The following should be discussed and managed with the parents prior to referral.
1.Drinking – most children do not drink enough daytime fluids. They should be encouraged to increase fluid intake throughout the day.
Recommended adequate daily fluid intake from drinks are:
At 5–8 years of age — 1000–1400 mL (girls); 1000–1400 mL (boys).
At 9–13 years of age — 1200–2100 mL (girls); 1400–2300 mL (boys).
At 14–18 years of age — 1400–2500 mL (girls); 2100–3200 mL (boys).
• Avoid drinking caffeine-based drinks (such as colas, coffee, and tea), fizzy or blackcurrant drinks.
• Drinks can be stopped 1 hour before bedtime if sufficient fluids have been taken during the day.
Here is a leaflet from ‘Bowel and Bladder UK’ for parents about encouraging fluids and why it’s important.
A downloadable drinking reward chart can be found on the link below
2. Children should be encouraged to ‘double void’ prior to bedtime.
3. Some parents choose to ‘lift’ their child – where they encourage them to pass urine late in the evening. This is OK provided the child is awake enough to realise that they are going to the toilet and why.
4. If the child is afraid of the dark, ensure there is a nightlight available in case they need to get up and go to the toilet overnight.
5. The Eric website has lots of useful information and practical tips for parents. https://www.eric.org.uk/Pages/Category/bedwetting
Once the above have been addressed, if there is no resolution in symptoms, we consider treating. Bedwetting is usually treated by a combination of an alarm system and medication (desmopressin)
– Bedwetting alarms are not currently available in the hospital but can be purchased online or via the ERIC website or through some community nurse led enuresis clinics. They work best if both parents and child are absolutely committed to getting up when they sound, changing bedding together etc.
– Desmopressin can be prescribed either short term (eg: to cover a residential stay) or longer term. Dosing should be as per the Children’s BNF. Medication does not need to be commenced in secondary care (for latest version of this NICE Pathway see: http://pathways.nice.org.uk/pathways/bedwetting-in-children-and-young-people
For detailed information suitable for parents, please look at the ‘Medicines for Children’ website.
For children with secondary enuresis (dry previously for > 6 months), there may be an organic cause. Some important things to consider and exclude are:
– Type 1 Diabetes Mellitus (urine dip, blood sugar as relevant)
– Urinary tract infection (urine dipstick)
– Anxiety especially if significant recent life events eg: bereavement, family loss, change in home or school circumstances, bullying
– Safeguarding concerns including sexual, emotional and physical abuse