WESTPORT, CT (Reuters Health), December 1, 2001 - Physicians need to be proactive in screening and treating school-aged children for primary nocturnal enuresis, according to a monograph produced by a symposium of pediatricians, pediatric nephrologists and pediatric urologists.
Their discussion is published in "Taking a Closer Look at Primary Nocturnal Enuresis," which appears in the October 17th issue of Infectious Diseases in Children. The symposium was sponsored by Aventis Pasteur.
Dr. Alan R. Greene, of Stanford University School of Medicine in California, and the other panel members agree that, unless underlying complications are present, most children with nocturnal enuresis can be managed safely and effectively by a general pediatrician.
"Once a simple screening urinalysis is performed, it's generally safe to go ahead and start treatment," Dr. Greene told Reuters Health. "I'll also observe the urine stream or make sure the parents have observed a good stream."
Dr. Greene may also measure children's bladder capacity by having them drink as much water as they can, then measure the amount they urinate. "If the amount is less than the child's age plus 2 ounces, then the bladder is smaller than average," he noted.
So for an 8-year-old, the capacity should be approximately 10 ounces. If it is less than that, bladder-stretching exercises may be needed. However, Dr. Greene noted, small bladders are responsible for only a very small percentage of bed-wetters.
What doctors are more likely to see are children who are difficult to arouse from sleep. If parents choose to treat their child with a conditioning alarm, which goes off when it senses moisture, the child is unlikely to wake up on his own, and parents will have to at least partially wake the child and walk him to the bathroom. The panelists disagreed as to whether the child must be fully awake when he is brought to the toilet to void.
Another option, often used in concert with the alarm, is oral desmopressin. "The most current research shows that desmopressin can be used as a 'bridge to maturity,' " Dr. Greene said.
He explained that up until recently, physicians have been concerned about using desmopressin for long periods of time. Evidence now shows that it is safe and effective, even when used for years.
"What I do in my practice is have the child take a drug holiday every 3 to 6 months, or taper the dose, to see if they still need it," he added.
However, what Dr. Green emphasized most was that even though approximately 5 million children have nocturnal enuresis, only about a third of patients or their parents will bring the subject up with their doctor.
"So once kids start school, physicians need to ask about it every year until patients report that they are consistently waking up dry," he concluded.
Infect Dis Child 2001;1:1-17.
