What is the first-line treatment for nocturnal enuresis in a child older than 5 years?

The first-line treatment for nocturnal enuresis in a child older than 5 years is the use of behavioral alarms. This approach, often referred to as a bedwetting alarm, involves a sensor that detects moisture and sounds an alarm to wake the child when they begin to urinate during sleep. This method helps to condition the child’s bladder and reinforces the connection between the sensation of a full bladder and waking up to urinate, promoting independence from bedwetting over time.

Behavioral alarms are favored due to their effectiveness in many children and the lack of pharmacological side effects, making them a preferable choice for long-term management. They also encourage involvement in the treatment process, which can enhance the child's confidence and responsibility regarding the condition.

Desmopressin may also be used as a treatment option, particularly for those with significant distress or when immediate control is necessary, but it is generally considered a second-line treatment. Imipramine and antidepressants do not primarily address the underlying issue of enuresis and come with potential side effects, making them less desirable as first-line therapies. Thus, behavioral alarms stand out as the most effective and safe initial approach to managing nocturnal enuresis in children.