flashcards_enuresis
At what age are most children dry by day and night?
Most children are dry by day and night by the age of 5 years. Children are dry by day only by the age of 4 years.
What is primary bedwetting without daytime symptoms?
Bedwetting where the volume of urine produced at night exceeds bladder capacity and the sensation of a full bladder does not wake the child.
What advice should be given to parents of children under 5 years with bedwetting?
Reassure that many children under 5 wet the bed and this usually resolves without intervention. Give diet advice, toileting advice, and consider a positive reward system.
What advice should be given to parents of children over 5 years with infrequent bedwetting?
Reassure parents, offer a watch-and-see approach, use a star or reward chart, and avoid punishing or embarrassing the child.
What is the first-line treatment for long-term primary bedwetting in children over 5 years?
Enuresis alarm with a positive reward system.
What is the second-line treatment for long-term primary bedwetting in children over 5 years?
Desmopressin, with fluid restriction 1 hour before until 8 hours after.
What is the recommendation if rapid or short-term control of bedwetting is required?
Offer desmopressin.
What should be done if bedwetting recurs following treatment?
Restart previously successful treatments and offer combination treatment with desmopressin and an enuresis alarm.
When should a child with primary bedwetting be referred to secondary care?
Refer if bedwetting has not responded to two courses of treatment.
What should be done for primary bedwetting with daytime symptoms?
Refer all children to secondary care or an enuresis clinic.
What underlying causes of secondary bedwetting can be managed in primary care?
UTI, constipation.
What underlying causes of secondary bedwetting are likely to need specialist referral?
Diabetes, recurrent UTI, psychological problems, family problems, developmental, attention or learning difficulties, known or suspected physical or neurological problems.
What is the summary approach for managing enuresis?
Look for possible causes (e.g., constipation, diabetes). Advise on reduced fluid intake before bed, diet and toileting behavior, reward systems (e.g., star charts), enuresis alarm, desmopressin.
