Flowchart – Night Time Wetting (Nocturnal Enuresis / Bedwetting)
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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Night time wetting identified by GP
Night time wetting 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
Primary – never been dry for a 6 month period
Secondary – dry for at least 6 months prior to this episode
• Demystify, reassure, educate
• Fluid optimisation – 6-8 drinks/day – offer Drinking Reward Chart
• Toileting advice – 4-7 voids/day - offer Toileting Reward Chart
• Advise on rewards for compliance
• Suggest trial without nappies or pull-ups
• Signpost to ERIC for further information/reassurance and advice on bedding protection etc
Pre school age
Reassure that 1 in 5 children age 4½ wet the bed at least once a week and many achieve dryness spontaneously. Advise to continue to follow above advice and to seek help from School Health Nurse if wetting persists beyond 5 years of age and intervention is desired.
No progress after implementation of initial advice
• Refer to School Health Nurse if not yet seen
• Reassess number of wet nights/week, size of wet patches, number of times/night, time of occurrence using Night Time Diary
• Discuss, explain, and offer treatment options