Alarm therapy (AT) is a first line-treatment for nocturnal enuresis (NE) conditioning the child to wake in response to an auditory stimulus when wetting begins. It is currently unclear whether waking children and guiding them to urinate when the alarm sounds improves the efficacy of alarm therapy, and the benefits of parental assistance in successful alarm therapy are controversial. To try and answer this, Tsuji et al. recruited children who underwent alarm therapy between 2006 and 2016. Patients were <15 years of age and exhibited NE at least three nights per week in the preceding six months. Parents were asked to decide whether they would wake their child during alarm therapy. According to parental decision, patients were divided into a family assisted group and an alarm control group. Efficacy of treatment was evaluated four months after the start of alarm therapy based on a voiding diary (kept by patients or parents). Overall, 78 were enrolled in the study; median age was 9.2 years and 48 were boys. The family assisted group had 44 patients and the alarm control group had 34. Dropout rates were similar (~30%) in both groups. There were also no differences in the proportion of children who achieved a full response (14 consecutive dry nights) or a partial response (greater than 50% reduction in wetting) at 16 weeks after the start of AT. Furthermore, relapse was not dissimilar (30% of children in the family assisted group and 40% of children in the alarm control group). The proportion of children who woke spontaneously to the alarm and went to urinate when the alarm sounded was similar in the family assisted group and the alarm control group (56.7% and 64.0%, respectively). Interestingly, these children demonstrated better responses (full response rate 64.7% in the family assisted group and 43.8% in the alarm control group) than those who did not wake spontaneously to the alarm (full response rate 38.5% in the family assisted group and 22.2% in the alarm control group), although the differences did not reach statistical significance. Overall, efficacy of alarm therapy obtained with family assistance (waking the child when the enuretic alarm was activated) was no different than the efficacy achieved without family assistance and perhaps we should let sleeping children lie . . .
Should we let sleeping children lie?
Reviewed by Neil Featherstone
The effect of family assistance to wake children with monosymptomatic enuresis in alarm therapy: a pilot study.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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