Nocturnal enuresis

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Note when inserted as is

Nocturnal enuresis
• Reviewed nighttime and daytime voiding, stooling, snoring, fluid intake, family history, and stressors
• No daytime wetting or urgency, constipation, snoring, excessive thirst or weight loss, straining or a weak stream, or abnormal lower back or genital exam
• UA deferred after shared decision making given a typical history
• Discussed that bedwetting is common and not under the child's control, so punishment does not help
• Recommended limiting drinks in the evening, especially caffeine and sugary drinks, voiding regularly during the day and right before bed, and praise for helping with the routine rather than for dry nights
• Habits alone for now; a bedwetting alarm discussed for when the child is motivated
• Follow up as needed

Bedwetting is common, often runs in families, and becomes less frequent each year as the bladder and the brain's signal to wake mature. Recommended supportive care with an emphasis on limiting evening drinks, voiding before bed, protecting the mattress, letting the child help change the sheets, and no punishment or teasing for wet nights. Return precautions given including pain or burning with urination, blood in the urine, excessive thirst, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Type: primary, secondary, with daytime symptoms
History reviewed (voiding, stooling, snoring, fluids, family history, stressors)
Daytime symptoms, constipation, snoring, thirst, weak stream present or absent
UA deferred vs negative including glucose
Natural history, not the child's fault, discipline not effective
Evening fluids, regular voiding and before bed, motivational praise
Alarm (first-line)
Desmopressin nightly; for sleepovers
Treat constipation; snoring evaluation; sleepover tips; stressors
Urology referral

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Follow-up as needed, 1 month on desmopressin, 3 months on alarm
Paragraph per branch (habits, alarm, desmopressin)

Used to decide, kept out of the note

Alarm plus desmopressin together

Return precautions in the template

pain or burning with urinationblood in the urineexcessive thirst

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.