Every child must be fully assessed using the appropriate Continence Assessment Form. If night time wetting (nocturnal enuresis / bedwetting) is identified, follow the flowchart below to ensure the child receives the correct assessment, treatment and management.

The ‘pop-up’ information boxes suggest who might deliver each intervention. In England the local CCG (Clinical Commissioning Group) can clarify who is commissioned to do so. Information to support the commissioning of children’s continence services can be found in the PCF’s Paediatric Continence Commissioning Guide. In Scotland and Wales, ask your GP, Health Visitor or School Health Nurse for advice on who provides local continence care.

Back to the Children's General Continence Flowchart

DEMYSTIFICATION
  • Discuss causes
  • Explain symptoms
  • Discuss treatments
  • Explain prognosis
NICE
Night time wetting identified by GP
If constipation and/or daytime bladder symptoms present follow Flowchart for Constipation and/or Flowchart for Daytime Bladders before addressing night time wetting
Night time wetting identified by School Health Nursing / Health Visiting / Children's Community Nursing / Learning Disability Team
If constipation and/or daytime bladder symptoms present follow Flowchart for Constipation and/or Flowchart for Daytime Bladders before addressing night time wetting
GP to inform/refer to School Health Nursing / Health Visiting / Children's Community Nursing / Learning Disability Team
Only night time wetting / monosymptomatic nocturnal enuresis OR constipation and/or daytime bladder symptoms treated and night time wetting persists
Primary – never been dry for a 6 month period
Secondary – dry for at least 6 months prior to this episode
INITIAL ADVICE:
WHO DOES THIS?
Night time wetting clinics are often run by the School Health Nursing Service. In some areas it is the Children’s Continence Service
No concerns
Assess for a systemic cause or trigger or comorbidities e.g. UTI, constipation, Diabetes mellitus, psychosocial situation, neurological cause
If present refer or treat as appropriate
Pre school age
School age
Reassure that 1 in 5 children age 4½ wet the bed at least once a week and many achieve dryness spontaneously. Advise to continue to follow above advice and to seek help from School Health Nurse if wetting persists beyond 5 years of age and intervention is desired
NO PROGRESS AFTER IMPLEMENTATION OF INITIAL ADVICE:
  • Refer to School Health Nurse if not yet seen
  • Reassess number of wet nights/week, size of wet patches, number of times/night, time of occurrence using Night Time Diary
  • Discuss, explain, and offer treatment options
IF SHORT TERM DRYNESS NEEDED PRIOR TO ASSESSMENT
e.g. for school trip
  • Prescribe 1 month Desmopressin e.g. DesmoMelts 120-240mcg
  • Ensure child and parents receive information e.g. ERIC’s Guide to Night Time Wetting and understand instructions for use
  • Emphasise need to stop drinking one hour before and for 8 hours after taking Desmopressin
Child seems suitable for Desmopressin as first line treatment. Start on e.g. 120mcg DesmoMelt
WHO DOES THIS?
Desmopressin is usually prescribed by the GP
Child seems suitable for an alarm as first line treatment
WHO DOES THIS?
Alarms are often loaned out by the School Nursing Service. In some areas it is the Children’s Continence Service
Follow NICE Desmopressin Algorithm
Follow NICE Alarm Algorithm
- Refer to ERIC’s Guide to Night Time Wetting for information about taking Desmopressin
- Provide Using Desmopressin as a treatment for bedwetting
- Monitor progress using  Night Time Diary