Nocturnal enuresis Health Dictionary

The involuntary passing of URINE during sleep. It is a condition predominantly of childhood, and usually genetically determined. Sometimes, however, it is a symptom of anxiety in a child, especially if there has been over-rigorous attempts at toilet-training or hostile or unloving behaviour by a parent. It can also be provoked by apparently unimportant changes in a child’s life – for example, moving house. In a small minority of cases it is due to some organic cause such as infection of the genitourinary tract.

The age at which a child achieves full control of bladder function varies considerably. Such control is sometimes achieved in the second year, but much more commonly not until 2–3 years old. Some children do not normally achieve such control until the fourth, or even ?fth, year, so that paediatricians are reluctant to make this diagnosis before a child is aged six.

The approach consists essentially of reassurance and ?rm but kindly and understanding training. In most cases the use of a ‘star chart’ and a buzzer alarm which wakens the child should he or she start passing urine is helpful. Where there are relationship or social problems, these need to be considered in treating the child. The few who have urinary infection or irritable bladders may respond to drug tretament.

Those who do not respond may be helped by DDAVP, an analogue of a pituitary hormone, which reduces the amount of urine produced overnight. It is licensed for use for three months at a time. Some children prefer to reserve it for occasions such as sleeping away from home. The antidepressant imipramine can help some children but has to be used cautiously because of side-effects.

For help, contact www.eric.org.uk