When do mos kids ahieve day and night-time continence?
by 3 or 4yrs.
How do you define Enuresis?
“the involuntary discharge of urine by day or night or both, in a child aged 5 years and older, in the absence of congenital or acquired defects of the nervous system or urinary tract”
How do you define nocturnal enuresis?
Primary or secondary
What is the difference?
Primary: The child has never achieved continence
Secondary: the child has been dry for at least 6 months before
With a 6year old boy – if the mum has tried a star chart already and it’s not worked what would be the next line?
- Enuriesis alarm?
- Trial of oral desmopressin?
- Trial of imipramine?
- Trial of intranals desmopressin?
- Restrict fluids in the afternoon and evening?
1- enuresis alarm
NICE guidelines (2010) guidance:
- Look for possible underlying cause / triggers (eg constipation, diabetes mellitus, UTI if recent)
- Advise on fluid intake, diet and toileting behaviour
- reward systems (eg Star charts). NICE recommend these “should be agreed behaviour rather than dry nights” eg Using the toilet to pass urine before sleep
- Consider whether alarm or drug treatment is appropriate, depending on age, maturity, and abilities of the child or young person, the frequency of bedwetting and the motivation and needs of the family.
- An enuresis alarm is first line for children under the age of 7years – particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family