Quality standard


This quality standard covers the assessment and management of nocturnal enuresis (bedwetting) in children and young people aged 18 years or younger. For more information see the topic overview.

The statements in this quality standard apply to children and young people aged 5 to 18 years. Children are generally expected to be dry by a developmental age of 5 years. It is important that children aged 5 to 7 years are not excluded from the management of bedwetting on the basis of age alone, and therefore this quality standard addresses the needs of these younger children alongside older children and young people.

Why this quality standard is needed

Nocturnal enuresis is the medical term for 'bedwetting'. It is a widespread and distressing condition that can have a deep impact on a child or young person's behaviour, emotional wellbeing and social life.

Experts and expert bodies differ in their definitions of nocturnal enuresis and bedwetting. In the NICE guideline on bedwetting in under 19s, the term bedwetting is used to describe the symptom of involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. The same definition is used in this quality standard.

The causes of bedwetting are not fully understood. Bedwetting can be considered to be a symptom that may result from a combination of different predisposing factors. There are a number of different disturbances of physiology that may be associated with bedwetting. These disturbances may be categorised as sleep arousal difficulties, polyuria and bladder dysfunction. Bedwetting also often runs in families.

The quality standard is expected to contribute to improvements in the following outcomes:

  • quality of life for children, young people and their families and carers

  • psychological wellbeing of children, young people and their families and carers.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcome framework published by the Department of Health:

Table 1 shows the outcomes, overarching indicators and improvement areas from the framework that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014/15


Overarching indicators and improvement areas

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

Improvement area

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of outpatient services

Coordinated services

The quality standard for nocturnal enuresis (bedwetting) specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole continence care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to children and young people who are bedwetting, and their parents or carers.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality continence service are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care practitioners involved in assessing, supporting and treating children and young people with bedwetting should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting children and young people with bedwetting. If appropriate, health and social care practitioners should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.