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Enuresis Alarms
Typically treatment is 6 to 8 weeks, but with treatment of
any condition, there is a great deal of variability. If you are familiar with
the normal distribution graph, this describes the treatment time parameter, i.e.
some children will respond and be finished with treatment within a week, a
larger group take 3–8 weeks, and a small group takes longer. While it is quite
normal for some children to take longer, if you become concerned about the time,
just contact us at support@urocare.com
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Don't limit drinks - it will not help, and in fact it
may make things worse. This is because the bedwetter produces high amounts
of urine because a hormone which is produced at night in adults and most
children to cut down the production of urine when asleep, is not produced in
large enough amounts in bedwetters. For this reason their production
of urine is too high. So the brain of the bedwetter tells the kidneys to
produce just as much urine at night as it does during the day, and limiting
drinks will not change the brain’s message to the kidneys.
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Don't expect that setting an alarm clock or waking
your child at a regular time to empty the bladder will teach the child to
wake - it doesn't.
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Don't blame your child or use punishment, as you can
see it is not the child's fault. An anxious child will be less able to
cooperate with you in the treatment.
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Some of the earliest drugs used for treating bedwetting
were antidepressants. Specialist doctors agree that they should never be used to
treat bedwetting, because few children are cured from bedwetting using these
drugs, and they can cause rashes, irritability and carry a risk of poisoning.
An alternative drug stimulates a reduction in urine (a
DDAVP) and can help for short term control, but most often bedwetting starts
again when the drug has stopped. However, used for two years or more at a
maintenance level it is successful for some children. But these drugs also have
side-effects, and in particular it is important to reduce water intake for the
next 10 hours after taking this medication. Because the medication is reducing
urine output, drinking after having the medication can result in a fluid build
up and affect the fluid balance of the brain, and cause mental confusion, or
even a convulsion (a fit). Doctors recommend that a child taking this kind of
drug should be monitored by a doctor to make sure it is being used correctly.
This means that allowing a child to take this medication while going to a school
camp, for example, is potentially dangerous because there may not be close
monitoring of the taking of fluids after the medication.
For you to be a team, there has to be an alignment between
you and your child. Maybe right now you are trying to use logic to get your
child to agree to doing something about the problem of bedwetting, but perhaps
your child is in an emotional, negative mode and so there is no alignment
between the logic that you are trying to use, and the emotional, maybe negative
state your child is in.
So when I say that you both need to be aligned, this means
that you both need to be in a logical, fact based mode in which there is little
or no emotion.
The way to get to the position of both being aligned is to have a very logical,
unemotional conversation with your child about his or her bedwetting. In
particular ask whether it bothers him or her, and whether he or she would like
to stop wetting the bed. If the answer is yes, then explain that you have to
work on it together as a team, and the team is you, your child and the DRI
Sleeper®. Explain that you all want the same thing, and that is for
him or her to be able to wake up if he or she needs to go to the bathroom in the
night.
Explain that the issue with bedwetting is that he or she
is too much asleep to wake up, and the only way to stop wetting the bed is to
learn to wake up, but that you both know that he or she cannot do that alone
(it's important that you also have agreement on that).
So what you are asking your child for, is for him or her
to agree to work as a team with you, and the DRI Sleeper®.
The next step is to summarize what you have both agreed on
and to make sure that your child understands that you are going to work together
as a team to beat the bedwetting.
The conversation you have just had with your child is an
example of how good communication proceeds, and so it is important that you tell
your child how grown up he or she has been in listening and understanding how
you are going to beat the bedwetting as a team.
It may be necessary to have this conversation again if
there are objections, but at all times stay unemotional and just stick to the
facts as I have explained above.
Finally if your child says that he or she does not want to
work as a team and will not use the DRI Sleeper®, then tell
him or her that you will leave it until he or she is old enough and ready to
work as a team. However, because he or she has decided to keep wetting the bed
then he or she will have to look after it, i.e, to change the bed linen and put
everything in the wash every day, and to make the bed up again (depending on the
age of your child you may need to help). If it happens in the night he or she
will have to do it then as well.
The point of this is that even a child must learn that
decisions have consequences. Cooperation has the consequence of working as a
team and being helped to solve things, not cooperating means the problem
continues and you have to look after it yourself. That's a very important lesson
of life.
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Over the next few weeks the child is learning to react
more and more quickly to the alarm, and then begins to "beat the
buzzer" by waking up before starting to pass urine. Now the child is
beginning to respond to the sensation of the bladder filling, which is exactly
where the treatment has been heading to.
The process is then to keep using the DRI Sleeper®
every night until there have been 14 nights in a row
with no triggering of the alarm, and no bedwetting.
All children who wet the bed sleep very deeply, but
research indicates that all young children sleep more heavily than adults,
because they spend more time in the deep sleep phases. Therefore there is no
consistent evidence that children who wet the bed actually sleep more heavily
than children who do not. Nonetheless parents will usually agree that their
bedwetter sleeps more heavily that their other children. So we have designed the
DRI Sleeper® alarm to be maximally alerting
for heavy sleepers, firstly because of its loudness and position on the
shoulder, and secondly because the frequency is particularly alerting.
There are several reasons why the DRI Sleeper® is more likely to wake your child.
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The alarm unit of the DRI Sleeper® is placed on a Velcro patch on the shoulder of the child, and so is much
closer than an alarm clock, and therefore, while the alarm clock may appear
to be quite loud, it is not as loud as the DRI Sleeper®.
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The DRI Sleeper® is
triggered as the child starts to pass urine, and this is likely to be when
the stage of sleep is closer to waking, and so there is a higher chance of
the child waking to the sound.
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An alarm clock being set to go off at a particular
time will have no relationship to the child experiencing the urge to
urinate, and so not only is the alarm clock not as loud as the DRI
Sleeper®, but it is going off without there being the
important relationship between the sound and the urge to empty the bladder,
and the child being in a lighter state of sleep.
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Surprisingly these are the children for whom the use of an
alarm is very important. Take a look at what well-known pediatrician Dr
Green says. He explains that the children who initially do not wake
to the alarm are very suitable for alarm treatment.
With these children the strategy is that you hear the
alarm, go into the room, put on the light, say your child’s name, and if no
waking is happening, wipe your child's face with a cool damp cloth. Leave the
alarm beeping.
Then have your child get up (by themselves) and go to the
bathroom with the alarm still sounding, and ONLY then should you unplug the
alarm.
The reason for this is so that waking is happening with
the alarm sounding, and a link between waking and the sound of the alarm can be
formed in your child’s brain.
It is very important that in the morning
that your child remembers the alarm sounding and going to the bathroom, because
only if your child remembers will learning happen effectively.
However, for these children there is this extra step in
the treatment program and so expect it to take longer.
Another strategy to assist with waking is what I call a
"priming" strategy. It is possible to “prime” your brain to
remember to do something in the future, for example we can say to ourselves that
we need to remember an appointment next Tuesday, and in fact as Tuesday
approaches the thought about that meeting comes into our mind. People also use
the same strategy when they need to wake early in the morning, they set the
alarm clock for the early hour, but almost invariably will wake up before the
alarm clock. What I suggest is that as your child is preparing for bed, that you
have her or him lie down in bed just as he or she would when he or she is
sleeping, have the alarm attached to the shoulder, and you trigger the alarm
with a coin or something similar. Your child is to get up, after a few moments
unplug the alarm, and go to the bathroom, pretending to use the bathroom as she
or he would if he or she needed to pass urine. Practise doing this five times in
order to assist (priming) your child's brain to be more ready to respond to the
alarm when it sounds during the night.
When there is still no progress (and I guess it’s no
comfort to you that not many children are in this category), a part of the
learning to wake to the alarm is practised during the day.
Have the alarm box already attached to a favourite pyjama
top, or maybe a T shirt that you have bought especially for this treatment
(anything that makes the process special will help).
Check the DRI Sleeper®. alarm is working
correctly by plugging in the Urosensor™ and touching the Urosensor™ surface
with a coin such as a dime to and noting that it beeps.
Before you follow this routine, make sure you know it
well. Explain it to your child, and make sure your child understands that this
practise is teaching the brain to be ready to wake to the buzzer, and, that with
practise your child's brain will get fast enough to beat the buzzer. Then he or
she will have dry beds.
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From dinner time on, have your child drink extra
liquids. This may sound strange, but we are wanting to get plenty of
practise at the routine of responding to the alarm.
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Have your child tell you when he or she needs to go to
the bathroom (you could call it having a “bladder signal” or any other
term you like, as long as it is one that you have agreed on and you continue
to use that term).
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Immediately go with your child to the bedroom, have
him or her put on the pyjama top with the alarm box attached, lie on the
bed, and pretend to be sleeping. Plug in the Urosensor™ of the DRI
Sleeper® Excel (or switch on the DRI Sleeper®
Eclipse) and
you pick up the Urosensor™ and hold it.
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When he or she is relaxed, you make the alarm
"beep" by touching the Urosensor™ sensing surface with a dime.
Then your child is to get up and you both run right along to the bathroom,
with the alarm still beeping.
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Have him or her unplug the Urosensor™ from the DRI Sleeper®
Excel alarm box (or switch off the DRI Sleeper®
Eclipse), just as would happen if this were during the night.
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When possible, another parent or sibling may also
help, by going to the parents’ room and when the DRI Sleeper®
alarm
starts beeping, "race" the child into the bathroom. Children of
this age tend to like this kind of competitive involvement. It also
encourages the sense of urgency to react to the DRI Sleeper®
alarm
beeping.
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Have your child splash his or her face vigorously five
times in a row with cold water. Then pretend to use the toilet for a few
seconds as if to urinate, and have your child say, "I have a bladder
signal (or whatever is the term you have agreed on), but I can wait to
urinate."
Return to the bedroom and repeat steps 3 to 7 above four
more times. If your child cannot hold off urinating, then let him or her urinate
and then continue until you have practised steps 3 to 7 five times in total.
If after a week your child is still not waking to the DRI Sleeper®
alarm at night, then increase the number of repetitions to 10
times per evening. For more difficult cases go to 20 repetitions in the 3rd
week.
If even this is not successful (and that’s very rare)
then leave it for a few months to allow more brain maturing and then start
again.
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The answer is no, and here is another aspect of bedwetting
that is not understood. As I mentioned before, children who suffer primary
bedwetting (never having been dry at night since coming out of diapers) produce
too much urine during the night, as well as being unable to wake themselves.
However, a consistent observation from my experience over 30 years, is that
after being successfully treated with the DRI Sleeper®,
within a month or two (and often more quickly) the child begins to sleep right
through the night, and does not wet the bed, but also does not need to get up to
go to the bathroom. This suggests that they are now moving into the more adult
pattern of producing less urine while they are asleep and therefore most often
not needing to get up during the night. However, this is a guess, and has not
been researched at this stage.'
A few children may go back to bedwetting after a few
months, and in that case simply using the DRI Sleeper®. again
will fix the problem. However there is also a method called over-learning which
can be used to prevent relapsing and to strengthen the
When your child has had 14 consecutive dry nights with no wetting and so no
alarm activation, start to have him or her drink an 8-10 oz glass of water
around a half an hour before bed. What this will do is make it necessary for him
or her to need to go to the bathroom two or three hours later, and either it
will cause the alarm to be triggered, or he or she will wake up. Either way this
brings about more learning to respond to the sensations of the bladder filling.
Continue with this for 7 nights. Then stop the extra drinks (let your child
drink what he or she wants to) but keep the DRI Sleeper®
attached each night until he or she has achieved 14 dry nights.
Yes, parents have used the DRI Sleeper®successfully during the day to teach the child to tune into their bladder
signals. Even from using the DRI Sleeper® at
night many parents notice an improvement during the day because their child has
become more aware of daytime bladder signals.
My child has special needs, can the
DRI Sleeper® be used to help with toilet
training?
Yes, the DRI Sleeper® has been used
successfully for children with special needs to assist them to become toilet
trained so that they can become mainstreamed at school.
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