Полезный гайд

[FRSM]

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

National Institute for Health and Clinical Excellence

Key priorities for implementation

Principles of care
•Inform children and young people with bedwetting and their parents or carers that bedwetting is not the child or young person’s fault and that punitive measures should not be used in the management of bedwetting
•Offer support, assessment and treatment tailored to the circumstances and needs of the child or young person and parents or carers
•Do not exclude younger children (for example, those under 7 years) from the management of bedwetting on the basis of age alone

Assessment and investigation
•Discuss with the parents or carers whether they need support, particularly if they are having difficulty coping with the burden of bedwetting, or if they are expressing anger, negativity or blame towards the child or young person

Planning management
•Consider whether or not it is appropriate to offer alarm or drug treatment, depending on the age of the child or young person, the frequency of bedwetting and the motivation and needs of the child or young person and their family

Advice on fluid intake, diet and toileting patterns
•Address excessive or insufficient fluid intake or abnormal toileting patterns before starting other treatment for bedwetting in children and young people

Reward systems
•Explain that reward systems with positive rewards for agreed behaviour rather than dry nights should be used either alone or in conjunction with other treatments for bedwetting. For example, rewards may be given for: •drinking recommended levels of fluid during the day
•using the toilet to pass urine before sleep
•engaging in management (for example, taking medication or helping to change sheets)


Initial treatment
•Offer an alarm as the first-line treatment to children and young people whose bedwetting has not responded to advice on fluids, toileting or an appropriate reward system, unless: •an alarm is considered undesirable to the child or young person or their parents and carers or
•an alarm is considered inappropriate, particularly if: •bedwetting is very infrequent (that is, less than 1–2 wet beds per week)
•the parents or carers are having emotional difficulty coping with the burden of bedwetting
•the parents or carers are expressing anger, negativity or blame towards the child or young person


•Offer desmopressin to children and young people over 7 years, if: •rapid-onset and/or short-term improvement in bedwetting is the priority of treatment or
•an alarm is inappropriate or undesirable


Lack of response to initial treatment options
•Refer children and young people with bedwetting that has not responded to courses of treatment with an alarm and/or desmopressin for further review and assessment of factors that may be associated with a poor response, such as an overactive bladder, an underlying disease or social and emotional factors

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
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