Nocturnal enuresis in children under 5 years old

Children under 5 years with bedwetting

Children are generally expected to be dry at night by a developmental age of 5 years, and historically it has been common practice not to offer advice to families of children who are younger than 5 years and are bedwetting.

NICE have outlined some recommendations specific to the under 5 age group indicating situations where healthcare professionals can offer useful advice and interventions (1):

• reassure parents or carers that many children under 5 years wet the bed, for example, approximately one in five children of 4 and a half years wets the bed at least once a week
• ask whether toilet training has been attempted, and if not, ask about the reasons for this and offer support and advice. If there are no reasons why toilet training should not be attempted, advise parents or carers to toilet train their child
• suggest a trial of at least 2 nights in a row without nappies or pull-ups for a child with bedwetting who is under 5 years and has been toilet trained by day for longer than 6 months. Offer advice on alternative bed protection to parents and carers. Consider a longer trial in children:
  • who are older
  • who achieve a reduction in wetness
  • whose family circumstances allow the trial to continue
• advise the parents or carers of a child under 5 years with bedwetting that if the child wakes at night, they should take him or her to the toilet

Consider further assessment and investigation to exclude a specific medical problem for children over 2 years who, despite awareness of toileting needs and showing appropriate toileting behaviour, are struggling to not wet themselves during the day as well as the night

Assess children under 5 years with bedwetting for constipation, as undiagnosed chronic constipation is a common cause of wetting and soiling in younger children

Reference:

• 1) NICE (October 2010).Nocturnal enuresis - The management of bedwetting in children and young people