Referral criteria from primary care - enuresis

• most children with nocturnal enuresis (bedwetting) can be managed in the community (1)
• however if there are factors suggesting an underlying physical abnormality, or if he or she does not respond to primary-care management, the child should be referred to a child specialist
  • for example, children with urinary tract abnormalities may present with daytime wetting (with or without night wetting) or difficulties with voiding, and therefore require specialist review and further detailed investigation (e.g. renal and bladder ultrasound)
    • children with such abnormalities are very unlikely to have wetting only at night
  • if the child has complex psychological difficulties then referral to a child psychologist may be required
    
    
• NICE state with respect to nocturnal enuresis (2):
  • consider assessment, investigation and/or referral when nocturnal enuresis is associated with:
    • severe daytime symptoms
    • a history of recurrent urinary infections
    • known or suspected physical or neurological problems
    • comorbidities or other factors
      • constipation and/or soiling
      • developmental, attention or learning difficulties
      • diabetes mellitus
      • behavioural or emotional problems
      • family problems or a vulnerable child or young person or family
  • investigate and treat children and young people with suspected urinary tract infection
  • investigate and treat children and young people with soiling or constipation
  • children and young people with suspected type 1 diabetes should be offered immediate (same day) referral to a multidisciplinary paediatric diabetes care team that has the competencies needed to confirm diagnosis and to provide immediate care
    
    
  • refer children and young people with bedwetting that has not responded to courses of treatment with an alarm and/or desmopressin for further review and assessment of factors that may be associated with a poor response, such as an overactive bladder, an underlying disease or social and emotional factors

Reference:

1. Drug and Therapeutics Bulletin (2004); 42(5):33-7.
2. NICE (October 2010).Nocturnal enuresis - The management of bedwetting in children and young people