Simple Strategies May Not Be Enough for Bedwetting

While parents can begin with simple strategies such as fluid restriction and rewards for dry nights, bedwetting alarms and some medications are more effective, a new study finds.

The 2013 Cochrane review on "Simple behavioural interventions for nocturnal enuresis in children" came out last month. This review found 16 trials which involved 1643 children.

The authors independently studied the quality and results of these trials before publishing their results. They compared simple strategies with known effective strategies such as bedwetting alarms and medication.

• Simple strategies included:
• Star charts and reward systems for dry nights
• Fluid restriction
• Bladder training (holding more during the day)
• Lifting or wakening during the night

No one simple strategy worked better than another, and none were as effective as enuresis alarms.

However, they concluded that parents could try simple strategies for 6 months as first line therapy, without any professional involvement. If no response, then move to alarm training or medication.

Alarm Training

Bedwetting alarms sense the first drops of urine and sound to alert the child and parents that wetting is happening. Alarm training is more demanding than medication and does require parent involvement, but there are no side effects and there are lower relapse rates.

(Parent involvement is required for all the simple strategies listed and parents may be relieved when their involvement actually results in progress toward dry nights.)

Medication

The authors noted that the effect of medication was not sustained at follow-up after completion of treatment with the drug therapies. They also mentioned the concern of safety and possible adverse effects. Some medications can be used on an as-needed basis.