Parents of kids who are having nighttime accidents may seek a technological solution in the form of a bed-wetting alarm. These devices clip onto kids’ underwear (or may even be special underwear with built-in sensors) to detect moisture, which triggers an alarm that is usually some combo of sound, light or vibration. The idea is that the alarm will wake the child up the moment he begins to urinate. And the selling point is that he may eventually sleep through the night without wetting at all. But the process is time-consuming and complex. It requires parental involvement in the middle of the night and diligent consistency. And the alarms are not cheap (the price range is from $50 to $170 per our research).
We asked Grace Hyun, M.D., associate director of pediatric urology at NYU Langone School of Medicine, if they’re worth the time and money. The key takeaway? If you have a bed wetter, don’t be alarmed—or rush to buy a device. Here, our edited and condensed conversation.
PureWow: When parents ask you about bed-wetting alarms, what age do their kids tend to be? Is there a certain age when we should be concerned that nighttime accidents have gone on too long?
Dr. Hyun: First, I want to make sure we are all talking about the same thing. The type of bedwetting we are describing is kids who only have nighttime issues. If there are any daytime urinary symptoms, then that is a different situation requiring a totally different approach. But as far as nighttime bed-wetting goes, I see kids at all ages. The younger they are, the more common it is. A 5-year-old who is bed-wetting is so, so prevalent that I don’t even necessarily think it’s a problem. As kids get older, the number of kids who will eventually get better on their own increases. Bedwetters, for the most part, all become dry. This is a temporary issue. With time and age, you just start getting drier and drier. In general, it seems that puberty makes a huge difference. I see very few pubertal or post-pubertal kids with bed-wetting.
It’s also highly genetic. So if you got dry at 5 or 6, then your kid will probably follow suit. If both parents didn’t get dry until they were 13 or 14, then don’t put so much pressure on your kid to be dry at 3.
It sounds like we should really try to remove shame from this conversation.
The first thing I tell every kid who comes to see me is “It’s not shameful at all! Don’t be embarrassed. There’s nothing wrong with you. What’s going on with you is a normal thing. I know you’re not the only person in your grade experiencing this. You’re not the only person in your school. It’s simply impossible. The numbers do not play out. So it’s not just you. It’s just that people don’t talk about it.” Everybody will brag that their kid could read at age 2½, or they potty trained themselves, or they play chess, or they are this super amazing travel sports person. No one talks about the fact that they’re all still in Pull-Ups at night. And they are! And it’s totally fine.
So at what age should we intervene?
Parents should intervene depending on the social situation. The older kids get, the more they are going to events like sleepovers, overnight trips or sleepaway camp. We really try to work on getting them dry so they can do the things that other kids their age are doing without any issues. The older the child, the more likely they are to have their own social life, and those kids are far more motivated to try to get dry. That’s when we’ll come up with a strategy for how to fix it.
Is this specifically a boy issue or does it happen with girls as well?
It happens to girls and boys. The older you get, the more likely it is to be a boy.
So if you have a child who is 7, 8 or 9, should you accept his bed-wetting as normal and not bother trying an alarm?
First of all, there are always behavior modifications and lifestyle changes you should try first before you consider any sort of alarm. I don’t tell people to do alarms younger than 9 or 10. Alarms don’t work well for younger kids because A) their body may not be ready to be dry at night and B) those lifestyle changes can be difficult for little kids because most of them do not care that they are not dry at night. And that is totally age-appropriate. They may say they are bummed out about bed-wetting, but when you try to put the various lifestyle changes into place, and you do it every single day because it’s really about consistency, then they don’t want to do it. And that’s very typical behavior for a 6- or 7-year- old: “Sure, I’ll eat broccoli every day” and then when you serve it, they say, “Nah, I don’t want to do it.”
Older kids tend to be more motivated to make changes. They also usually only wet once a night. If you’re having accidents multiple times a night, then you’re just not that close to being dry at night and I would just wait it out. Using an alarm too early is going to be such an exercise in futility and lack of sleep and family stress. If a child can’t make consistent lifestyle changes, then they are not ready to be dry. And that is OK! Everyone eventually becomes dry and they will eventually be ready to make those changes.
Can you walk me through what those lifestyle changes would be?
Yes. What happens to your body during the day drives what happens at night. At nighttime, these kids’ bladders are very sensitive and fragile, so you have to empty your bladder frequently during the daytime, ideally every two to two and a half hours, so you’ve made yourself as dry as possible. We all have friends who are camels and never go to the bathroom. These kids cannot do that.
The second thing is you have to drink water, and not juice, soda or tea. The more water you drink, the more you flush out all the toxins in your body, the better that is for you at night.
The third thing is to make sure your colon is as healthy as possible. If you don’t have soft, normal, daily bowel movements, it can adversely affect your bladder. Kids have very sensitive bladders. It can be confusing to parents because a child can have daily bowel movements and still be completely backed up with stool that will adversely affect their bladder. Many times just starting a laxative will lead to dryness. It’s a game-changer for these kids. It’s amazing. And laxatives really are very, very safe products.
The final thing is you can’t drink 90 minutes before bed. You just can’t do it. And I understand very well how life gets in the way. You have a late dinner or soccer practice or school activities, all that stuff. I totally get it. But your body does not care. If you can’t restrict fluids an hour and a half before you go to sleep, you may not stay dry. You can’t fight science.
And then you always, always, always have to pee right before you go to sleep.
These behavior changes need to be performed every single day for months to see any result. You are teaching your body a new habit that takes weeks to take effect. This is where people can fail because consistency is difficult.
What should you do if your child has made all those lifestyle changes and is still bed-wetting?
You have two options: Continue the behavior changes and A) start taking medication to be dry. The medication works very well, however it is a Band-Aid, not a cure. Once he stops taking the meds, he won’t be dry anymore. Or B) you can try an alarm. And interestingly, alarms can be curative. Meaning that if you are successful with the alarm, it is almost always true that you will stay dry. Bed-wetting has to do with a neural pathway. For these kids, the brain and the bladder do not talk to each other at night. What the alarm can do is jump-start that neural pathway. But the issue is that most people do not use the alarm correctly.
So let’s talk about how an alarm should be used to maximize success.
First of all, it is a time commitment. This takes at least three months. And it requires parental involvement. Bedwetters are such heavy sleepers that they will not wake up when that alarm goes off. So the fact of the matter is that somebody else has to wake up their dead-to-the-world child when the alarm goes off. And that’s usually, obviously, the mom. And then you have to do this every single night. Consistency is key. And there can be no fighting. I tell patients and their parents, “If you guys are going to fight at two in the morning about this, then it’s not worth it.” I understand that you might be unhappy or groggy, but you have to be able to do this.
Parents will also say, “We tried the alarm, and he wet the bed every night.” I say, “Yes! The alarm is not there to prevent the accident from happening. The alarm is there to tell you when the event is happening.” The alarm is not some magic thing that makes you stop wetting the bed. It’s just a machine. You clip it onto your underwear, the sensor gets wet, meaning you will have an accident, and the alarm goes off. Your child does not wake up. You, Mom, have to wake up. Mom then has to go and wake the child. At that point, the child cleans himself up, finishes up in the bathroom, whatever it is.
The most important aspect about using the alarm effectively is that the child, the patient himself, then needs to reset that alarm and go back to bed. He cannot just roll over and go back to sleep. His mother cannot reset the alarm for him. If he does not reset the alarm himself, if he is not involved, then there is no new learned pathway that’s being initiated.
Just like any learned process in the body, whether it be playing music or sports or anything, it takes a very long time of consistent practice for this to kick in. That’s why none of us are in better shape after going to the gym for two days. Therefore you have to consider, “When are we going to do this? I don’t know if we can take three months to do this during the school year. Sleep is important.” I totally agree. You have to be able to make that time commitment. If it works, it works beautifully. The success rates are pretty good. But you can’t use the alarm twice a week and skip a few days. Then your body learns nothing. That’s like saying, “I’m going to learn to play the piano by practicing once.”
Do you have a favorite alarm?
I always tell people to go to Bed Wetting Store and just get the cheapest one. You don’t need all the bells and whistles—the vibrator or the colors going off—because the kid is not going to wake up. It just has to be loud enough that someone else will wake up.
So something about the kid’s act of resetting the alarm himself makes him more consciously aware of what is going on with his bladder?
Yes. It’s similar to the way people use alarms to wake up in the morning. If you set your alarm for 6 a.m. every day, many times you will wake up right before the alarm goes off. And you’re like, “I know this alarm is about to go off, so I’m just going to wake up now” and then your alarm goes off. Similarly, a bed-wetting alarm helps you train yourself to wake up before the accident.
But while you are training your body, if you don’t wake up and reset the alarm yourself, if your mother does it for you, I guarantee it will never work. It’s just like if your mother wakes you up for school every day, there is no way you’re going to wake up before your mother comes in to pull your covers off and yell at you. When the body knows that someone else is going to take care of a problem, it does not learn anything new. It’s like watching somebody else do laundry. All those kids who get to college and are like, “I’ve never done laundry before. I don’t know how to do it!” And yet they’ve seen their mother do it 8 billion times. But they still don’t know how to do it. Until they do it for themselves that one time. And then they’re like, “Oh, I get it now.”
Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.
Correct. If used properly, alarms can be very effective. But it has to be with the correct patient who has made the behavior changes to promote success. It is a long family commitment, and age has a lot to do with it.