Although a large percentage of children with nocturnal enuresis will achieve bladder control using the enuresis alarm, a sizeable number acquire only partial success using such methodology. This study describes a series of interventions designed to assist one boy who continued to achieve only limited success in nocturnal bladder control. Establishing the effective component of the programme was achieved by detailed self recording of potentially influential factors. Mood states, fluid consumption, interventions, bed time and spontaneous waking were recorded for 28 days. A clear relationship emerged linking bedwetting accidents exclusively to nights the boy woke spontaneously but chose not to use the toilet. Drawing his awareness to this pattern encouraged him to take the appropriate action on waking and for the first time he achieved a criteria of 14 consecutive dry nights. At a 6-month follow-up this progress was maintained.