This is a common question this time of year. I am re-posting some suggestions that I wrote last year about this time. Parents wonder what to do??

First, if your child is currently using an alarm, we would not expect him or her to take it to camp with them. They can interrupt usage and restart when they come home.

Secondly, a back up plan should be in place, even for kids who wet intermittently. There are a few choices:

• Wear disposable pants, with a plan for putting them on discreetly and disposal in the morning. Disposables come in all sizes, even small through extra large adult sizes. If your child has outgrown traditional children’s pull-ups, there are still many options. Disposable male guards or women’s incontinence pads can be secured to regular underwear to catch a small amount of urine. Disposable underpads that lie on a sheet or in a sleeping bag have tape strips to hold them in place.

• Use washable bedtime pants to preserve dignity. These can be a nice back-up for kids who are dry most nights but want to make sure there is no leakage onto bedding.

• Waterproof sleeping bag liners fit into a regular sleeping bag. They provide a comfortable, waterproof surface for sleeping without raising questions from other campers.

• Mattress overlays can be used on top of a sheet or used inside a sleeping bag. The overlays can be discreetly pulled into place when your child is ready to go to sleep. The new blue cloud overlays are colorful and look like a regular piece of bedding.

• Make arrangements with the camp counselor to have toileting twice before bedtime and to continue a lifting routine if this is used successfully at home. (Lifting is when a caregiver walks the child to the bathroom at a designated time.)

• Medication, such as desmopressin, can be used temporarily to decrease the amount of urine produced that night. The correct dosage should be determined a week or two before camp begins. Only a small amount of liquid (2-4 ounces) should be ingested once this medication is used. It is best dosed shortly before actually going to sleep.

Lastly, make sure that your child knows that they are not alone and most camps are very helpful in discreetly handling any wetting episodes. Fluid of choice after dinner is water. Double voiding before going to sleep is helpful. Staying well hydrated during the day is helpful so the kids are not so thirsty later in the day.

Although I have not seen research that directly connects seasonal allergies to an increase in bedwetting, there are some factors that may coincide to increase your son’s wetting episodes. First, does he take any medications during this time? Antihistamines, even non-sedating ones, may change his sleep patterns. You could experiment with dosing times to see if the time of day the medication is given makes a difference. Some allergy medications increase thirst so your son could be drinking more than usual. Increasing fluids during the day so he isn’t so thirsty in the evening is important.

With spring, more outdoor play and sports activities are also common. A later bedtime and going to bed exhausted can contribute to bedwetting. Trying to maintain a schedule where he gets an adequate amount of sleep each night can be helpful.

Other than seasonal allergies, some children’s bladders may be “allergic” to certain foods. Some foods have been reported to make the bladder more irritable (contracts more easily) or increase the production of urine. These foods include citrus (lemonade or orange juice), artificial food colors, carbonation, foods with added Vit C ( or megadoses of Vit C), candy and foods with high sugar content. Milk and milk products produce some natural sedative effects so in some cases cause the kids to sleep more soundly. Having milk products earlier in the day is best. Experimenting with eliminating most of these things allows you to see the impact, if any, on the wetting episodes. Then gradually restart and keep tract of your son’s response. If you do the elimination diet while he is using a bedwetting alarm, it is very easy to know when and how often the wetting occurs. You can see for yourselves if allergy medication, diet, milk, fatigue, or any other springtime event makes a difference.

Results: The number of wet nights decreased with DDAVP treatment. Delta power, distribution of sleep stages, number of arousals, arousal index and the effect of arousals on sleep stages did not differ significantly between the two groups. Bed-wetting occurred within each sleep stage and did not follow any particular pattern. In most cases, it was preceded by an arousal reaction, but no awakening occurred.

Conclusion: DDAVP has no effect on the sleep architecture of children with bedwetting.

This study concluded that DDAVP did not affect the sleep patterns of children who take it. Since its mechanism of action is to work locally on the kidneys to produce more concentrated urine, the results are exactly what I expected.

The reason that this study was so interesting to me; however, was that these sleep studies indicated that bedwetting occurs during every sleep stage and does not follow a particular pattern. This is exactly what I see clinically in the families that I work with each day. There are some organizations that talk about bedwetting as a sleep disorder and how bedwetting children stay in the deep sleep phase longer and wet during this phase. This is based on research that was done in Canada in 1968. In the more recent research report that I just read, bedwetting did not occur only in the deep sleep stage but throughout the entire sleep cycle, with no pattern. Families report that the bedwetting alarm goes off at different times each night, anywhere from 30 minutes after bedtime to 30 minutes before wakening in the morning. The child cannot be in deep sleep all of these times.

Anyway, it would have been nice to have a larger sample size but this is good information.

Medication often has immediate results, but when you stop it, the relapse rate is high-about 80 percent. DDAVP allows about half the children who use it to sleep dry that night, which makes it particularly useful for sleepovers and camps. DDAVP is available in two forms: a nasal spray and tablet. The tablet is now preferred because it delivers a more consistent and convenient dose. The nasal spray has a Black Box Warning because of some reported cases of seizures and death because of water intoxication. Also, children with allergic congestion can get erratic results with the nasal spray.

Dosage of DDAVP must be individualized, with one to three tablets (0.2 mg.) each night before bed as the recommended dose. The greatest number of dry nights is achieved by 0.4 to 0.6 mg. nightly. If your child is taking the medication for a situation outside of his home, such as sleepover camp, start it ahead of time to establish the appropriate dose. Your child’s doctor or nurse practitioner is responsible for determining your child’s dosage, but the general recommendation is as follows:
• If your child wets when taking one tablet, increase it to two.
• If wetting occurs with two tablets, his dosage should be three tablets.
• Three tablets is the maximum amount recommended for any age group.

DDAVP is generally safe with few side effects. Reported side effects include headache, stomach ache or water intoxication if a large amount of water is ingested after taking it. The manufacturer provides fluid guidelines, recommending no more than four ounces of water before bedtime. This medication can be safely used for three- to six-month intervals with a one week break. If wetting persists, it can be used for another interval. DDAVP is expensive, as much as $3-4 per tablet. The cost should be taken into account when considering long-term use.

DDAVP does not stop wetting in every child. Increasing the length of time taken will not make it work. The expected results should be seen in a week or two. Parents should realize that this medication does not provide long-lasting effects, but it does provide short-term dryness for many children. For long lasting results, getting to dryness by using a bedwetting alarm has a more permanent response.

Bedwetting can be so frustrating at times. It sounds like you have explored many avenues to get your son to dryness. Since it sounds like his daytime voiding is inefficient, working on that a little more may help. Did the urologist recommend a timed voiding program in the daytime? The kids wear a vibratory wristwatch that discreetly reminds them to go to the bathroom about every 2 hours, even if they don’t feel like it. If he hasn’t tried this yet, it may help to empty his bladder more efficiently during the day. I use the Vibrowatch for my patients because it can be set to precise times. I like to set times that do not require the kids to leave the middle of class, and allow them to start the bus ride home at the end of the day with an empty bladder. Taking a water bottle to school helps to assure that they are adequately hydrated during the day and not thirsty late in the day. Once he’s done this for a few months, he could restart the alarm at night.

I do see this phenomenon regularly in the kids that I work with. I don’t know of a medical explanation, but I do see more wetting in children who have colds, ear infections, flu etc. and who are on medications such as antibiotics, cold medicine, and acetaminophen. It seems like the body is working hard to fight off the virus or bacteria, and cannot attend to the alarm or other bodily messages. Some parents discontinue the alarm for a few nights when the kids are most ill, then restart it when he feels better. That is perfectly fine.

The good news is that once the kids are off the medication and feeling better, dryness patterns do return. Working around challenges that face families is part of getting to dryness. Ultimately, your son will be able to stay dry, no matter what the challenges are.

First of all, stock up on protective undergarments. Because they don’t require washing and drying, disposables are ideal for travel. It’s a good idea to buy more than you think your child will need, just in case. In addition to what you can find in the grocery stores, we carry several styles of pull-ups are available in sizes to fit larger or older kids. For example, the Tranquility Overnight Disposable Underwear, are available in an XS Adult (17-28” waist) and S Adult (22-36” waist) and absorb more a quart of urine, about a cup more than GoodNites.

Disposable underpads are also a great product to have when traveling. They have an absorbent layer and a waterproof layer and can be placed right on top of the fitted sheet. The most popular ones are the underpads with the adhesive strips on the back. These pads stay in place, even if your child is a restless sleeper. They can also be used with moisture-sensing alarms, so they’re a good option if you intend to use your alarm through the vacation. Again, it’s a good idea to pack more than you think you need, especially since these aren’t available in most stores.

If your child is mostly dry, but you want to ensure that your host or hotel’s bedding stays as clean as when you found it, take along a precautionary waterproof overlay. This can be discreetly placed on top of the sheet at bedtime and removed when the bed is made up the next day.

We receive many questions about temporarily stopping the use of the bedwetting alarm during travel. Taking a break for a few nights when your family is not at home is okay. Have a back-up plan using disposables or medication, and resume using the alarm when you return home.

You’re on the right tract by addressing this now. Using a bedwetting alarm for the next few months will enable your daughter to begin getting up when her bladder is full. This new behavior is one that will enable her to stay dry no matter where she is. Some families wait too long before beginning an alarm and expect that 2 weeks will be long enough for their child to become dry before camp. Since the average child takes 10-12 weeks to get to dryness, starting early enough is important.

Desmopressin (DDAVP) works by decreasing the amount of urine produced that night. If a smaller amount of urine is produced, the need to empty the bladder is less frequent. On the nights that your daughter can “hold” the amount of urine produced, she has a dry night. On the nights where she needs to get up to empty, she wets. In order for the alarm to do its job, it has to sound in response to wetness. Therefore, I recommend decreasing or discontinuing the desmopressin when beginning the alarm. This allows for more practice times. There is no harm in combining medication and the alarm, but she may make quicker progress initially if she hears the alarm every night and begins to learn the correct response. Some families use a little medication if the wetting happens more than once a night or if there is a night where using the alarm is impractical. As progress takes place, the medication is no longer needed.