Wetting in Children

1
Wetting in Children

• Dawn Diaz Saldano, RN, MSN, CPNP
• Pediatric Nurse Practitioner
• Division of Urology
• Childrens Memorial Hospital

2
Nocturnal Enuresis

• Bedwetting occurs in children 5years old
• One of the main features is deep sleep
• It is estimated that
• 5-7million children wet the bed at night

3
Nocturnal Enuresis

• Is outgrown
• Is not related to child being lazy
• Is familial
• Often there is no urologic structural problem

4
Use of Enuresis Alarm
Right food
Meds
Inducements
Poo
Try for Dry Alarm
5
Enuresis Alarms
6
Inducements
Star charts Rewards/treats Story Grab bag
Right food
Meds
Inducements
Poo
Try for Dry Alarm
7
Medications
Right food
Oxybutynin for small bladder capacity Desmopressin
decreases urine production
Meds
Inducements
Poo
Try for Dry Alarm
8
Lower Urinary Tract Symptoms

• Children may have day time wetting after
• Toilet training
• Wetting accidents
• Dribbling into underwear or damp underwear
• Dysuria
• Urinary frequency
• Urinary urgency (bathroom emergency)
• Constipation
• Vaginitis

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Promote Positive Reinforcement
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Treatment

• No quick fix
• Labor intensive
• Heavy parental involvement
• Child cooperation
• May take months to years to reestablish optimal
  bladder dynamics
• Behavioral problems may be disruptive
• Parents need support and guidance

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Treatment

• Timed voiding or elimination
• Double void
• Straddle voiding
• Medications
• Prophylactic antibiotics
• Oxybutynin
• Polyethylene glycol (Miralax)
• Fiber supplements

12
Thank you