Your child is wetting his bed and you don't know what to do. Medical treatment is not the only strategy that helps. Motivational counselling in combination with medical treatment offer the best results.

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Motivational counselling includes the following:

• The child assumes an active role by keeping track of wet and dry nights on a calendar.
• Fluids are not consumed 2-3 hours before going to bed.
• The child has to try to urinate before going to bed.
• As soon as the child is old enough he or she has to take responsibility for changing the bedding and putting on dry clothes when wet.
• No punishment and angry parents are allowed.
• Positive reinforcement is given for dry nights.This can be in the form of congratulations, a star on the calendar and even a small gift when a set target is reached.The key here is to take small steps and set realistic goals.
• Continuous reassurance about the cause and the outcome should be given with the aim to remove blame and guilt.

Imipramine
Imipramine (Tofranil™ and various generics) was initially used as an anti-depressant and is thought to relax the bladder muscles and making the bladder less sensitive to filling.

This will then give the child more time before he or she needs to go to the toilet. It is falling out of favour because of side effects like decreased appetite, irritability, headaches and constipation, because it can be lethal in overdose and because of newer drugs like DDAVP™.

Desmopressin
Desmopressin (DDAVP™) is a hormone that is secreted in the body and is also called anti-diuretic hormone (ADH). It has an almost immediate effect of reducing urine output and therefore reduces bed-wetting.

It has a success rate as high as 70%, but relapses are common if the drug is discontinued too early. It is also very effective for special occasions like sleepovers when a dry night is very important to the child. A drawback is that it is substantially more expensive than imipramine.

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