Nocturnal enuresis The majority of children achieve day and night time continence by 3 or 4 years of age. Enuresis may be defined as the 'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract' Nocturnal enuresis can be defined as either primary (the child has never achieved continence) or secondary (the child has been dry for at least 6 months before) NICE issued guidance in 2010. Management: look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset) advise on fluid intake, diet and toileting behaviour reward systems (e.g. Star charts). NICE recommend these 'should be given for agreed behaviour rather than dry nights' e.g. Using the toilet to pass urine before sleep NICE advise: 'Consider whether alarm or drug treatment is appropriate, depending on the age, maturity and abilities of the child or young person, the frequency of bedwetting and the motivation and needs of the family'. Generally: an enuresis alarm is first-line for children under the age of 7 years desmopressin may be used first-line for children over the ago 7 years, particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family

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