May 6, 2005 -- It is a problem that affects around 20% of 5-year-olds and up to 3% of teens. Frequent nighttime bed-wetting can be emotionally devastating for a child of any age, but a new research review shows that most kids don't have to suffer.
According to the analysis, one of the oldest treatments for bed-wetting is also one of the most effective.
Nighttime alarms that vibrate, ring, or light up when a child starts to wet the bed were found to work better to stop bed-wetting permanently than the most widely prescribed drug.
"About 50% of children are cured after three to four months of treatment with the alarm," Cathryn Glazener, MD, PhD, tells WebMD. "Alarms are certainly more of a hassle than drugs at first, but they are also much more likely to work long term."
Drug Works Faster
While children who took the drug desmopressen (also known as Concentraid and DDAVP) stopped nighttime bed-wetting faster than those who used the alarms, they were more likely to start wetting the bed again after stopping treatment.
The review was conducted by The Cochrane Collaboration, an independent group that evaluates medical research.
Many children occasionally wet the bed, but the medical condition known as nocturnal enuresis is nighttime bed-wetting that occurs at an age when a child could reasonably be expected to be dry. That age, according to the report, is 5 years old.
Teaching the Bladder
The causes of the condition aren't clear. Delayed or immature development of the bladder may be one factor.
Although most children eventually grow out of bed-wetting without treatment, many suffer for years unnecessarily, Glazener says.
"For some families it is no big deal, but it can potentially be very disruptive to a household and certainly distressing to the child," she says. "When things get to this point, it is time to seek treatment."
Children who are bed wetters are at an increased risk for emotional and physical abuse, says the report.
In some form or another, alarms have been used to stop bed-wetting for almost 70 years. These days the devices are fairly sophisticated and either vibrate, ring, or light up when a special mattress pad senses the first signs of moisture.
"The idea is to wake the child before they have emptied their bladder so they will have to get up and go to the bathroom to finish," Glazener says.
Over time the body becomes conditioned to wake up when the bladder is full.
Half Were Cured
Glazener and colleagues analyzed 55 trials comparing the effectiveness of bed-wetting alarms to treatment with desmopressen and several other therapies that have been less well studied.
Of the 2,345 children enrolled in the studies, two-thirds of those used an alarm for two weeks straight. About half of the children began bed-wetting again after stopping the alarm treatment.
Studies involving other therapies, such as behavior modification and alternative treatments like hypnosis and acupuncture, were generally of poor quality, the researchers noted. As a result, it was not possible to evaluate their effectiveness.
Combining Alarm and Medication
Pediatric psychologist Michael Mellon, PhD, of the Mayo Clinic in Rochester, Minn., tells WebMD that combining the alarm and medication seems to work best for children who often wet the bed several times during the night.
Mellon calls drug therapy a "management option" rather than a cure for bed-wetting. He says he is disturbed that it is the only treatment that is often recommended by pediatricians and family doctors.
Drug treatment typically costs between $100 and $120 a month, and Mellon says the relapse rate after kids stop taking medications is about 90%. The relapse rate for alarm treatment among children who go through the Mayo Clinic program is about 20%, he says.
"These families can end up spending thousands of dollars on drug treatment vs. a few hundred for alarm treatment, and insurance companies routinely pay for the medication and not the alarm," he says. "That makes no sense at all."
Mellon says he is also disturbed by recent ads promoting big-kid-sized disposable diapers for children who wet the bed.
"It is upsetting to see kids who are 8, 9 and even 10 years old being told to wear pull-up diapers, instead of treating them at age 6 with a treatment that is very effective at stopping them from wetting permanently," he says.