Aug. 21, 2000 -- Some 10% of all school-age children have serious bed-wetting problems, and coping with this problem can be a difficult and costly struggle for families. But an alarm that sounds in response to wetness -- and which can be purchased at drugstores for as little as $60 -- can be more effective than either psychotherapy or drugs alone at helping children to stay dry through the night, a study has found.
Accompanied by a strong family commitment and psychological counseling, such "bell and pad" systems have a cure rate of 75%, says a study published in the journal Pediatric Psychology. And when combined with medication such as DDAVP, which acts on the kidneys to reduce the flow of urine, the urine alarms are even more effective, the study says.
"Sometimes children wet more than once a night or have a delayed response to urine alarms, but combination therapy with DDAVP pushes the cure rate toward 100%," says lead author and pediatric psychologist Michael Mellon, PhD, an assistant professor at Mayo Medical School in Rochester, Minn.
"Unfortunately, most doctors just recommend DDAVP to prevent the bladder from filling, but it's only about 50% effective," says Mellon, who with a colleague reviewed the available research since 1960 to determine the most effective treatments for bed-wetting. The alarms alone, without psychological intervention, also have about a 50% success rate, he says.
Many children wet their bed occasionally, but the medical condition known as nocturnal enuresis is defined as bedwetting that occurs at least twice a week for three months or more, after medical conditions and drug side effects have been ruled out. The cause of the often-inherited condition is not yet known. Without treatment, 15% of bedwetting cases will resolve themselves each year, but it can often take several years for a child to outgrow the condition.
Treatment with a urine alarm can help restore a child's self-esteem, but it places demands on the whole family. "An alarm sounds when the pad senses moisture, then mom or dad get up to help the child rinse off, change the bed, and reset the alarm," says child psychologist Steven Waksman, PhD, who used the system with two of his own children in Portland, Ore. "It doesn't shock kids, it only trains them to wake up in response to a full bladder," he explains.
Although the urine alarm has been available since 1938 and it is known to be effective, neither the alarm nor the psychological treatment recommended to go along with it are usually covered by health insurance, Mellon tells WebMD. "But over time, it actually costs much less than medication and doesn't have any side effects." While the DDAVP costs $90 to $120 a month and can take three years to work, the alarm and psychological intervention cost $600 to $700 total and can work in less than four months.
But before parents rush out to buy urine alarms, there are a few things they should keep in mind, Waksman tells WebMD:
- The systems are designed for kids over age 6.
- A cure is more likely if a psychologist is consulted.
- It usually takes about a month for the bed-wetting to stop.
- Children should use the system for three to four months.
- There's a chance of regression within the first year.
But what about kids 6 and under? "Be patient, encourage them to wear pull-up diapers to bed, and do everything possible to preserve their self-esteem," says child psychologist Lawrence Balter, PhD, professor of applied psychology at New York University.
Balter also recommends that parents:
- Not humiliate, embarrass, or punish their children over bed-wetting incidents
- Avoid comparisons with other children
- Reassure their children that the condition is only temporary
- Discuss any family history of bed-wetting with their child's doctors