Paediatrics - nocturnal enuresis (bet-wetting)

In this episode of The Good GP, host Dr Krystyna de Lange is joined once again by Dr Tim Jones, a GP in Hobart with a special interest in general paediatrics. 

The topic of discussion is nocturnal enuresis or bedwetting in children. 

Dr Jones shares insightful information about the commonality of bedwetting, explaining that by the age of four, one in three children still experience bedwetting, with the numbers decreasing as they get older. 

Dr Jones emphasises the importance of addressing the social and emotional impacts of bedwetting, even though it tends to resolve naturally over time.

Dr de Lange asks Dr Jones about his approach to taking a history and conducting an examination when families seek help for bedwetting. Dr Jones highlights the significance of understanding whether bedwetting is a new concern or has always been present, as this can determine the underlying cause. He also discusses the importance of looking for associated conditions such as polydipsia, polyuria, constipation, and obstructive sleep apnea. Dr Jones concludes his explanation by outlining the key aspects of his examination, including palpating the child's abdomen, considering a genital exam, and assessing for signs of spina bifida or tethered cord.

Moving on to management, Dr de Lange asks Dr Jones about the general advice he gives to families once primary bedwetting with no underlying causes has been established. Dr Jones stresses the importance of understanding the parent's perception of bedwetting and tailoring the advice accordingly. He highlights the need to reassure parents that bedwetting is normal and not caused by anything the child is doing. Quoting statistics about the prevalence of bedwetting can help normalise the situation for families. Dr Jones and Dr de Lange also discuss the fact that in many cases, the child themselves are not overly worried about bedwetting unless it has been made a big issue within the family. Reassurance and de-stigmatization are often enough to alleviate concerns.  Dr Jones also shares his perspectives on medication management and when medications like Desmopressin and other medications might be prescribed.  

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