Flowchart – Daytime Bladders
Every child must be fully assessed using the appropriate Continence Assessment Form. If constipation is identified, follow the flowchart below to ensure the child receives the correct assessment, treatment and management.
The ‘pop-up’ information boxes suggest who might deliver each intervention. In England the local CCG (Clinical Commissioning Group) can clarify who is commissioned to do so. Information to support the commissioning of children’s continence services can be found in the PCF’s Paediatric Continence Commissioning Guide. In Scotland and Wales, ask your GP, Health Visitor or School Health Nurse for advice on who provides local continence care.
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Daytime bladder problems identified by GP
Daytime bladder problems identified by School Health Nursing / Health Visiting / Children's Community Nursing / Learning Disability Team
GP to inform/refer to School Health Nursing / Health Visiting / Children’s Community Nursing / Learning Disability Team
Child to be referred to GP
CHILD TO BE ASSESSED for underlying organic cause:
• Perform urinalysis to exclude Urinary Tract Infection (UTI) / Diabetes mellitus
• Check lower limb neurology and appearance of spine to exclude neurological link e.g. spinal anomaly
• Constant dribbling of urine is never functional
• Check for abdominal mass/large bladder
• Check for faltering growth
If present refer or treat as appropriate
If confirmed UTI may need renal ultrasound scan (USS) – include post void residual
• Demystify, reassure, educate
• Fluid optimisation – 6-8 drinks/day – offer Drinking Reward Chart
• Promote water, milk in moderation, well diluted fruit juice/squash
• Avoid caffeinated drinks
• Limit carbonated drinks, artificial colourings/flavourings
• Observe effect of blackcurrant/orange
• Toileting advice – 4-7 voids/day – offer Toileting Reward Chart
• Advise on rewards for compliance
• Signpost to ERIC for further information/reassurance and advice on absorbent pants, children’s disposable pads etc
Reassure that functional daytime bladder problems are common in young children. Most spontaneously resolves as the bladder matures. Advise to continue to follow above advice and to liaise with Health Visitor.
No progress after implementation of initial advice
Provide information and leaflets as appropriate and discharge.
• Refer to School Health Nurse if not yet seen
• Ask family to complete Intake/Output Chart over three days
• Discuss, explain and offer treatment options
• Consider prescribing anti-cholinergic e.g. Oxybutynin IF no suspicion of incomplete bladder emptying
• Use Lyrinel XL if child can swallow tablets