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Simple Strategies Aren't Always Enough for Bedwetting

In tougher cases, alarms or medications may be the answer, experts say
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WebMD News from HealthDay

By Kathleen Doheny

HealthDay Reporter

TUESDAY, Aug. 27 (HealthDay News) -- While techniques such as fluid restriction can help some children who have problems with bedwetting, alarms and medications are more effective, a new study finds.

"Simple behavioral therapies such as rewarding the child for dry nights or taking the child to the toilet during the night can sometimes help with bedwetting, and is better than doing nothing," said study leader Dr. Patrina Caldwell, a pediatrician at the Children's Hospital at Westmead and senior lecturer at the University of Sydney, in Australia.

"However, there are more effective treatments such as bedwetting alarm training or medications," she said. But alarm training is more difficult, she noted.

Bedwetting affects about 5 million children in the United States, with up to 20 percent of 5-year-olds having the problem. Most kids outgrow the problem, known medically as nocturnal enuresis, and only 2 percent of adults are affected. However, bedwetting can be frustrating, stressful and traumatic. Remedies and treatments abound, but with much debate about which are best.

In the United States, two medications are approved for childhood bedwetting -- desmopressin (DDAVP) and imipramine (Tofranil) -- although others are also used off-label.

Dr. Trevor Resnick, chief of neurology at Miami Children's Hospital, said he only prescribes medication on an as-needed basis, such as to spare children embarrassment on a sleepover.

The new report was published recently in The Cochrane Library.

For the review, Caldwell's team reviewed 16 published studies involving more than 1,600 children, with about half trying simple interventions. Among them were fluid retention, rewards for dry nights (such as stars on chart), and lifting children and taking them to the bathroom after they have been asleep.

No one simple strategy worked better than another, the researchers found. When they compared alarm training with the simple strategies, the alarm training was more effective. And treatment with medication alone was better than the simple interventions.

However, the researcher noted that "the findings from this review should be interpreted cautiously due to the poor quality and small sizes of the trials."

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