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NICE ADVICE FOR PATIENTS AND THEIR PARENTS OR CARERS

Advice on fluid intake, diet and toileting patterns

Advise children and young people with bedwetting and their parents or carers that:

  • adequate daily fluid intake is important in the management of bedwetting
  • daily fluid intake varies according to ambient temperature, dietary intake and physical activity

A suggested daily intake of drinks for children and young people is given below:

Age Sex Total drinks per day
4 - 8 years Female 1000ml - 1400ml
4 - 8 years Male 1000ml - 1400ml
9 - 13 years Female 1200ml - 2100ml
9 - 13 years Male 1400ml - 2300ml
14 - 18 years Female 1400ml - 2500ml
14 - 18 years Male 2100ml - 3200ml

Adapted from CG111 Nocturnal enuresis - the management of bedwetting in children and young people: understanding NICE guidance. October 2010.

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Advise the child or young person and parents or carers that the consumption of caffeine-based drinks should be avoided in children and young people with bedwetting.

Advise the child or young person and parents or carers to eat a healthy diet and not to restrict diet as a form of treatment for bedwetting. Read more...

Advise the child or young person of the importance of using the toilet at regular intervals throughout the day.

Advise parents or carers to encourage the child or young person to use the toilet to pass urine at regular intervals during the day and before sleep (typically between four and seven times in total). This should be continued alongside the chosen treatment for bedwetting.

Address excessive or insufficient fluid intake or abnormal toileting patterns before starting other treatment for bedwetting in children and young people.

Suggest a trial without nappies or pull-ups for a child or young person with bedwetting who is toilet trained by day and is wearing nappies or pull-ups at night. Offer advice on alternative bed protection to parents and carers.

Reward Systems

Explain that reward systems with positive rewards for agreed behaviour rather than dry nights should be used either alone or in conjunction with other treatments for bedwetting. For example, rewards may be given for:

  • drinking recommended levels of fluid during the day
  • using the toilet to pass urine before sleep
  • engaging in management (for example, taking medication or helping to change sheets)

Inform parents or carers that they should not use systems that penalise or remove previously gained rewards.