Treatment of bedwetting in children with comorbidities using bell and pad alarm: treatment practices and outcomes.

Abstract

Introduction: It has been established that children suffering from nocturnal enuresis (NE; bedwetting) can be treated with bell and pad alarm conditioning however there is limited information about treatment practices and outcomes for enuretic children with comorbidities. A retrospective audit of 3000 pediatric medical records is currently being conducted to determine the efficacy and treatment practices using the Ramsey Coote bell and pad in Australia. As part of this audit, information on children with the following comorbidities is also being collected - Attention Deficit Disorder, Autism Spectrum Disorder, Intellectual Disability, Conduct Disorder. Materials & Methods: Using a clinical audit data collection tool and carrying out an in depth review of practices, which were audited as part of a multicentre audit, the following have been examined: the success (cure rate) of treatment and relapse rates in the children opulation withand without comorbidities, implications in terms of clinical outcomes after analysis of practice protocols, patient evaluations and clinical records. Results: Treatment protocol: an 8 week alarm program in the home using the Ramsey Coote bell and pad alarm. If the child did not respond in the 8-week period, treatment was extended for another 4 weeks or longer as required. Number of patients Cure Rate % Attention deficit disorder 19 61.0 Autism spectrum disorder 37 51.4 p<0.01 Intellectual disability 56 54.4 p<0.001 Conduct disorder 6 50.0 No recorded condition 1700 76.6 1818 patient records were analysed at the time of publication.

Conclusions: The treatment of NE for children with comorbidities utilising the bell and pad alarm is appropriate with the inclusion of the behavioural approaches used by psychologists and the protocols by the nurse practitioner to cure or help children improve their quality of life. Longer treatment times where appropriate, formalized overlearning and/or use of the Ramsey Coote vibrating disc would be recommended as part of the pathway for care and success for these groups.