When bed wetting does not occur every night, it means that the learning system is functioning partially. When the child wets the bed every night, it means that the learning system does not function at all.
There can be more than one reason for why this happens. Some of the possible causes are high fluid consumption before bedtime, fatigue, weather changes, cold nights, bad mood, mental tension, illness, and many more.
Bedwetting, in most cases, stems from deep sleep. Many parents report about attempts to treat their child with a bedwetting alarm (enuresis alarm). Everyone in the house woke up except the wet child.
97% of the parents reported that their child is a very deep sleeper. Nevertheless, the child responded positively to the comprehensive treatment despite the deep sleep.
A very common misconception about the bedwetting alarm treatment is that the purpose of the alarm is to teach the child to wake up at night to go to the bathroom.
This is not true.
The purpose of this treatment is to condition the reflex system, which is subconscious; therefore, the child waking to the alarm is not a compulsory condition for success. They learn subconsciously to connect between involuntary micturition to the unpleasant alarm response and the waking up and walking to the toilet.
When the child does not wake to the alarm, the parents are instructed to do some essential activities that are vital for the learning process (reflex conditioning).
About 40% to 50% of patients will stop bedwetting by using a bedwetting alarm. For most patients, however, the alarm is insufficient, and other therapeutic techniques must be added to the treatment.
Treatment with an alarm has to be short (no longer than five to six months). Otherwise, the child gets used to the alarm, and the deterrent effect disappears. Continuation of the treatment with the alarm means “more of the same.” It causes frustration and disappointment in the child and undermines their confidence in being able to succeed.
Prolonged failure of the treatment might affect future success.
The starting point of possible future treatment might be influenced by high skepticism and low motivation. To sum it up, self-wakening by the child to the alarm is not a compulsory condition to determine how successful the treatment is.
Treatment solely by the alarm will be insufficient in most cases.
When parents consider seeking treatment for their enuretic child, they should take the following parameters into consideration:
Behavioral treatment should not be considered when the child is suffering from emotional stress or has psychological problems that may be the result of acute trauma (loss of a close relative, exposure to a threatening event, such as physical or sexual assault, involvement in a car accident, violence within the family, conflicts between the parents, and more).
In these cases, enuresis should not be treated, and treatment should be focused on the causes rather than the enuretic symptom.
Some parents look at bedwetting as a personal failure and are highly motivated to treat the child even if the child is not ready yet and is not troubled by the problem. An attempt to force treatment in such cases might create unnecessary tension between the child and the parents, and the treatment will end in failure.
The behavioral treatment with the bedwetting alarm does not alter the child’s sleep patterns.
The change that takes place is that the child will learn, during sleep, to identify the signal from the pressured bladder to the reflex system in the brain.
As a result, the child will act in one of two ways:
During the last phase of the bedwetting treatment, when the child is completely or almost completely dry, we see 3 possible situations:
All three of these situations are good with no preference of one over the other. However, the reason why one occurs rather than the other depends on a few factors:
This being said, it really doesn’t matter if the child wakes up at night or not as long as they stay dry.