Early Intervention for newborns: Rule of 1, 3, 6 - Dr. Esam Haddad Specialist Pediatrician

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Symptoms, Prevention and all you need to know on Bedwetting (Nocturnal Enuresis)

Symptoms, Prevention and all you need to know on Bedwetting (Nocturnal Enuresis)

Almost most children by the age of 6 for girls and 8 for boys will be dry or continent at night, few of them will have uncontrollable leakage of urine while sleeping or being wet at night.

  • Still the main cause of bedwetting is slow developments or delay maturation of brain — bladder control.
  • Both the action of urination and the action of defection are dependent on neural connection and communications between brain, bladder and rectum.

The brain produce antidiuretic hormone ADH which slows the kidney urine production, it helps make less urine at night, when the brain does not make enough ADH or when the kidney stops responding to it more urine is produced.

  • Strong genetic association with bedwetting, if one parent was enuretic there is 44% chance of enuresis in the child, if both parents was enuretic 77% chance of enuresis in the child.
  • Age at resolution in parents can guide expectation of resolution in child
  • Children with nocturnal enuresis manifests differently either with excessive urine production at night (nocturnal polyuria), or with poor sleep arousal and/or reduced bladder capacity or combination of all but not because of poor parenting or laziness
  • Children with nocturnal enuresis may have night time and daytime symptoms like urinary urgency, frequency or incontinence of urine detrusor over activity. This group requires a different clinical approach with focusing on treating daytime bladder symptoms which commonly involves pharmacotherapy with urotherapy.



Is a condition when a child  begins wetting again after having stayed dry.

  • History of avoiding dysfunction manifests in prolonged withholding urine and often combined with constipation.
  • Stress (new brother or sister, sleeping alone, starting a new school, family crises, accident or trauma)
  • Enuresis can be associated with pinworms + symptoms of anal itching more at night
  • Obesity leads to obstructive sleep apnea OSA results in snoring, day time sleepiness leads to poor academic performance, cardiopulmonary diseases, behavioral problems, irritability, hyperactivity like ADHD syndrome, and nocturnal enuresis.
  • Can be secondary to diabetes mellitus or Diabetes insipidus (uncommon condition in which the kidneys are unable to prevent the excretion of water)
  • If enuresis associated with night time headache and failure to thrive could……be an intracranial tumor in the region of pituitary.
  • If there is incontinence day or night in previously toilet trained child associated with Urinary Tract Infection (UTIs) and failure to thrive with positive ultrasound for bilateral hydronephrosis indicate to do VCUG, a minimally invasive test that uses a special x-ray technology called fluoroscopy to visualize your child’s urinary tract and bladder and possible posterior ureteral valve.
  • Also in condition like cerebral salt wasting, hypersecretion of Atrial Nat uretic Peptide (ANP) manifests with high urine output and hypernatriuria with hyponatremia.
  • If Associated with persistent dam under wear in females (day and night) may indicate ectopic ureter
  • Food allergy have been reported to lead to enuresis in 10% of affected patients ,some of these children are reported to benefit from elimination of certain foods from the diet such as citrus fruit, juices, food high in caffeine and sugar ,dairy products artificially collared drinks and chocolate


  • Reassurance of the parents in primary monosymptomatic the brain bladder control will be developed naturally or speed up with medication.
  • Acute treatment should be avoided before the age of 6 years, starting with urine analyses including specific gratify, urine culture should be obtained specially in girls.
  • Exclude any type of voiding dysfunction during the day time as this may be the cause of nocturnal enuresis.
  • Fluid restriction in the evening is moderately successful, (increase AM fluids and decrease PM fluids, double voiding before bed, regular sleep and awake schedule).
  • Motivational therapy.
  • Conditioning therapy (vibratory alarm) 30-60% successful in children with arousal difficulties rather than children with overproduction urine at night.
  • Children with day time incontinence or over activity bladder might require anticholinergic medication.


Children with day and night time symptoms may require anticholinergic and DDAVP medication. For medical assistance and consultation for your child’s well being, book for appointment with Dr. Esam Haddad, Specialist Paediatrician GMCClinics.

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