NCLEX Review Guide: Pediatric Enuresis

Definition and Classification

• Primary enuresis occurs when a child has never achieved consistent dryness for 6+ months, typically affecting children who haven't developed nighttime bladder control.
• Secondary enuresis develops after at least 6 months of dryness, often indicating underlying medical or psychological factors requiring investigation.
• Nocturnal enuresis (bedwetting) is most common, affecting 15-20% of 5-year-olds and gradually decreasing with age.
• Diurnal enuresis (daytime wetting) is less common but may indicate urinary tract infections or anatomical abnormalities.

Primary Causes and Risk Factors

• Developmental delay in antidiuretic hormone (ADH) production leads to increased nighttime urine production in many children.
• Small functional bladder capacity combined with deep sleep patterns prevents awakening when bladder is full.
• Genetic predisposition shows 77% risk with both parents affected, 44% with one parent affected.
• Constipation can compress bladder and reduce capacity, contributing to both daytime and nighttime accidents.

Assessment Priorities

1. Obtain detailed history including voiding patterns, fluid intake, family history
2. Assess for red flags: UTI symptoms, constipation, diabetes signs
3. Evaluate psychosocial impact on child and family relationships
4. Document frequency and pattern using voiding diary for 1-2 weeks

Therapeutic Interventions

• Behavioral modifications include scheduled voiding every 2 hours, limiting fluids 2 hours before bedtime, and double voiding techniques.
• Moisture alarms are first-line treatment with 70% success rate, conditioning child to wake when voiding begins.
• Pharmacological options include desmopressin (DDAVP) to reduce nighttime urine production for short-term management.
• Positive reinforcement systems using sticker charts reward dry nights without punishment for wet nights.

Frequently Confused Concepts