Children's Health: Beating the Bed-wetting Blues (cont.)

But you also asked whether pull-ups would be promoting the bed-wetting later on. I think you might guess, as I mentioned before, since this is involuntary, I don't think it would have a negative or positive effect. If your daughter is not embarrassed to wear them on an overnight, by all means, go ahead and save her the difficulties of not wearing them. I don't think it's going to make a difference in the long run. But many parents find the medications a more effective way to deal with overnights than using pull-ups.

Try either and let me know how it goes.

What solutions do you suggest when parents come to you with a child who is bed-wetting at age six or seven?

I think the most important thing, again, is for parents to understand that this is almost certainly not a sign of a problem, either medical or psychological. They need to understand that it's not their child's fault -- their child isn't being lazy or willful. What it is, we think, is just an immaturity of the brain. When our bladder, in the middle of the night, says it wants to urinate, our brains are able to turn the bladder off even though we're asleep. But children with primary bed-wetting are unable to do that for some reason until the connections are made from the brain to the bladder. The most important thing to understand is that this is not a medical problem or a psychological problem. It's certainly inconvenient and no fun for anybody at times but as I mentioned, the child's self-esteem is more important than dealing with it in a way that would be negative for the child.

If a child is 6, we know that still about 10% or so of them are not dry at night normally. The question is if you should do anything about it. Since it's not a medical or psychological problem you don't really have to unless you want to. Why would you want to? If the child is embarrassed and is looking for help with it -- and most 6-year-olds frankly are not that motivated yet -- or if it's interrupting the family routine or causing bad relationships within the family to such an extent that you want to see if you can get rid of it so everybody can sleep better at night -- those are the reasons to treat it.

On the other hand, if you don't mind it that much and you've come to terms with it and your child is OK with it -- it's perfectly acceptable just to let it go and wait for it to go away on its own. If it doesn't in the next year or two and things change and you want to try some of the treatments then, you can.

It's really a parents' choice and child's choice about when and if to deal with nighttime bed-wetting.

Having said that, if you have decided and your child has decided that you'd like to deal with it, are there some behavioral approaches that you can take? Understanding that it's not the child's fault, that it's nothing conscious they are doing -- are there things you can do short of medication, like withholding liquids or restricting certain types of liquids, that would help with the issue?

Sure and parents do it all the time. Not having the child drink much after dinner, waking them up to pee before you go to bed or a half hour before they usually wet the bed, not having too much stimulation like a television on in the room after they go to sleep -- these are common interventions parents try. The problem is they are not all that effective and rarely do the job -- but it might and it's certainly worth a try.

If you look at the research that has been done on bed-wetting, there's no question that the most effective treatments are the alarms -- they are effective in about three-quarters of children. The major advantage is that once a child is somehow trained by the alarm, the recurrence of bed-wetting is much lower than any other technique. If you stop the alarm, the odds are good that the child will not relapse and will continue to stay dry.

So, the nighttime alarm is probably the best way to go if you really want to attack nighttime bed-wetting in a successful way, but it does require your child's cooperation. I should also say your child should know the alarm is not a punishment but a reminder to wake him or her up at night to help him or her to be dry. It also requires some family intervention initially of everybody getting up with the child when the alarm first goes off and taking the child to the bathroom. It requires some work and may take even months to be successful in the three-quarters of cases that it works but it is by far the best treatment for nighttime bed-wetting that we have.

The alarm system that you're talking about -- is this with a sensor for wetness or will it work with just an alarm to wake the child up?

These are enuresis alarms which have a sensor for wetness that then transmits a signal to either a beeper or a buzzer that makes noise or a vibrating beeper that vibrates, or for children who just can't wake up to save their lives, both making a noise and vibrating to wake them up. When the sensor senses wetness the alarm goes off and hopefully the child wakes up or the parent wakes the child up, then they go to the bathroom and finish the job.

We don't really understand why they work. Somehow they seem to train the sleeping brain to be more aroused, awake and alert, and to avoid urinating when the urge exists. When they work, some children are then able to sleep through the night completely without even waking up and staying dry. Others wake up when they feel the urge to pee and go to the bathroom.

As I said though, in about a quarter of the cases, the alarms may not work so well. In those cases if you're really stuck and your child is getting older, sometimes a combination of the alarm and DDAVP will work more effectively than either one alone.

Could you explain the kinds of medications that may be tried? I do want to emphasize again your point that the medications are not as effective as the alarms and they don't continue to be effective once you stop taking the medications but if the child has short-term needs to be dry for sleepover camp for instance, what would those medications be and what are some of the potential side effects of those medications?

"If you look at the research that has been done on bed-wetting, there's no question that the most effective treatments are the alarms -- they are effective in about three-quarters of children."

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