into school mode.

That transition can be tough for kids from kindergarten right through to high school. Some deal with the social anxiety, altered sleep patterns and academic pressure of early September by throwing tantrums or bickering with siblings. Others have subconscious reactions: wetting the bed or waking up from nightmares.

For those nighttime interruptions, the cause is often the shake-up of a child's eating and sleeping schedules, says Kay Meier, a pediatrician at Misericordia Child Health Clinic in Edmonton.

She tells the parents of her patients to start "walking the clock back" two weeks before school starts. Don't enforce a 9 p.m. bedtime right away, she suggests. Instead, start waking your kids up half an hour earlier each morning. It's "way kinder," she says. They'll start adjusting their bed time themselves to balance things out.

But sometimes prevention isn't enough to stop accidents.

If your child wets the bed, attempting a meaningful conversation at 2 a.m. to figure out if there's an emotional cause might not work. Instead, help her clean up and say, "Tomorrow, some time when you're ready, we'll talk about this," Dr. Meier advises.

Alyson Schafer, the Toronto-based author of Ain't Misbehavin': Tactics for Tantrums, Meltdowns, Bedtime Blues and Other Perfectly Normal Kid Behaviors, says if you know from previous years your child is prone to bedwetting when school starts, put a sleeping bag on the floor so he can strip the soiled sheets off his bed, change into fresh pyjamas, and go to sleep without waking you up.

While your nurturing instinct might be to let your daughter sleep in your bed till morning if she has a nightmare, resist indulging her, Ms. Schafer says.

"If you say, 'Look, they're anxious, it's the first day of school, I'm going to let them sleep in my bed,' you're dead in the water. You're saying there's a benefit to being anxious because you get what you want," she says. "You'll have three bad nights of taking them back to their room, but it'll buy you the rest of the school year of good sleep habits."

But vulnerability isn't the only way children exhibit signs of back-to-school stress. Some use aggression as an outlet, which can be a challenge for parents to deal with if they also want to be a disciplinarian.

Many children can become more irritable in the dog days of summer, Dr. Meier says. Some will start bickering with their siblings (often about issues unrelated to school) or throw seemingly out-of-the-blue tantrums.

"The first thing that can be done is to take a big breath and not jump on every small infraction because that will increase the stress," Dr. Meier says.

The cause of a temper tantrum may not always be obvious to parents, who often forget returning to school comes with a range of social pressures in addition to academic ones, Ms. Schafer says.

"It could be discouraging to know that your social status is being challenged because you're going into a new classroom. Or that you have maybe been the athletic person in the family and you've shone all summer at family bike trips but your brother's the scholar and now you're going back to school and he's going to take the limelight again," she says.

If a younger child is reluctant to talk about how he's nervous about being bullied at school or not performing well in classes, encourage him to put his thoughts down on paper or draw pictures, Dr. Meier says.

"It's a great way to get rid of a little tempest in their head."

Karyn Gordon, a Toronto youth expert and family consultant, says parents should take the lead with a "what to expect" conversation before school starts.

If you know your child is nervous about having to be in a class with someone who bullied him the year before, you may want to avoid the topic so as not to cause him any more grief. But focusing entirely on the positive doesn't help. Let your child ask all the "what if this happens" worst-case-scenario questions and answer them honestly, she says.

One of her clients sits down with her kids every year before school starts and helps each one create a list of goals: one academic, one social and one health/fitness-related. The strategy can work to get kids talking about what they liked and didn't like about their last year of school.

A wealth of behavioural pediatrics research suggests communicating with your children using touch can calm them down as well.

"Hugging, rumpling someone's hair, a thumbs up, a small pat on the back – for many kids that carries an enormous amount of emotional goodness," Dr. Meier says.

But Ms. Schafer also warns against being too forgiving of children who act out during this time of year. If they want that chocolate bar and throw a tantrum, you might say, 'She's having a tough time, I'll let her have it.' Wrong move.

You've just trained that child inadvertently to use their mood to get their way – and earn pity.. "If you pity your child, you're saying I don't have faith in you," she says.

You can be helpful and empathetic, she says, "but I wouldn't change limits and boundaries."

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