r753_2000
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A mother brings his 5 year old son, complaining of bedwetting. What is the appropriate management?
a) reassurance
b) imipramine
c) DDVAP
c) reward system
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| rubyedward
Forum Elite
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i wud go a) reassurace, of course after excluding UTI, recent stress, medications etc.
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| chemamr
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First (as rubyedward says) you have to study him, clinical history, tests.
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| r753_2000
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Up to what age is eneuresis still considered normal?
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| bobby
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normal up to 3 yrs.
at 5yrs, i will advice the mother to use a reward system. (C) if the PE is negative for other possible cause.
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| chemamr
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I think itīs not a good question. You donīt know the patient, donīt know the diagnosis (thus). Then how are you going to treat him. First you have tu rule out somethings to try to cure the underlying cause (if he has one). I think the correct answer should be a diagnostic work up.
Or maybe the question is wrong in the age of the patient, maybe it should be a lesser age (like 3 years) and the answer should be reassurance. Who knows ? 
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| nightflight1945
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Up to 6 years and in some references up to 5 years enuresis is considered normal,so if it makes a great psychologic problem you should start treatment but if not reassurance is sufficient.
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| mdwannabe
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Post 5 years of age, it is considered abnormal and warrants evaluation... 1st rule out organic causes... UA, Valves eval etc... if all is well...try wet alarms, behavior modification etc...then Desmopressin first, then Tricyclics (US recomend)...add psych threpy to meds.
In this Q.. I'd go for DDAVP
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| chemamr
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i found reassurance for the parents should be the first step in the management, then everything else.
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| mdwannabe
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not after 5 years of age. After 5 years it is abnormal... gotta manage it.
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| aliakram
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Bedwetting by 5 is Normal. Post 5 Abnormal.
Step I Even with 5 or more, one must know weather child got continence before and has started this new? If he had been continent rule out any drastic change in child environment (psychic causes), All normal Do Urinary exam along with that, Diabetic check etc.
Step II Child never continent move to reward and behav modification or if child continent and has some psychic issue same.
Step III Nothing works, still problem persists try Imipramine or Desipramine
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