Age-related considerations
Depending on the child's age, treatment can be approached in different ways.
No matter what age, education and advice should be given to all children and families to dispel misconceptions and to help the child reduce the likelihood of having to urinate while sleeping.
If the child is under age five, the parent should be advised that bedwetting is normal and that non-pharmacological advice should be used.
If the child is five or six-years-old, most clinicians do not express worry. Behavioural and motivational therapies can be used.
Behavioural and motivational therapies should be tried before starting a bedwetting alarm. They are typically recommended only if the child is seven-years-old or older and is motivated to treating the condition. Bedwetting alarms can also be combined with the over-learning method to reduce the risk of future relapse. These alarms can be more effective and have less relapse than medication, but take longer to work.
Medication, i.e., desmopressin, is also typically only started after trying behavioural and motivational therapies for several months and if the child is at least seven-years-old. Medications can and should be combined with non-pharmacological treatment. Sometimes, medication is tried before an alarm if the family is not committed to using it or if the patient desires a quicker therapeutic response.
Unfortunately, as the child gets older, cure becomes less likely. Combination medication therapies may be seen in older children.
No matter what age, education and advice should be given to all children and families to dispel misconceptions and to help the child reduce the likelihood of having to urinate while sleeping.
If the child is under age five, the parent should be advised that bedwetting is normal and that non-pharmacological advice should be used.
If the child is five or six-years-old, most clinicians do not express worry. Behavioural and motivational therapies can be used.
Behavioural and motivational therapies should be tried before starting a bedwetting alarm. They are typically recommended only if the child is seven-years-old or older and is motivated to treating the condition. Bedwetting alarms can also be combined with the over-learning method to reduce the risk of future relapse. These alarms can be more effective and have less relapse than medication, but take longer to work.
Medication, i.e., desmopressin, is also typically only started after trying behavioural and motivational therapies for several months and if the child is at least seven-years-old. Medications can and should be combined with non-pharmacological treatment. Sometimes, medication is tried before an alarm if the family is not committed to using it or if the patient desires a quicker therapeutic response.
Unfortunately, as the child gets older, cure becomes less likely. Combination medication therapies may be seen in older children.
Asking an Expert
The following is a great video featuring Dr. Norman Wolfish, a leading bedwetting expert, who addresses treatment for patients of several different ages, and includes discussions about wearing diapers, unusual urinating behaviours, and the psychological impact of the disorder.
References:
Tu ND, Baskin LS. Management of nocturnal enuresis in children. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.
Tu ND, Baskin LS. Management of nocturnal enuresis in children. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.