New NICE guidance on bedwetting

28 October 2010

New NICE guidelines on nocturnal enuresis in children specifies no minimum age limit on the assessment and management of the condition.

Bedwetting is an extremely common condition and children are generally expected to no longer wet the bed by a developmental age of five. Common practice has been to only consider treating children for their bedwetting after age seven. But with the new NICE guidance healthcare professionals are now more likely to consider whether children under seven years may benefit from appropriate advice and treatments currently available on the NHS.

Dr Gillian Leng, Deputy Chief Executive of NICE said: "Many children experience some form of bedwetting as they grow up and this can have a significant impact on their behaviour, emotional wellbeing and social life. It can also be very stressful for their parents or carers. For these reasons, our clinical guideline does not specify a minimum age limit. This means that for the first time advice or treatments will be available to children under seven years, who may have previously been excluded from these services due to their age."

Among the recommendations, NICE advises healthcare professionals involved in the treatment as nocturnal enuresis to not exclude under-7s from the management of bedwetting on the basis of age alone. It should be made clear to parents or carers that bedwetting is not the child's fault and that punitive measures are not appropriate. Parents should be encouraged to reward children for agreed behaviour rather than for dry nights, e.g. for drinking the recommended levels during the day, going to the toilet before sleep, taking medication, or for helping to change the sheets.

Children who have not responded to treatment (e.g. 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, such as an overactive bladder, an underlying disease, or social and emotional factors.

Says Dr Leng: "Our guideline has been based on the evidence of what has been shown to work well in the assessment and management of childhood bedwetting, and so I hope that it will support healthcare professionals when they are presented with children and teenagers with this sensitive condition."

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