You are describing most children. Even children who do not have bed wetting exhibit sound sleep patterns and are not easily alerted to sounds. In a study that was done by the fire department, up to 89% of all children tested (non-bed wetting) were not awakened to the sound of a smoke detector of 85 decibels. All of the adults in these households were awakened and the children were finally alerted by their parents’ voices.

This same phenomenon often occurs when using bed wetting alarms initially. Even though most of our bed wetting alarms sound at about 80 decibels, many children will not arouse independently when the alarm sounds. In the beginning, the alarm is for the parents. When you hear your son’s alarm sound, go to his room and remind him what is happening and what he should do. We know that children can be conditioned to respond to familiar sounds and eventually know how to respond to that sound. Over time, your son will understand that the sound he is hearing is important and means that he should stop the flow of urine and get out of bed to go to the bathroom. Of course, if he hears the alarm and knows what to do from the first night on, that makes your job a little easier.

Our wireless alarms, the Rodger and Malem wireless, can both be ordered with dual receivers, one for your son’s room and one for your room. This works well for homes where the bedrooms are far apart. Both of these wireless alarms have a volume control dial on the receiver so the volume can be adjusted to be louder than the shoulder worn models. Another feature unique to the wireless alarms is that your son must get out of bed to turn the alarm off and stop the noise. Wireless alarms are great for those older children who are good at reaching for the alarm on their shoulder, turning it off and rolling over.

The wearable alarms, like the Malem Ultimate or Malem auditory, have a strong constant tone of about 80 decibels. If you cannot hear this alarm from your room, you could use a baby monitor in your son’s room. The Malem Selectable alarm and the wireless alarms all offer a choice of 8 different tones. In some situations, one tone is more likely to alert your son than others. You could experiment with different sounds to see what works best.

(I get this question so frequently that I am re-posting some information from last year).

The parents of a total of 6147 children aged 6 to 11 years completed a questionnaire about sleep-related symptoms, family and medical history. Those children with a high risk for obstructive sleep apnea (about 400 children), along with a chosen low-risk group (about 200) underwent overnight sleep studies. They found that about 9 kids out of 100 in each group wet the bed. Children without obstructive sleep apnea wet as much as children with sleep apnea. They also observed that about twice as many boys as girls wet their beds.

Sleep apnea is suspected when children have loud snoring, large tonsils, mouth breathing, and excessive daytime sleepiness. Allergies and being overweight are contributing factors. Children suspected of obstructive sleep apnea should be evaluated by a Pediatric ENT specialist and may be tested using a pediatric sleep study. This study confirms the presence of sleep apnea, where breathing stops temporarily during sleep. About 2% of children are affected. Although snoring is a common symptom in children with obstructive sleep apnea, it is important to remember that between 10-20 percent of normal children snore (primary snoring) on a regular or intermittent basis.

So it seems that a combination of snoring and bedwetting is not enough to recommend removing tonsils without further testing to confirm sleep apnea. Treating allergies with nasal steroids and losing weight are conservative treatments for some children with continuous snoring and obstructive sleep apnea. Treating sleep apnea may or may not make any difference in the frequency of bedwetting. Bedwetting alarms continue to be the treatment of choice, even in this group of children.

The children who consumed the largest amount of caffeine did not have the highest incidence of bedwetting but they did sleep fewer hours at night. In the older children, aged 8 to 12, the average amount of caffeine consumed was equivalent to three 12-ounce cans of soda per day. These children slept an average of 8.47 hours per night, which is less than the recommended 9 hours per night for this age group.

So it seems that telling your children that drinking caffeine/sodas will cause them to wet the bed may not be the truth. We do know that caffeinated drinks contribute to less hours of sleep per night, and sodas contribute to obesity and dental caries so it does seem prudent to continue to limit your children’s intake of caffeine for other reasons.

Link to see entire article, http://download.journals.elsevierhealth.com/pdfs/journals/0022-3476/PIIS0022347610009935.pdf

Congratulations to your son, JS. The response that your son had is typical of many of the kids who have failed to get dry through the use of medications. There was an interesting study published last month in Urology. It was a retrospective study of about 100 children who had partial or no response to the medications that your son used, and/or kids who had begun wetting again after stopping the medication. Of these children, more than half got to dryness when enuresis alarms were started and importantly, up to 88.9% did not have relapse 6 months after stopping the use of the alarm. This study was reported from Samsung Medical Center in Seoul, Korea, and the conclusion was that enuresis alarms were an effective therapy for children with pharmacotherapy-resistant nocturnal enuresis.

I want to emphasize that bedwetting alarms are very effective cures for bedwetting, even in kids who have tried medication and failed. With the possible side effects and high relapse rate of medications, enuresis alarms are a much safer and more permanent cure, as well. They should be the first-line treatment for bedwetting.

By far, these doctors recommended bedwetting alarms as the first line of treatment for children and families who are ready to get to dryness. Most were familiar with the on-going research that proves that bedwetting alarms are the most effective cure for bedwetting. Some had concerns about the cost and safety of medications which could be prescribed for bedwetting. All were dismayed about the fact that health insurance often covers expensive medications but frequently does not reimburse for inexpensive bedwetting alarms. Two doctors stated that they had written appeals to their insurers about this situation. Even though it might take less time to write a prescription, many doctors offered information about bedwetting alarms and how effective they are to their patients. They told their patients that it is not a quick fix but a permanent cure that pays off in the whole picture.

Many of the physicians had used alarms for their own children with bedwetting and stated that they share this knowledge and experience with their patients. At least 6 came to our exhibit and thanked us for speaking with them last year about their own children. Their success stories were fun to hear about. About a third of the health care providers had never seen or touched an alarm, even though they recommended them.

We had working samples of different styles of bedwetting alarms for them to learn about. Comments we heard were, “Wow, this is much smaller than I thought it would be.” “This is easy enough for the kids to hook up themselves.” “The ones with the receiver for the parents’ room are a great idea”. “This looks and sounds like a toy- I can see why kids wouldn’t mind using this”. We enjoyed talking to new doctors in their residency and medical school, who were eager to see current products. Their lectures on urine and stool problems did not cover much about treatment and types of bedwetting alarms.

My goal was to remind the medical community that using a bedwetting alarm can effectively eliminate years of embarrassing wetting episodes. Any school-aged child who suffers from nighttime wetting can benefit from this simple device.

This same phenomenon often occurs when using bedwetting alarms initially. Even though most of our bedwetting alarms sound at about 80 decibels, many children will not arouse independently when the alarm sounds. In the beginning, the alarm is for the parents. When you hear your son’s alarm sound, go to his room and remind him what is happening and what he should do. We know that children can be conditioned to respond to familiar sounds and eventually know how to respond to that sound. Over time, your son will understand that the sound he is hearing is important and means that he should stop the flow of urine and get out of bed to go to the bathroom. Of course, if he hears the alarm and knows what to do from the first night on, that makes your job a little easier.

Our wireless alarms, the Rodger and Malem wireless, can both be ordered with dual receivers, one for your son’s room and one for your room. This works well for homes where the bedrooms are far apart. The wearable alarms, like the Malem Ultimate or Malem auditory, have a strong constant tone of about 80 decibels. If you cannot hear this alarm from your room, you could use a baby monitor in your son’s room. The Malem Selectable alarm and the wireless alarms all offer a choice of 8 different tones. In some situations, one tone is more likely to alert your son than others. You could experiment with different sounds to see what works best.

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.

Although bedwetting is very common in children, the cause seems to be multi-factorial and not well understood. We do know that bedwetting runs in families and the actual genetic marker has been determined. With both sides of your family affected, more than 70% of offspring are affected. We don’t know exactly what that genetic trigger is, however. For example, do these kids sleep differently, do their bladders contain less, do they pay less attention, etc?

Research has been done to look at risk factors for children with bedwetting. I’d like to share with you some research that was just published online in The Journal of Urology online, Dec 2009. The research was done in Australia using a questionnaire for the parents of 2,856 children. The questionnaire asked about the prevalence of bedwetting among many other general questions about their children. The average age was 7 years and the prevalence of bedwetting was 18%. Bedwetting was defined as any wetting in the previous month, with mild-1-6 nights, moderate-more than 7, severe-every night.

This research did confirm some modifiable risk factors that have been identified in the past years. Encopresis (leaking stool) and daytime wetting were associated with 23% of the kids with bedwetting. I think it is important to note that these two issues should be solved before bedwetting is addressed. In some situations, bedwetting will cease with the cure of the other problems. Males were also more likely to have severe enuresis, when adjusted for age.

Emotional stressors and social concerns were only associated with the moderate bedwetting, not the nightly wetting. This is good news for parents who worry that there is a psychological reason or bad parenting as the cause for their children’s wetting.

AS, if either of your children have encopresis, constipation or daytime wetting, this should be brought to your pediatrician’s attention immediately. As for the other temperamental characteristics that you mentioned, it doesn’t seem that there is a pre-disposition for one type to be more affected than others. I do see all shapes, sizes and personalities of kids in my bedwetting practice but most are just great kids. There is a little higher correlation of ADHD in children with bedwetting, but they can still achieve dryness. From your description, it sounds like both of your children would benefit from treatment using a bedwetting alarm.

A cure is defined as a means of correcting or relieving anything that is troublesome or detrimental. The “curative approach” to bedwetting is presently limited to bedwetting alarms. Research demonstrates that the success rate of using a bedwetting alarm approaches 80%. “Supportive approaches” help buy time until your son stops wetting on his own. Examples of these include: waterproof pants and bedding, waking him when you go to bed, restricting fluids, setting alarm clocks, motivational techniques and medication. Many families try these techniques during the years that it takes for their child to stop wetting on their own. Using a bedwetting alarm speeds up the development of dry nights, with the average child achieving dryness in 10-12 weeks. Once the behavior of getting up and going to the bathroom is achieved, the relapse rate is low.

Bedwetting alarms have been around for 30 or 40 years, but the technology has improved to the point that they are small, comfortable, safe and reasonably priced. Using a non-medicinal, behavioral approach to bedwetting should be a first-line recommendation. However, there is a lot of information to be covered in medical school and residency, and common childhood problems such as this get little attention. Health care providers learn through continuing education, as well as by listening to their patients and through their own personal experiences. Once your son gets to dryness after using a bedwetting alarm, let your doctor know about your experience. Over time, he or she may pass this information to other families with this problem.

Results were impressive. A total of 79% of the patients achieved dryness, defined as 14 consecutive nights of dryness, in an average of 10.4 weeks. A further 13% achieved a reduction of wet nights. For those who had not achieved dryness by 16 weeks, they were given the option to continue. 19% of the patients did take longer than 16 weeks to get to dryness. (This is an important finding. Most studies are conducted for 3-4 months with no follow-up beyond this time) Boys took longer to achieve initial dryness (boys 14.8 weeks, girls 10.9 weeks) but there was no difference in the relapse rates at 6 and 24 months.

The other impressive area in this study was their level of follow-up. They contacted 100% of the participants at 6 months and 99.2% at 2 years. Relapse was defined as 2 wet nights within 2 weeks. 27% reported some relapse at 6 months, 35% at 2 years. This relapse rate is so much lower than that reported after trials of medication, where the relapse rate approaches 90%.

This research continues to prove that bedwetting alarms are an effective cure for bedwetting and the relapse rate is lower than any other method we have.