From the Guidelines
The treatment for pediatric nocturia should begin with behavioral modifications, including limiting fluid intake 1-2 hours before bedtime and establishing a regular voiding schedule, as well as addressing any underlying causes, with desmopressin (DDAVP) considered for children with nocturnal polyuria at doses of 0.2-0.6 mg orally at bedtime, as recommended by the most recent and highest quality study 1.
Behavioral Modifications
Behavioral modifications are essential in treating pediatric nocturia, including:
- Limiting fluid intake 1-2 hours before bedtime, particularly avoiding caffeinated beverages
- Establishing a regular voiding schedule during the day
- Ensuring the child empties their bladder completely before sleep
- Encouraging physical activity and a healthy bowel regimen to prevent constipation
Pharmacological Treatment
For children with nocturnal polyuria, desmopressin (DDAVP) may be prescribed at doses of 0.2-0.6 mg orally at bedtime, though this should be used cautiously due to the risk of hyponatremia, as noted in 1 and 1.
Additional Considerations
It's essential to rule out medical conditions such as diabetes, sleep apnea, or neurological disorders that may cause nocturia, and treatment should be individualized based on the child's age, specific symptoms, and underlying causes, as emphasized in 1 and 1.
Supportive Approach
A supportive, non-punitive approach is crucial as nocturia can be distressing for children and families, and bedwetting alarms can help children develop awareness of bladder fullness, as discussed in 1 and 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Childhood Enuresis Initially, an oral dose of 25 mg/day should be tried in children aged 6 and older. Medication should be given one hour before bedtime If a satisfactory response does not occur within one week, increase the dose to 50 mg nightly in children under 12 years; children over 12 may receive up to 75 mg nightly. The safety and effectiveness of Imipramine Hydrochloride Tablets USP as temporary adjunctive therapy for nocturnal enuresis in children less than 6 years of age has not been established.
The treatment for pediatric nocturia is imipramine (PO), with the following dosages:
- Children aged 6 and older: initially 25 mg/day, one hour before bedtime
- Children under 12 years: up to 50 mg nightly if no response to initial dose
- Children over 12 years: up to 75 mg nightly if no response to initial dose
- A dose of 2.5 mg/kg/day should not be exceeded in childhood 2. Note: The safety and effectiveness of imipramine for nocturnal enuresis in children less than 6 years of age has not been established 2.
From the Research
Treatment Options for Pediatric Nocturia
- Non-pharmacological therapies, such as enuresis alarm therapy, bladder training, pelvic floor retraining, and dietary modification, offer effective and low-risk options for managing nocturnal enuresis in children 3
- Pharmacological interventions, including desmopressin and anticholinergics, can be used to treat nocturnal enuresis, with combination therapies showing superior efficacy and faster results compared to monotherapy 3
- Desmopressin is a commonly used medication for treating nocturia, and has been shown to be effective in reducing nocturia episodes in patients with underlying neurological diseases 4
Lifestyle Modifications
- Reducing evening fluid intake is a recommended lifestyle modification for managing nocturia 5
- Treatment strategies should always involve lifestyle changes and behavioral modifications, with the targeted treatment of underlying medical conditions that may cause nocturia 6
Pharmacological Therapies
- Desmopressin remains the only drug approved specifically for the treatment of nocturia 6
- Low-dose imipramine has been shown to be effective in combination with desmopressin for treating primary nocturnal enuresis in children who are non-responders to desmopressin alone 7
- Anticholinergics can be used in combination with desmopressin to treat nocturnal enuresis in children 3