Bedwetting in children and young people

Structure

Evidence of local arrangements to ensure that children and young people whose bedwetting has not responded to courses of initial treatments can access a specialist review.

Data source: Local data collection.

Process

Proportion of children and young people whose bedwetting has not responded to courses of initial treatments who are referred for a specialist review.

Numerator – the number in the denominator referred for a specialist review.

Denominator – the number of children and young people whose bedwetting has not responded to courses of initial treatments.

Data source: Local data collection.

Outcome

Reduction in inappropriate hospital referrals.

Data source: Local data collection.

Bedwetting that has not responded

Bedwetting has not responded to treatment if the child has not achieved 14 consecutive dry nights or a 90% improvement in the number of wet nights per week. The response to treatment should be assessed as follows:

[Adapted from NICE's guideline on bedwetting in under 19s, recommendations 1.8.2, 1.8.4, 1.10.6, 1.10.11 and 1.11.3]

Courses of initial treatments

An alarm should be offered as first‑line treatment unless it is considered undesirable or inappropriate (for example, if bedwetting is very infrequent, that is, less than 1 or 2 wet beds per week, or the parents or carers are having emotional difficulty coping with the burden of bedwetting or are expressing anger, negativity or blame towards the child or young person).

Desmopressin may be offered to children and young people older than 7 years if an alarm is undesirable or inappropriate, or if the priority for the child is to achieve a quick short‑term improvement in bedwetting.

Consideration of which initial treatment is most appropriate will depend on the child or young person's age, the frequency of bedwetting and the motivation and needs of the child or young person and their parents or carers.

An alarm or desmopressin may be considered for children aged 5 to 7 years. The decision about suitable treatment for 5- to 7‑year‑olds should take into account the pattern of bedwetting as well as the child's ability, maturity, motivation and understanding of an alarm, their wider living circumstances and the views of their parents or carers.

If bedwetting does not respond to initial alarm treatment, courses of treatment with a combination of alarm and desmopressin and/or desmopressin alone may be offered depending on the response achieved and whether an alarm remains acceptable. [Adapted from NICE's guideline on bedwetting in under 19s, recommendations 1.4.5, 1.8.1, 1.8.8, 1.10.1, 1.10.2, 1.9.1 and 1.9.2]

Specialist review

Children and young people whose bedwetting has not responded to courses of initial treatments should be referred to the next step up in service that provides comprehensive continence assessment and treatment for children and young people (for example, from a level 1 service such as in primary care which provides general advice and may also provide initial treatment, to a level 2 specialist service that undertakes comprehensive assessment, or level 3 secondary or tertiary services for children and young people with symptoms that require medical assessment). The characteristics and settings for these services would depend on local arrangements.

An example of a level 2 service is a children's community continence service that treats bladder and bowel problems and delayed toilet training, and is delivered by an experienced and competent multidisciplinary team led by a paediatric continence nurse specialist. [Adapted from the Paediatric Continence Forum's Paediatric continence commissioning guide, section 1.5]