National Institute for Health and Clinical Excellence (NICE)
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First national guidance to help treat bedwetting in children

Children under the age of seven should now be considered for treatment for bedwetting, as NICE signals a change to current practice.

While most children will grow out of wetting the bed as they learn to control their bladder at night, for some it can continue into late childhood.

Over a fifth of children aged between four and five will regularly wet the bed, but GPs and nurses have traditionally only offered treatment to children once they reach the age of seven.

This latest guidance, the first to address bedwetting or nocturnal enuresis, no longer places a minimum age limit on the management of the condition, allowing healthcare professionals to offer young children advice and treatment for bedwetting if they feel it is appropriate.

GPs and practice nurses should explain to children and parents or carers that reward systems with positive rewards for agreed behavior, like going to the toilet before bed, rather than dry nights should be used either alone or in conjunction with other treatments for bedwetting.

Suggest the use of an alarm as a first-line treatment for children with bedwetting, unless an alarm is considerable undesirable to the child or parents and carers or if the child has very infrequent bedwetting and is only wetting the bed 1-2 times a week.

If an alarm is inappropriate or undesirable, then children should be offered the medication desmopressin, says NICE.

Children who do not respond to desmopressin or the use of an alarm should be referred to a specialist for further review and assessment. This can help to identify any underlying disease or any social and emotional factors that may be involved.

Dr Gillian Leng, Deputy Chief Executive of NICE said: “Many children experience some form of bedwetting as they grow up and this can have a significant impact on their behaviour, emotional wellbeing and social life.

“It can also be very stressful for their parents or carers. For these reasons, our clinical guideline does not specify a minimum age limit. This means that for the first time advice or treatments will be available to children under seven years, who may have previously been excluded from advice and services due to their age.”

Dr Mark MacKenzie, a GP who helped develop the guidance, added: “The guideline from NICE outlines the variety of ways that the NHS can help families cope with this condition. It also provides advice on when bedwetting may be a symptom of an underlying condition - such as a urinary tract infection, diabetes, or emotional troubles like bullying and maltreatment.

”I hope that this guideline reassures GPs and other healthcare professionals that they are treating these patients in the most effective ways possible.”

Nocturnal enuresis - the management of bedwetting in children and young people




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