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This is urinary incontinence in a child after 5 years of age when micturition control usually achieved.
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It is considered a problem if regular bedwetting occurs in children 6 yrs and older, although many boys do not become dry until 8 yrs.
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After the age of 6, investigations including an intravenous urogram or US are necessary to exclude urinary tract abnormalities and diabetes. Ensure a normal daily fluid intake and toileting regime.
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Advice for parents on managing the child
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Do not scold or punish the child
Praise the child often, when appropriate
Consider a star-chart diary with a star/dry night
Do not stop the child drinking after the evening meal, but avoid caffeine drinks
Do not wake the child at night to visit the toilet
Use a night-light to help the child who wakes
Some parents use a nappy to keep the bed dry but try using special absorbent pads beneath the bottom sheet rather than a nappy
Make sure the child has a shower or bath before going to kindergarten or school
Reassure the child there is nothing wrong; it is a common problem that will go away
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Treatment Urotherapy or improving urination habits is first line. Many methods have been tried, but the bedwetting alarm system is generally regarded to be the most effective. If the child has emotional problems, counselling or hypnotherapy may be desirable. Desmopressin acetate is effective and very useful on school camps.
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Stepwise management trial
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Conditioning therapy:
– pad or bell alarm or
– body worn alarm (e.g. Malem night-trainer)
If a trial fails, have a 3-mth break and try again with close supervision.
Desmopressin acetate tablets or nasal spray each night:
Desmopressin + alarm (avoid water load before bed: the child should not drink for 1 hr before and 8 hours after)
Planned waking
The above is preferred to tricyclic antidepressants such as imipramine.