NICE issues bedwetting guidelines for pediatricians

December 15, 2010

The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the management of bedwetting in children and young people.

 

The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the management of bedwetting in children and young people. This guideline, published online in the British Medical Journal, is based on clinical evidence and original health economic analyses.

The recommendations include addressing excessive or insufficient fluid intake or abnormal toileting patterns before starting other treatment for bedwetting in children. Children who have not responded to courses of treatment with an alarm and/or desmopressin should be referred to a relevant specialist so that they can be assessed for factors that may be associated with a poor response (eg, overactive bladder, an underlying disease, or social and emotional factors).

Children younger than 7 years old should not be excluded from the management of bedwetting on the basis of age alone, according to the Guideline Development Group.

Points of emphasis to parents and caregivers of bedwetting children and young adults include not restricting fluids during the day, because it is important that the child or young person has enough to drink. The correct amount of fluid will depend on the circumstances, such as temperature, diet, and activity.

Parents should remember that bedwetting is not the child’s fault, so punitive measures should not be used. Parents should be encouraged to reward their children for agreed behavior, such as drinking the recommended levels during the day, going to the toilet before sleep, taking medication, or helping to change the sheets, rather than for dry nights, advised the guideline committee. Parents or caregivers may need a considerable amount of support, particularly if they are having difficulty coping with the bedwetting or if they are expressing anger, negativity, or blame toward the child.

Nunes VD, O’Flynn N, Evans J, Sawyer L; the Guidance Development Group. Management of bedwetting in children and young people: summary of NICE guidance. BMJ. 341:c5399. doi: 10.1136/bmj.c5399.