Bedwetting alarms are essential in the treatment of bedwetting. Studies indicate a 60-80% long-term cure rate when used correctly. For a child who has bedwetting, once the bladder is full, instead of waking to go to the bathroom or "holding it" as the non-bedwetting child does, the bladder releases all of the urine into the bed. No one knows exactly why this occurs in some children and not in others. Certainly factors such as deep sleep, small bladder capacity, increased nighttime urine production, constipation and food sensitivities play a part in bedwetting. It seems that these children's nervous systems do not respond to the full bladder-that they are "wired differently". In the child with bedwetting, the brain has to learn what the appropriate response to a full bladder is. This is where the bedwetting alarm is useful.

A bedwetting (enuresis) alarm is a device that emits an auditory and/or tactile sensation in response to wetness. The alarm is attached to the child's underwear or pajamas in the area that one would expect the first drop of urine to be noticed. When the child wets, the alarm makes a loud noise to alert the child and his/her parents that wetting is occurring. In theory, the child hears or feels this and learns to get out of bed and empty their urine into the toilet. Gradually, over several months, the child learns to respond to the feeling of a full bladder by going to the bathroom before the alarm goes off. This is a type of behavioral conditioning. It differs from arbitrarily setting an alarm clock to go off at a certain time or by the parents waking the child when they are up. The best type of conditioning is in response to the child's full bladder and urination, which will vary in time from night to night.

A common myth is that the bedwetting alarm is useless in children who are deep-sleepers. Almost all children with bedwetting sleep more soundly than their peers who do not have bedwetting. However, not all soundly-sleeping children have bedwetting! Initially, the parents play an important part in arousing the sleeping child once the alarm has gone off.

In my experience, more than three-forth's of these children do not initially awake to the loud (80db) alarm once they are asleep. When they hear the alarm tested while they are awake, they can't believe they could possibly sleep through that loud sound. But, at least initially, this is the case.

Because the loud sound is what alerts the parents to assist their child and help them to the bathroom, an auditory alarm is necessary. A vibratory only alarm, which is similar to a pager worn in the underwear, does not allow the parents to help the child respond. Many parents report that their child sleeps through this type of alarm and wakes up wet with no idea of what they could have done differently.

In order to be effective, the alarm has to work 100% of the time.

• If the alarm becomes unhooked during the night, the child has lost an opportunity for learning.
• Some children will unintentionally pull off the alarm or otherwise disconnect it as their first response to the noise. If this happens before the parent hears it, the child wakes up wet with an unattached alarm.
• For this reason, an alarm that attaches firmly to the clothing is preferred. The alarms with a metal snap closure, similar to a snap on clothing, can become unattached by a restless sleeper or because they are used on clothing that is too thick.

Some alarms, such as the Malem ones, have a two step turn-off, preventing accidentally pulling it off. (The alarm sounds, alerting you that this happened.) Correct placement on the clothing is necessary so that the alarm can sense the first drop of urine.

The clothing would have to be saturated with urine before the alarm would respond if the placement is incorrect or if the clothing is too loose fitting. For this reason, boxer shorts or loose fitting pajama bottoms would not be the best choice. Snug fitting panties or briefs are ideal.

An alarm with a permanent placement for the urine sensor, is another option. The Rodger Wireless Alarm consists of specially designed briefs with the sensor threads sewn in place. The small transmitter is snapped on the waistband and the receiver is plugged into the wall or placed on the nightstand. Once the underwear senses the moisture, the receiver continues to sound until the wall unit is turned off. Someone must get out of bed to attend to this alarm! And why not go to the bathroom while you're up?

The bell and pad type alarms(where the child lays on a sensor pad) are still available but are inferior to the newer, smaller alarms. In this type of set-up, the urine must leak onto a pad under the child before the alarm will sound. If the child rolls off the pad or does not wet a large amount, the alarm will not sound. Also, the size of this alarm and the firm plastic texture that the child must sleep on make it cumbersome and uncomfortable to use.

Since bedwetting alarms are a mainstay in the treatment of bedwetting, it's an easy first step that most parents can take. No prescription is necessary and children over 6 years can learn to respond.