Quality statement 3: Initial treatment

Quality statement

Children and young people, and their parents or carers if appropriate, have a discussion about initial treatment if bedwetting has not improved after changing their daily routine.

Rationale

The choice of initial treatment should be informed by the comprehensive initial assessment, and should take into account the preference of the child or young person and, if appropriate, their parents or carers. Factors such as age, associated functional difficulties and disabilities, financial burdens and living situations may affect their preferences. Discussing the initial treatment options with their healthcare professional will ensure that children and young people, and their parents or carers if appropriate, are able to make an informed decision about which treatment will meet their specific needs.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people, and their parents or carers if appropriate, have a discussion about initial treatment if bedwetting has not improved after changing their daily routine.

Data source: Local data collection.

Process

Proportion of children and young people whose bedwetting has not improved after changing their daily routine who have a recorded discussion (including their parents or carers if appropriate) about initial treatment.

Numerator – the number in the denominator who have a recorded discussion (including their parents or carers if appropriate) about initial treatment.

Denominator – the number of children and young people whose bedwetting has not improved after changing their daily routine.

Data source: Local data collection.

Outcome

Children, young people and their parents or carers are actively involved in decisions about their care.

Data source: Local data collection. The NHS England GP Patient Survey asks how good the GP was in involving people in decisions about their care (this is not specific to bedwetting in children and young people).

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GPs and NHS trusts) ensure that systems and policies are in place for healthcare professionals to discuss initial treatment with children and young people, and their parents or carers if appropriate, if bedwetting has not improved after changing their daily routine.

Healthcare professionals (such as GPs, school nurses and community nurses) discuss initial treatment with children and young people, and their parents or carers if appropriate, if bedwetting has not improved after changing their daily routine.

Commissioners (such as clinical commissioning groups, local authorities and NHS England area teams) ensure that the services they commission have policies that include discussion of initial treatment with children and young people, and their parents or carers if appropriate, if bedwetting has not improved after changing their daily routine.

What the quality statement means for children, young people, parents and carers

Children and young people with bedwetting that hasn't improved after changing their daily routine (and their parents or carers if appropriate) discuss possible treatment (such as a bedwetting alarm or medication) with their healthcare professional.

Source guidance

  • Nocturnal enuresis (NICE clinical guideline 111), recommendations 1.4.1 to 1.4.5, 1.8.1, 1.10.1 and 1.10.2.

Definitions of terms used in this quality statement

Changing their daily routine

This involves making changes to the child or young person's routine based on information and advice provided on fluid intake, toileting, lifting and waking and the use of reward systems. [Adapted from NICE clinical guideline 111 recommendations 1.5 to 1.7]

Initial treatment for bedwetting

An alarm should be offered as first‑line treatment unless it is considered undesirable or inappropriate (for example, if bedwetting is very infrequent, that is, less than 1 or 2 wet beds per week, or the parents or carers are having emotional difficulty coping with the burden of bedwetting or are expressing anger, negativity or blame towards the child or young person).

Desmopressin may be offered as initial treatment to children and young people older than 7 years if an alarm is undesirable or inappropriate, or if the priority for the child is to achieve a rapid short‑term improvement in bedwetting.

Consideration of which initial treatment is most appropriate will depend on the child or young person's age, the frequency of bedwetting and the motivation and needs of the child or young person and their parents or carers.

An alarm or desmopressin may be considered for children aged 5 to 7 years. The decision about suitable treatment for 5‑ to 7‑year‑olds should take into account the pattern of bedwetting as well as the child's ability, maturity, motivation and understanding of an alarm, their wider living circumstances and the views of their parents or carers. [Adapted from NICE clinical guideline 111 recommendations 1.4.5, 1.8.1, 1.8.8, 1.10.1 and 1.10.2]

Equality and diversity considerations

When discussing initial treatment of bedwetting in children and young people with developmental or learning difficulties or physical disabilities, healthcare professionals should be aware that symptoms can be improved with the correct support and treatment.

Initial treatment may be considered for children and young people with developmental or learning difficulties or physical disabilities, tailored to their individual needs and abilities.

The quality statement does not cover children younger than 5 years. The decision about whether to formally manage bedwetting in children younger than 5 years would be a clinical judgement; it would not be appropriate in all cases.