General advice

Food and drink

It is important that the child or young person has enough to drink during the day. The healthcare team should give advice on the right amount (see table 1) and explain that this will depend on the circumstances (such as temperature, diet and activity). Drinks containing caffeine (such as cola, tea and coffee) should be avoided. The healthcare team should also give advice on a healthy diet. The child or young person's diet should not be restricted in any way to try and treat bedwetting.

Table 1 Suggested total daily intake of fluid from drinks

Age (years)

Sex

Total drink intake per day (ml)

4–8

Female

Male

1000–1400

1000–1400

9–13

Female

Male

1200–2100

1400–2300

14–18

Female

Male

1400–2500

2100–3200

Toilet use

You should also be given help with any problems the child or young person has with their pattern of toilet use. The child or young person should be given advice on the importance of using the toilet regularly during the day and you should encourage use of the toilet at regular intervals (around four to seven times a day, including just before bed). This should continue alongside any other treatment for bedwetting.

If any changes to drinking and toilet habits are needed, these should be made before treatment for bedwetting starts.

If the child or young person is wearing nappies or pull-ups at night, a trial without them may be suggested. The healthcare team should offer you advice on alternative bed protection.

Reward systems

The healthcare team should explain how you can use a reward system (using sticker or star charts, for example, although this will depend on the age of the child or young person) to help with bedwetting. Rewards can be used on their own or alongside other treatments, such as bedwetting alarms (see bedwetting alarms). If you have a young child who has some dry nights, the healthcare team should initially advise you to try a reward system on its own.

Rewards should be given for agreed behaviour rather than dry nights, for example, they may be given for drinking the correct amount during the day, using the toilet before sleep, helping to change wet sheets and, if appropriate, taking tablets or using an alarm correctly. These should be agreed with the child or young person beforehand. Systems that punish or take away rewards should not be used.

Lifting, waking and training programmes

The healthcare team should offer the following advice:

  • Lifting (carrying or walking the child or young person with or without waking them) or waking the child or young person to take them to the toilet during the night will not help to keep them dry in the long term.

  • Waking the child or young person during the night to take them to the toilet should only be used as a short-term practical measure (for example, if you are on holiday or away from home).

  • Young people with bedwetting that has not responded to treatment might find that waking themselves up (for example, using a mobile phone alarm or an alarm clock) to go to the toilet during the night is a useful strategy to help prevent wetting the bed.

Types of training programme that should not be used are those that:

  • involve holding on and waiting before urinating, or stopping the flow of urine

  • use a combination of different rewards, punishments, training routines, waking routines and alarms (sometimes called dry-bed training).

Advice for children under 5 years

If your child is not yet toilet trained, the healthcare team should advise you to start toilet training, unless there are reasons why it should not be attempted. You should be offered support and advice about toilet training.

If your child has been toilet trained during the day for more than 6 months, the healthcare team should suggest that your child tries at least 2 nights in a row without nappies, and even longer if your child is closer to 5 years, or if wetness is reduced or it is acceptable to your family to continue. The healthcare team should offer you advice on alternative bed protection.

If your child wakes during the night you should take him or her to the toilet.

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