most children with nocturnal enuresis (bedwetting) can be managed in the community (1)
however if there are factors suggesting an underlying physical abnormality, or if he or she does not respond to primary-care management, the child should be referred to a child specialist
for example, children with urinary tract abnormalities may present with daytime wetting (with or without night wetting) or difficulties with voiding, and therefore require specialist review and further detailed investigation (e.g. renal and bladder ultrasound)
children with such abnormalities are very unlikely to have wetting only at night
if the child has complex psychological difficulties then referral to a child psychologist may be required
NICE state with respect to nocturnal enuresis (2):
consider assessment, investigation and/or referral when nocturnal enuresis is associated with:
severe daytime symptoms
a history of recurrent urinary infections
known or suspected physical or neurological problems
comorbidities or other factors
constipation and/or soiling
developmental, attention or learning difficulties
diabetes mellitus
behavioural or emotional problems
family problems or a vulnerable child or young person or family
investigate and treat children and young people with suspected urinary tract infection
investigate and treat children and young people with soiling or constipation
children and young people with suspected type 1 diabetes should be offered immediate (same day) referral to a multidisciplinary paediatric diabetes care team that has the competencies needed to confirm diagnosis and to provide immediate care
refer children and young people with bedwetting that has not responded to courses of treatment with an alarm and/or desmopressin for further review and assessment of factors that may be associated with a poor response, such as an overactive bladder, an underlying disease or social and emotional factors
Reference:
Drug and Therapeutics Bulletin (2004); 42(5):33-7.
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