What is the first-line long-term treatment recommended for a child with significant nighttime bedwetting?

The recommended first-line long-term treatment for a child with significant nighttime bedwetting, or nocturnal enuresis, is the use of an enuresis alarm. This approach is based on conditioning techniques that help the child develop awareness of bladder fullness during sleep.

Enuresis alarms work by detecting moisture and triggering an auditory or vibratory signal to wake the child, thus training them to respond to the sensation of a full bladder. Over time, this can lead to increased control over bladder function during the night and helps in making lasting behavioral changes.

While encouragement strategies can support the child and family by providing emotional and psychological reinforcement, they are not considered a formal intervention for long-term management. Biofeedback therapy is not typically used as a primary treatment for nocturnal enuresis; it may have limited applicability in this context. Desmopressin, a synthetic analogue of vasopressin, can be effective in certain situations, particularly in children with a specific type of enuresis, but it is not the first-line approach due to concerns about dependence and the potential for side effects. Thus, the enuresis alarm stands out as the most effective initial long-term intervention in managing significant bedwetting in children.