II. Indications
- Nocturnal Enuresis (Bed wetting) at least 1-2 times weekly typically in a child age 6 years and older
III. Preparations: Devices
- Bell, light, vibrator, or buzzer and Pad (Alarm)
- Alarms when device becomes wet
- Acoustic devices emit a loud sound
- Bed alarms that wake the child (instead of the parent) are most effective
- Children prefer body-worn bed alarms over bed pads
- Do not use electric shock alarms!
IV. Efficacy
- Higher success rate (75%) than medications
- Least relapse rate after therapy is stopped (41%)
- Most effective in children age >6 years with frequent Nocturnal Enuresis (at least weekly) and in highly motivated families
V. Advantages
- Best efficacy of any method in Nocturnal Enuresis (better than Desmopressin and Imipramine)
- Low initial cost ($100) compared with medications
- Alarm may be covered by insurance
- Vibratory alarms are available for Hearing impaired
VI. Disadvantages
- Requires use often for up to 15 weeks for full effect
- Reevaluate at 2-3 weeks after starting
- Consider other therapy if no effect by 6 weeks (consider re-trial every 2 years despite failed prior trial)
- May discontinue after 2 weeks of consecutive dry nights (restart if relapse)
- High drop-out rate (10-30%)
- Bed wetting should be at least 1-2 nights weekly to be warranted
- Parents and children must be motivated for success
- Parents often need to sleep in same room with child initially to assist awakening to the alarm
- Child may need to be awakened and carried to bathroom to finish voiding