{"id":4429,"date":"2022-09-26T13:03:53","date_gmt":"2022-09-26T12:03:53","guid":{"rendered":"https:\/\/eric.org.uk\/?page_id=4429"},"modified":"2022-10-25T15:06:42","modified_gmt":"2022-10-25T14:06:42","slug":"flowchart-daytime-bladders","status":"publish","type":"page","link":"https:\/\/eric.org.uk\/childrens-continence-pathway\/flowchart-daytime-bladders\/","title":{"rendered":"Flowchart &#8211; Daytime Bladders"},"content":{"rendered":"<nav aria-label=\"breadcrumbs\"><p><a href=\"https:\/\/eric.org.uk\">Home<\/a> &gt; <a href=\"https:\/\/eric.org.uk\/childrens-continence-pathway\/\">Children&#x2019;s Continence Pathway<\/a><\/p><\/nav><h1>\n\t\tH1 heading\n\t<\/h1>\n\t<p>Every child must be fully assessed using the appropriate <a href=\"https:\/\/eric.org.uk\/continence-assessment-forms\/\">Continence Assessment Form<\/a>. If <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Constipation&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Children with constipation may open their bowels less than once every three days; pass occasional very large motions, or have more frequent small motions; stools may be different textures and may be offensive smelling; they may withhold or strain to prevent themselves from passing large painful stools and may have problems with abdominal pain and distension, or soiling. Children with constipation often have reduced appetite, are unhappy, irritable or moody and may have reduced energy levels. All of the latter symptoms may improve for a time after a large bowel motion.&lt;\/div&gt;\" href=\"https:\/\/eric.org.uk\/glossary\/constipation\/\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">constipation<\/a> is identified, follow the flowchart below to ensure the child receives the correct assessment, treatment and management.<\/p>\n<p>The &#x2018;pop-up&#x2019; 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&#x2019;s continence services can be found in the <a href=\"http:\/\/www.paediatriccontinenceforum.org\/wp-content\/uploads\/2015\/09\/Paediatric-Continence-Commissioning-Guide-2014-PCF.pdf\" target=\"_blank\" rel=\"noopener\">PCF&#x2019;s Paediatric Continence Commissioning Guide<\/a>. In Scotland and Wales, ask your GP, Health Visitor or School Health Nurse for advice on who provides local continence care.<\/p>\n<p><a href=\"https:\/\/eric.org.uk\/childrens-continence-pathway\/general-flowchart\/\">Back to the Children&#x2019;s General Continence Flowchart<\/a><\/p>\n\t<p>Daytime bladder problems identified by GP<\/p>\n\t<a href=\"#\" id=\"trigger-\" data-modal=\"\" data-node=\"\">\n\t\t\t\t\t\t\tMore info\n\t\t\t<\/a>\n\t\t\t\t\t\tPreview\n\t\t\tmodal-\n\t\t\t\t\t\t\t\t\t\t\t<h2 id=\"modal-title-\">More information<\/h2>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<p>If symptoms of constipation present follow <a href=\"https:\/\/eric.org.uk\/childrens-continence-pathway\/flowchart-constipation\/\">Flowchart for Constipation<\/a> before addressing <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;daytime wetting&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;&amp;lt;!-- wp:paragraph --&amp;gt;Can also be called urinary incontinence leakage of urine. It used to be called diurnal enuresis.&amp;lt;br\/&amp;gt;&amp;lt;!-- \/wp:paragraph --&amp;gt;&lt;\/div&gt;\" href=\"daytime%20wetting\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">daytime wetting<\/a>.<\/p>\n\t<p>Daytime bladder problems identified by School Health Nursing \/ Health Visiting \/ Children&#x2019;s Community Nursing \/ Learning Disability Team<\/p>\n\t<a href=\"#\" id=\"trigger-\" data-modal=\"\" data-node=\"\">\n\t\t\t\t\t\t\tMore info\n\t\t\t<\/a>\n\t\t\t\t\t\tPreview\n\t\t\tmodal-\n\t\t\t\t\t\t\t\t\t\t\t<h2 id=\"modal-title-\">More information<\/h2>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<p>If symptoms of constipation present follow <a href=\"https:\/\/eric.org.uk\/childrens-continence-pathway\/flowchart-constipation\/\">Flowchart for Constipation<\/a> before addressing daytime wetting.<\/p>\n\t<p>GP to inform\/refer to School Health Nursing \/ Health Visiting \/ Children&#x2019;s Community Nursing \/ Learning Disability Team<\/p>\n\t<p>Child to be referred to GP<\/p>\n\t<p><strong>CHILD TO BE ASSESSED<\/strong> for underlying organic cause:<\/p>\n<p>&bull; Perform urinalysis to exclude Urinary Tract Infection (<a class=\"glossaryLink\"  aria-describedby=\"tt\"  data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;uti&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;&amp;lt;!-- wp:paragraph --&amp;gt;Abbreviation for urinary tract infection. This could be an infection of the kidneys, ureters, bladder or urethra. Symptoms include odd-smelling wee, frequent\/urgent need to wee, difficulty or pain when doing a wee. May also cause day or night time wetting.&amp;lt;br\/&amp;gt;&amp;lt;!-- \/wp:paragraph --&amp;gt;&lt;\/div&gt;\"  href=\"uti\"  data-mobile-support=\"0\"  data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex='0' role='link'>UTI<\/a>) \/ Diabetes mellitus<\/p>\n<p>&#x2022; Check lower limb neurology and appearance of spine to exclude neurological link e.g. spinal anomaly<\/p>\n<p>&bull; Constant dribbling of urine is never <a class=\"glossaryLink\"  aria-describedby=\"tt\"  data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;functional&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;&amp;lt;!-- wp:paragraph --&amp;gt;A functional problem is one where there is no underlying cause. Another word for it is idiopathic&amp;lt;br\/&amp;gt;&amp;lt;!-- \/wp:paragraph --&amp;gt;&lt;\/div&gt;\"  href=\"functional \"  data-mobile-support=\"0\"  data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex='0' role='link'>functional<\/a><\/p>\n<p>&#x2022; Check for abdominal mass\/large bladder<\/p>\n<p>&#x2022; Check for faltering growth<\/p>\n\t<a href=\"#\" id=\"trigger-\" data-modal=\"\" data-node=\"\">\n\t\t\t\t\t\t\tMore info\n\t\t\t<\/a>\n\t\t\t\t\t\tPreview\n\t\t\tmodal-\n\t\t\t\t\t\t\t\t\t\t\t<h2 id=\"modal-title-\">More information<\/h2>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<p>WHO DOES THIS?<\/p>\n<p>Physical examinations are usually performed by doctors &#x2013; this might be your GP, school doctor or paediatrician. some nurse specialists\/practitioners also do physical examinations.<\/p>\n\t<p>No concerns<\/p>\n\t<p>If present refer or treat as appropriate<\/p>\n\t<p>If confirmed UTI may need renal ultrasound scan (USS) &#x2013; include post void residual<\/p>\n\t<p><a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;NICE guidelines&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;&amp;lt;!-- wp:paragraph --&amp;gt;The National Institute for Health and Care Excellence (NICE) provide guidance to improve health and social care. Their guidelines should be followed by all health professionals. There are NICE guidelines for the treatment of constipation, bedwetting and urinary tract infections.&amp;lt;br\/&amp;gt;&amp;lt;!-- \/wp:paragraph --&amp;gt;&lt;\/div&gt;\" href=\"NICE%20guidelines%20\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">NICE Guidelines<\/a>: <a href=\"http:\/\/www.nice.org.uk\/cg54\" target=\"_blank\" rel=\"noopener\">Urinary Tract Infection in Children<\/a><\/p>\n\t<h3>Initial advice<\/h3>\n<p>&#x2022; Demystify, reassure, educate<\/p>\n<p>&#x2022; Provide <a href=\"https:\/\/eric.org.uk\/advice-for-children-with-daytime-bladder-problems\/\">Advice for Children with Daytime Bladder Problems<\/a><\/p>\n<p>&#x2022; Fluid optimisation &#x2013; 6-8 drinks\/day &#x2013; offer <a href=\"https:\/\/eric.org.uk\/drinking-reward-chart\/\">Drinking Reward Chart<\/a><\/p>\n<p>&#x2022; Promote water, milk in moderation, well diluted fruit juice\/squash<\/p>\n<p>&#x2022; Avoid caffeinated drinks<\/p>\n<p>&#x2022; Limit carbonated drinks, artificial colourings\/flavourings<\/p>\n<p>&#x2022; Observe effect of blackcurrant\/orange<\/p>\n<p>&#x2022; Toileting advice &#x2013; 4-7 voids\/day &#x2013; offer <a href=\"https:\/\/eric.org.uk\/toileting-reward-chart\/\">Toileting Reward Chart<\/a><\/p>\n<p>&#x2022; Advise on rewards for compliance<\/p>\n<p>&#x2022; Signpost to ERIC for further information\/reassurance and advice on absorbent pants, children&#x2019;s disposable pads etc<\/p>\n\t<a href=\"#\" id=\"trigger-\" data-modal=\"\" data-node=\"\">\n\t\t\t\t\t\t\tMore info\n\t\t\t<\/a>\n\t\t\t\t\t\tPreview\n\t\t\tmodal-\n\t\t\t\t\t\t\t\t\t\t\t<h2 id=\"modal-title-\">More information<\/h2>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<p>WHO DOES THIS?<\/p>\n<p>The information may be provided by the School Health Nurse\/Health Visiting\/Children&#x2019;s Community Nursing\/Learning Disability Team and\/or ERIC.<\/p>\n\t<p><strong>Pre-school age<\/strong><\/p>\n<p>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.<\/p>\n\t<p><strong>School age<\/strong><\/p>\n\t<p>No progress after implementation of initial advice<\/p>\n\t<h3>Symptoms improved?<\/h3>\n<p>Provide information and leaflets as appropriate and discharge.<\/p>\n\t<p>&#x2022; Refer to School Health Nurse if not yet seen<\/p>\n<p>&#x2022; Ask family to complete <a href=\"https:\/\/eric.org.uk\/intake-output-chart\/\">Intake\/Output Chart<\/a> over three days<\/p>\n<p>&#x2022; Discuss, explain and offer treatment options<\/p>\n<p>&#x2022; Consider prescribing anti-cholinergic e.g. Oxybutynin IF no suspicion of incomplete bladder emptying<\/p>\n<p>&#x2022; Use Lyrinel XL if child can swallow tablets<\/p>\n\t<a href=\"#\" id=\"trigger-\" data-modal=\"\" data-node=\"\">\n\t\t\t\t\t\t\tMore info\n\t\t\t<\/a>\n\t\t\t\t\t\tPreview\n\t\t\tmodal-\n\t\t\t\t\t\t\t\t\t\t\t<h2 id=\"modal-title-\">More information<\/h2>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<p>WHO DOES THIS?<\/p>\n<p>Anti-cholinergics are usually prescribed by the GP or paediatrician. Some nurses prescribe too. The information may be provided by them but may be supplemented by the School Health Nurse\/Health Visiting\/Children&#x2019;s Community Nursing\/Learning Disability Team and\/or ERIC.&#xA0;<\/p>\n\t<h3>Symptoms improved?<\/h3>\n<p>Provide information and leaflets as appropriate and discharge.<\/p>\n<p>If child is commenced on an anti-cholinergic GP to review every six months.<\/p>\n\t<h3>Symptoms ongoing?<\/h3>\n<p>Refer to Paediatric Continence Service or equivalent local service using<a href=\"https:\/\/www.eric.org.uk\/pdf-referral-form\"> Referral Form<\/a><\/p>\n\t\t\t<a href=\"https:\/\/eric.org.uk\/resources\/referral-form\/\" download target=\"_self\" role=\"button\" rel=\"noopener\">\n\t\t\t\t\t\t\tReferral form\n\t\t\t<\/a>\n\n","protected":false},"excerpt":{"rendered":"<p>Home &gt; Children&rsquo;s Continence Pathway H1 heading Every child must be fully assessed using the appropriate Continence Assessment Form. If constipation is identified, follow the flowchart below to ensure the [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":3012,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"acf":[],"_links":{"self":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/4429"}],"collection":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/comments?post=4429"}],"version-history":[{"count":4,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/4429\/revisions"}],"predecessor-version":[{"id":6223,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/4429\/revisions\/6223"}],"up":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/3012"}],"wp:attachment":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/media?parent=4429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}