Key Pediatric Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


January 10, 2018

In This Article


Steering Committee of World Bedwetting Day 2017

The first medical appointment for children with enuresis is usually with the GP when the child is aged ≥5 yr. Treatment of enuresis below the age of 5 yr is not recommended.

At this stage, it is essential to screen for patients with bladder dysfunction (eg, overactive bladder [OAB], daytime incontinence).

Treatment of enuresis in primary care is only advisable if monosymptomatic is suspected (ie, no daytime bladder dysfunction is detected).

Nocturnal polyuria can be treated using the vasopressin analogue desmopressin, which reduces the amount of urine during the night. In most countries, the recommended starting dose for children is 120 µg/day (melt) or 200 mg/day (tablet). Desmopressin treatment can be optimized by following appropriate recommendations. If children with nocturnal polyuria are unresponsive to desmopressin despite good adherence, referral is advised. Increasing the dose is not recommended in primary care.

Small maximum voided volumes and arousal problems in children with MNE are treated using a bedwetting alarm.

Patients should drink sufficiently during the day (∼1000 mL/day for child of 10 kg; 1500 mL/day for child of 20 kg), and achieve urinary output ∼30–40 mL/kg, with fluid restriction before sleep. A trial of this advice can be recommended before the start of alarm/desmopressin.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: