A few medications are indicated for children with bedwetting. Medications are designed to curb bedwetting by either decreasing the amount of urine produced at night or by allowing the bladder to hold more urine. Medication often has immediate results, but when you stop it, the relapse rate is high-about 80 percent. If you use medication for 12 weeks and stop, most children will still be wetting. The most frequently prescribed medication for enuresis is DDAVP. This synthetic form of the natural hormone vasopressin decreases the quantity of urine produced for eight to 12 hours. It works quickly, usually within one hour of taking it.

DDAVP allows many children to sleep dry that night, which makes it particularly useful for sleepovers and camps. DDAVP is available in two forms: a nasal spray and tablet. The tablet is preferred because it delivers a more consistent and convenient dose. Also, children with allergic congestion can get erratic results with the nasal spray. Dosage of DDAVP must be individualized, with one to three tablets (0.2 mg.) each night before bed as the recommended dose. The greatest number of dry nights is achieved by 0.4 to 0.6 mg. nightly.(37) If your child is taking the medication for a situation outside of his home, such as sleepover camp, start it ahead of time to establish the appropriate dose. Your child's doctor or nurse practitioner is responsible for determining your child's dosage, but the general recommendation is as follows:

• If your child wets when taking one tablet, increase it to two.
• If wetting occurs with two tablets, his dosage should be three tablets.
• Three tablets is the maximum amount recommended for any age group.

DDAVP does not stop wetting in every child. Increasing the length of time taken will not make it work. The expected results should be seen in a week or two. Parents should realize that this medication does not provide long-lasting effects, but it does buy time.

DDAVP is a safe medication with very few side effects. Reported side effects include headache or water intoxication if a large amount of water is ingested after taking it. The manufacturer provides fluid guidelines, recommending no more than four ounces of water before bedtime. This medication can be safely used for three- to six-month intervals with a one week break. If wetting persists, it can be used for another interval. DDAVP is expensive, as much as $4 per tablet. The cost should be taken into account when considering long-term use.

Oxybutynin(Ditropan) is another medication that can be useful in treating enuresis in some children. If your child has clinical signs of small functional bladder capacity-frequency or urgency during the day-this medication may also assist with nighttime dryness. Ditropan works by relaxing the bladder's smooth muscle, increasing bladder capacity and delaying the initial desire to void. Your child's health-care provider can help you decide if this medication would be a helpful adjunct; he will determine the proper dosage. This medication is not expensive, and it's safe. Possible side effects include a dry mouth, constipation and decreased ability to sweat. Drinking daytime fluids and taking breaks to "cool off" are important in the summer.