When should I consider referring a child with enuresis to a specialist for further evaluation?

Consider referring a child with enuresis to a specialist for further evaluation if any of the following apply:

• There are severe daytime urinary symptoms such as urgency, frequency, daytime wetting, abdominal straining, poor urinary stream, or pain passing urine.
• There is a history of recurrent urinary tract infections.
• There are known or suspected physical or neurological problems.
• The child has comorbidities or other complicating factors, including constipation, soiling, developmental, attention or learning difficulties, diabetes mellitus, behavioural or emotional problems, or family or social vulnerabilities.
• Bedwetting started recently (in the last few days or weeks) and may indicate systemic illness.
• Secondary bedwetting or daytime wetting persists despite adequate assessment and management, unless explained by medical causes or clear stressful situations.
• There is suspicion of maltreatment related to bedwetting.

Referral should be considered to ensure appropriate assessment, investigation, and management tailored to the child's needs and to address any underlying conditions or complications.

Additional considerations: Children with suspected type 1 diabetes should be referred immediately to a multidisciplinary paediatric diabetes team. Children under 5 years with bedwetting should be assessed for constipation as per NICE guidelines.

These recommendations are based on NICE guideline CG111 on bedwetting in under 19s ¹.